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Binkley KE. Multiple Chemical Sensitivity/Idiopathic Environmental Intolerance: A Practical Approach to Diagnosis and Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3645-3649. [PMID: 37660733 DOI: 10.1016/j.jaip.2023.08.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023]
Abstract
Patients with multiple chemical sensitivity, now called idiopathic environmental intolerance, frequently present to clinical immunologists and allergists for diagnosis and treatment. Patients report a plethora of respiratory and multisystem problems attributed to a wide variety of unrelated, otherwise non-noxious, triggers. They may go to extreme, often seemingly bizarre lengths to avoid contact with everyday exposures and may become housebound, unable to work or function socially. Often beginning with exposure to odors, triggers can multiply to involve foods, clothing, medications, and even electromagnetic radiation. The condition cannot be explained by IgE-mediated or other immune processes, and clinical immunologists and allergists may feel unprepared to care for such patients. In this article, a paradigm to understand the probable mechanisms underlying this condition and a practical approach to diagnosis and management will be presented.
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Affiliation(s)
- Karen E Binkley
- Division of Clinical Immunology and Allergy, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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Molot J, Sears M, Anisman H. Multiple Chemical Sensitivity: It's time to catch up to the science. Neurosci Biobehav Rev 2023; 151:105227. [PMID: 37172924 DOI: 10.1016/j.neubiorev.2023.105227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
Multiple chemical sensitivity (MCS) is a complex medical condition associated with low dose chemical exposures. MCS is characterized by diverse features and common comorbidities, including fibromyalgia, cough hypersensitivity, asthma, and migraine, and stress/anxiety, with which the syndrome shares numerous neurobiological processes and altered functioning within diverse brain regions. Predictive factors linked to MCS comprise genetic influences, gene-environment interactions, oxidative stress, systemic inflammation, cell dysfunction, and psychosocial influences. The development of MCS may be attributed to the sensitization of transient receptor potential (TRP) receptors, notably TRPV1 and TRPA1. Capsaicin inhalation challenge studies demonstrated that TRPV1 sensitization is manifested in MCS, and functional brain imaging studies revealed that TRPV1 and TRPA1 agonists promote brain-region specific neuronal variations. Unfortunately, MCS has often been inappropriately viewed as stemming exclusively from psychological disturbances, which has fostered patients being stigmatized and ostracized, and often being denied accommodation for their disability. Evidence-based education is essential to provide appropriate support and advocacy. Greater recognition of receptor-mediated biological mechanisms should be incorporated in laws, and regulation of environmental exposures.
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Affiliation(s)
- John Molot
- Family Medicine, University of Ottawa Faculty of Medicine, Ottawa ON Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa Canada.
| | - Margaret Sears
- Family Medicine, University of Ottawa Faculty of Medicine, Ottawa ON Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa Canada.
| | - Hymie Anisman
- Family Medicine, University of Ottawa Faculty of Medicine, Ottawa ON Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa Canada.
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Watrin L, Nordin S, Szemerszky R, Wilhelm O, Witthöft M, Köteles F. Psychological models of development of idiopathic environmental intolerances: Evidence from longitudinal population-based data. ENVIRONMENTAL RESEARCH 2022; 204:111774. [PMID: 34506786 DOI: 10.1016/j.envres.2021.111774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/20/2021] [Accepted: 07/24/2021] [Indexed: 06/13/2023]
Abstract
The origin of idiopathic environmental intolerances (IEIs) is an open question. According to the psychological approaches, various top-down factors play a dominant role in the development of IEIs. The general psychopathology model assumes a propensity towards mental ill-health (negative affectivity) increases the probability of developing IEIs. The attribution model emphasizes the importance of mistaken attribution of experienced somatic symptoms; thus, more symptoms should lead to more IEIs. Finally, the nocebo model highlights the role of expectations in the development of IEIs. In this case, worries about the harmful effects of environmental factors are assumed to evoke IEIs. We estimated cross-lagged panel models with latent variables based on longitudinal data obtained at two time points (six years apart) from a large near-representative community sample to test the hypothesized associations. Indicators of chemical intolerance, electromagnetic hypersensitivity, and sound sensitivity fit well under a common latent factor of IEIs. This factor, in turn, showed considerable temporal stability. However, whereas a positive association was found between IEIs and increased somatic symptoms and modern health worries six years later, the changes therein could not be predicted as hypothesized by the three psychological models. We discuss the implications of these results, as well as methodological aspects in the measurement and prediction of change in IEIs.
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Affiliation(s)
- Luc Watrin
- Institute for Psychology and Education, Ulm University, Germany.
| | | | - Renáta Szemerszky
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Hungary
| | - Oliver Wilhelm
- Institute for Psychology and Education, Ulm University, Germany
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Germany
| | - Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Hungary
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4
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Zucco GM, Doty RL. Multiple Chemical Sensitivity. Brain Sci 2021; 12:46. [PMID: 35053790 PMCID: PMC8773480 DOI: 10.3390/brainsci12010046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 01/09/2023] Open
Abstract
Multiple Chemical Sensitivity (MCS), a condition also known as Chemical Sensitivity (CS), Chemical Intolerance (CI), Idiopathic Environmental Illness (IEI) and Toxicant Induced Loss of Tolerance (TILT), is an acquired multifactorial syndrome characterized by a recurrent set of debilitating symptoms. The symptoms of this controversial disorder are reported to be induced by environmental chemicals at doses far below those usually harmful to most persons. They involve a large spectrum of organ systems and typically disappear when the environmental chemicals are removed. However, no clear link has emerged among self-reported MCS symptoms and widely accepted objective measures of physiological dysfunction, and no clear dose-response relationship between exposure and symptom reactions has been observed. In addition, the underlying etiology and pathogenic processes of the disorder remain unknown and disputed, although biologic and psychologic hypotheses abound. It is currently debated whether MCS should be considered a clinical entity at all. Nevertheless, in the last few decades MCS has received considerable scientific and governmental attention in light of the many persons reporting this illness. In this review, we provide a general overview of the history, definition, demographics, prevalence, and etiologic challenges in defining and understanding MCS.
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Affiliation(s)
- Gesualdo M Zucco
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, 35100 Padova, Italy
| | - Richard L Doty
- Smell and Taste Center, Department of Otorhinolaryngology, Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Tu CY, Liu WS, Chen YF, Huang WL. Is severity a clinically meaningful specifier of somatic symptom disorder? J Psychosom Res 2020; 133:110108. [PMID: 32276194 DOI: 10.1016/j.jpsychores.2020.110108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/07/2020] [Accepted: 04/02/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Few existing studies have investigated the clinical relevance of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) somatic symptom disorder (SSD) severity rated by clinicians. We examined the association of SSD severity with psychiatric and medical comorbidity, psychological features and help-seeking attitude and behaviours. METHODS A total of 123 patients with SSD were prospectively recruited and completed several types of self-report instrument. Information about medical comorbidity and healthcare use was gathered from the participants and medical record review. Common comorbid psychiatric diagnoses of SSD were assessed by psychiatrists. Group differences of patients with SSD of varying severity were assessed with ANOVA and chi-square tests. Multiple linear regression models were used to examine the relationships between SSD severity and psychological features. RESULTS Prevalence of medical comorbidity and comorbid psychiatric diagnoses of SSD was not significantly different among patients with varying SSD severity. Patients with severe SSD had the highest Patient Health Questionnaire-15 (PHQ-15), Health Anxiety Questionnaire (HAQ), Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) scores. Help-seeking behaviour was not associated with SSD severity. After controlling for demographic variables, the associations between 'severe SSD' and the PHQ-15, HAQ, BDI-II and BAI scores were significant. CONCLUSION SSD severity rated by clinicians was not associated with comorbid medical or psychiatric diagnoses. Compared to patients with mild/moderate SSD, patients with severe SSD not only had higher somatic distress and health anxiety but also higher levels of anxiety/depression. However, SSD severity was not associated with help-seeking attitude and behaviour.
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Affiliation(s)
- Chao-Ying Tu
- Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
| | - Wei-Shih Liu
- Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
| | - Yen-Fu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Selinheimo S, Vuokko A, Hublin C, Järnefelt H, Karvala K, Sainio M, Suojalehto H, Paunio T. Psychosocial treatments for employees with non-specific and persistent physical symptoms associated with indoor air: A randomised controlled trial with a one-year follow-up. J Psychosom Res 2020; 131:109962. [PMID: 32078837 DOI: 10.1016/j.jpsychores.2020.109962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Persistent physical symptoms (PPS) associated with indoor air without an adequate pathophysiological- or environmental-related explanation may lead to work disability and decreased health-related quality of life (HRQoL). We attempted to assess the effect of cognitive behavioural therapy (CBT) for PPS and also psychoeducation (PE) on these symptoms involving disability. METHOD The intention-to-treat (ITT) sample included 52 employees recruited from an occupational healthcare service randomised as either controls undergoing treatment as usual (TAU) or TAU enhanced with CBT or PE. The primary outcome was HRQoL measuring the severity of symptoms and restrictions in everyday life caused by them. Secondary outcomes included depressive, anxiety and insomnia symptoms, and intolerance to environmental factors, assessed at baseline and at 3-, 6- and 12-month follow-ups. RESULTS At the 12-month follow-up assessment point, no statistically significant differences between treatments emerged following adjustment for gender, age, and HRQoL before the waiting period in the ITT analysis [F(2,46)=2.89, p=.07]. The secondary analysis revealed a significant improvement in HRQoL in the combined intervention group as compared with controls [F(1,47)=5.06, p=.03, g=0.41]. In total, 15% of participants dropped out during follow-up. CONCLUSIONS The results suggest that CBT for PPS or PE might not have a robust effect on HRQoL in PPS associated with indoor air, but the study did not achieve the planned power. Despite difficulties during the recruitment process, the final dropout rates remained low, and participants positively evaluated CBT, suggesting that it represents an acceptable treatment to them. Trial status This study was registered at the ClinicalTrials.gov registry (NCT02069002).
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Affiliation(s)
- Sanna Selinheimo
- Finnish Institute of Occupational Health, Helsinki, Finland; Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.
| | - Aki Vuokko
- Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Christer Hublin
- Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Heli Järnefelt
- Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Kirsi Karvala
- Finnish Institute of Occupational Health, Helsinki, Finland; Insurance Medicine and Rehabilitation Unit, Keva, Finland.
| | - Markku Sainio
- Finnish Institute of Occupational Health, Helsinki, Finland.
| | | | - Tiina Paunio
- Finnish Institute of Occupational Health, Helsinki, Finland; Department of Health, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry and the SleepWell Research Program, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Multiple Chemical Sensitivity: Review of the State of the Art in Epidemiology, Diagnosis, and Future Perspectives. J Occup Environ Med 2019; 60:138-146. [PMID: 29111991 PMCID: PMC5794238 DOI: 10.1097/jom.0000000000001215] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Systematic bibliography analysis of about the last 17 years on multiple chemical sensitivity (MCS) was carried out in order to detect new diagnostic and epidemiological evidence. The MCS is a complex syndrome that manifests as a result of exposure to a low level of various common contaminants. The etiology, diagnosis, and treatment are still debated among researchers. METHOD Querying PubMed, Web of Science, Scopus, Cochrane library, both using some specific MESH terms combined with MESH subheadings and through free search, even by Google. RESULTS The studies were analyzed by verifying 1) the typology of study design; 2) criteria for case definition; 3) presence of attendances in the emergency departments and hospital admissions, and 4) analysis of the risk factors. OUTLOOK With this review, we give some general considerations and hypothesis for possible future research.
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Modern health worries: Deriving two measurement invariant short scales for cross-cultural research with Ant Colony Optimization. PLoS One 2019; 14:e0211819. [PMID: 30730928 PMCID: PMC6366774 DOI: 10.1371/journal.pone.0211819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/21/2019] [Indexed: 11/19/2022] Open
Abstract
Worries about possible harmful effects of new technologies (modern health worries) have intensely been investigated in the last decade. However, the comparability of translated self-report measures across countries is often problematic. This study aimed to overcome this problem by developing psychometrically sound brief versions of the widely used 25-item Modern Health Worries Scale (MHWS) suitable for multi-country use. Based on data of overall 5,176 individuals from four European countries (England, Germany, Hungary, Sweden), Ant Colony Optimization was used to identify the indicators that optimize model fit and measurement invariance across countries. Two scales were developed. A short (12-item) version of the MHWS that represents the four-factor structure of the original version and an ultra-short (4-item) scale that only measures the general construct. Both scales show that overall levels of health worries were highest in England and Hungary, but that the main reason for concern (e.g. electromagnetic radiation or food related fears) differs considerably between these countries. This study also shows that even if measurement invariance of translated self-report instruments across countries is problematic, it can be optimized by using adequate item selection procedures. Differences of modern health worries across countries and recommendations for cross-cultural research are discussed.
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Claassen-van Dessel N, van der Wouden JC, Twisk JWR, Dekker J, van der Horst HE. Predicting the course of persistent physical symptoms: Development and internal validation of prediction models for symptom severity and functional status during 2 years of follow-up. J Psychosom Res 2018; 108:1-13. [PMID: 29602318 DOI: 10.1016/j.jpsychores.2018.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/18/2018] [Accepted: 02/20/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Increased knowledge about predictors of the course of persistent physical symptoms (PPS) is needed to identify patients at risk for long-term PPS in clinical settings. Therefore, we developed prediction models for the course of PPS in terms of symptom-severity and related functional status during a 2-year follow-up period. METHODS We used data of the PROSPECTS cohort study, consisting of 325 PPS patients from several health care settings. Symptom severity (PHQ-15), physical functioning (RAND 36 PCS) and mental functioning (RAND 36 MCS) were assessed at baseline and 6, 12 and 24 months afterwards. We applied mixed model analyses to develop prediction models for all outcomes, using all follow-up measurements. Potential predictors were based on empirical and theoretical literature and measured at baseline. RESULTS For symptom severity, physical functioning and mental functioning we identified predictors for the adverse course of PPS included physical comorbidity, higher severity and longer duration of PPS at baseline, anxiety, catastrophizing cognitions, embarrassment and fear avoidance cognitions, avoidance or resting behaviour and neuroticism. Predictors of a favourable course included limited alcohol use, higher education, higher levels of physical and mental functioning at baseline, symptom focusing, damage cognitions and extraversion. Explained interpersonal variance for all three models varied between 70.5 and 76.0%. Performance of the models was comparable in primary and secondary/tertiary care. CONCLUSION The presented prediction models identified several relevant demographic, medical, psychological and behavioural predictors for adverse and favourable courses of PPS. External validation of the presented models is needed prior to clinical implementation.
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Affiliation(s)
- Nikki Claassen-van Dessel
- Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Johannes W R Twisk
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Department of Health Sciences, VU University Amsterdam, The Netherlands
| | - Joost Dekker
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Department of Health Sciences, VU University Amsterdam, The Netherlands; Department of Rehabilitation Medicine and Department of Psychiatry, VU University Medical Center Amsterdam, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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The association between multiple chemical sensitivity and mental illness: Evidence from a nationally representative sample of Canadians. J Psychosom Res 2017; 99:40-44. [PMID: 28712429 DOI: 10.1016/j.jpsychores.2017.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/17/2017] [Accepted: 06/05/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The goal of the present study was to investigate the association between multiple chemical sensitivity (MCS) and major depressive disorder (MDD), generalized anxiety disorder (GAD), MDD and GAD comorbidity (MDD+GAD), severe distress, and positive mental wellbeing. METHODS This cross-sectional investigation was carried out using the 2012 Canadian Community Health Survey - Mental Health Component. The study population consisted of 21,977 individuals aged 20 and older, from Canada's ten provinces. Odds ratios were computed using multinomial logistic regression to calculate estimates of the association between MCS and mental illness. All analyses were weighted to take into account the complex survey design. RESULTS Individuals with MCS had 2.37 (1.55, 3.64) times greater odds of MDD, 3.09 (1.80, 5.30) times greater odds of MDD+GAD, and 2.60 (1.67, 4.07) times greater odds of severe distress. No association between MCS and GAD was observed. A sex difference was observed with males with MCS having lower odds of positive mental wellbeing, whereas no association was observed in females. CONCLUSIONS The present study findings supported an association between MCS and mental illness. The causal mechanism supporting this association remains unclear.
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Weiss EM, Singewald E, Baldus C, Hofer E, Marksteiner J, Nasrouei S, Ruepp B, Kapfhammer HP, Fitz W, Mai C, Bauer A, Papousek I, Holzer P. Differences in psychological and somatic symptom cluster score profiles between subjects with Idiopathic environmental intolerance, major depression and schizophrenia. Psychiatry Res 2017; 249:187-194. [PMID: 28113122 DOI: 10.1016/j.psychres.2016.12.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/29/2016] [Accepted: 12/28/2016] [Indexed: 11/24/2022]
Abstract
Idiopathic Environmental Intolerance (IEI) has been associated with psychogenic factors and an increased number of comorbid psychiatric disorders such as depression and anxiety disorder. The purpose of the current study was to examine a possible overlap of psychological and somatic symptoms between subjects with IEI and patients with major depression and schizophrenia as well as to specify characteristic differences. The different symptom clusters included symptoms of chemical intolerance, neurotoxicity and psychological distress as well as measurements of mental health such as anxiety, depression, somatoform symptoms, and schizophrenia-specific disturbances in cognitive domains. IEI patients reported higher overall levels in physical symptoms such as chemical intolerance, neurotoxicity and somatic symptoms not attributable to an organic cause. Schizophrenia patients showed higher overall levels in self-experienced disturbances in several schizophrenia-specific cognitive domains, whereas general psychological distress, anxiety and depression were rated highest by patients with major depression. Importantly, the groups markedly differed in the shapes of profiles of various symptom clusters. Our results provide evidence that IEI patients can be distinguished on the phenomenological level from patients with major depression or schizophrenia, and that distinct domains of psychological and somatic symptoms are particularly problematic in specific diagnostic groups.
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Affiliation(s)
- Elisabeth M Weiss
- Department of Psychology, Biological Psychology Unit, University of Graz, Austria.
| | - Evelin Singewald
- Department of Psychiatry and Psychotherapy A, LKH Hall, Austria; Research Unit of Translational Neurogastroenterology, Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Universitätsplatz 4, A-8010 Graz, Austria
| | - Claudia Baldus
- Department of Psychology, Biological Psychology Unit, University of Graz, Austria
| | - Ellen Hofer
- Department of Psychology, Biological Psychology Unit, University of Graz, Austria
| | | | - Sarah Nasrouei
- Department of Psychiatry and Psychotherapy A, LKH Hall, Austria
| | - Beatrix Ruepp
- Department of Psychiatry and Psychotherapy A, LKH Hall, Austria
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Werner Fitz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Christoph Mai
- Umweltmedizin, Fachkliniken Nordfriesland, Bredstedt, Germany
| | - Anke Bauer
- Umweltmedizin, Fachkliniken Nordfriesland, Bredstedt, Germany
| | - Ilona Papousek
- Department of Psychology, Biological Psychology Unit, University of Graz, Austria
| | - Peter Holzer
- Research Unit of Translational Neurogastroenterology, Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Universitätsplatz 4, A-8010 Graz, Austria; BioTechMed-Graz, Krenngasse 37/1, 8010 Graz, Austria
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Abstract
OBJECTIVE A 5-year follow-up study showed that a group of patients with airway symptoms from chemicals and scents had lasting symptoms, together with enduring increased capsaicin cough sensitivity. The aim was to follow up the same patients after another 5 years. METHODS All previously participants were invited for an additional follow-up. They visited the clinic twice; at one opportunity, they undertook a capsaicin inhalation provocation, and at the other, a methacholine provocation, and answered various questionnaires. RESULTS Sixteen patients attende the study after a median of 8 years. They reported unchanged symptoms from chemicals and scents; the capsaicin cough sensitivity was still increased, and the repeatability for the capsaicin inhalation was good. CONCLUSIONS Airway symptoms induced by chemicals and scents constitute a chronic disease, with unchanged trigger factors, persistent symptoms, and unchanged, long-lasting sensory hyperreactivity.All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.This study was supported by grants from the Herman Krefting Foundation Against Asthma/Allergy, the Swedish Heart and Lung Foundation, and the Swedish Cancer and Allergy Fund.
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Szemerszky R, Dömötör Z, Berkes T, Köteles F. Attribution-Based Nocebo Effects. Perceived Effects of a Placebo Pill and a Sham Magnetic Field on Cognitive Performance and Somatic Symptoms. Int J Behav Med 2016; 23:204-13. [PMID: 26420517 DOI: 10.1007/s12529-015-9511-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Negative non-specific (nocebo-like) effects of medications and electromagnetic fields are often described as results of mistaken attribution. PURPOSE The current study aimed to find empirical evidence supporting this theory. METHOD Participants completed questionnaires assessing modern health worries, health anxiety, and somatosensory amplification, were assigned to one of three conditions (placebo pill with sedative information, sham magnetic field, or control), and completed a 14-min vigilance task. Changes in physiological arousal (heart rate, heart rate variability, and skin conductance) and reported symptoms were also measured. Finally, causal attributions concerning cognitive performance and reported symptoms were assessed. RESULTS No increase in symptom reports and physiological arousal was measured in the two intervention groups. A perceived negative effect on cognitive performance was attributed to both sham conditions, and attributions were connected to modern health worries. A proportion of reported symptoms was ascribed to the placebo pill but not to the sham magnetic field. Symptom attributions were not related to any assessed psychological variables. CONCLUSIONS An aroused physiological state is not necessary for the automatic causal attribution process. Negative effects attributed to medication and environmental factors can be regarded as unavoidable side effects of human cognitive-emotional functioning; they might be alleviated, but cannot be completely eradicated.
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Affiliation(s)
- Renáta Szemerszky
- Institute of Health Promotion and Sport Sciences, Eötvös Loránd University, Bogdánfy Ödön u. 10., Budapest, 1117, Hungary
| | - Zsuzsanna Dömötör
- Doctoral School of Psychology and Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Tímea Berkes
- Institute of Health Promotion and Sport Sciences, Eötvös Loránd University, Bogdánfy Ödön u. 10., Budapest, 1117, Hungary
| | - Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, Eötvös Loránd University, Bogdánfy Ödön u. 10., Budapest, 1117, Hungary.
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Selinheimo S, Vuokko A, Sainio M, Karvala K, Suojalehto H, Järnefelt H, Paunio T. Comparing cognitive-behavioural psychotherapy and psychoeducation for non-specific symptoms associated with indoor air: a randomised control trial protocol. BMJ Open 2016; 6:e011003. [PMID: 27266771 PMCID: PMC4908864 DOI: 10.1136/bmjopen-2015-011003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Indoor air-related conditions share similarities with other conditions that are characterised by medically unexplained symptoms (MUS)-a combination of non-specific symptoms that cannot be fully explained by structural bodily pathology. In cases of indoor air-related conditions, these symptoms are not fully explained by either medical conditions or the immunological-toxicological effects of environmental factors. The condition may be disabling, including a non-adaptive health behaviour. In this multifaceted phenomenon, psychosocial factors influence the experienced symptoms. Currently, there is no evidence of clinical management of symptoms, which are associated with the indoor environment and cannot be resolved by removing the triggering environmental factors. The aim of this study is to compare the effect of treatment-as-usual (TAU) and two psychosocial interventions on the quality of life, and the work ability of employees with non-specific indoor air-related symptomatology. METHODS AND ANALYSES The aim of this ongoing randomised controlled trial is to recruit 60 participants, in collaboration with 5 occupational health service units. The main inclusion criterion is the presence of indoor air-related recurrent symptoms in ≥2 organ systems, which have no pathophysiological explanation. After baseline clinical investigations, participants are randomised into interventions, which all include TAU: cognitive-behavioural psychotherapy, psychoeducation and TAU (control condition). Health-related quality of life, measured using the 15D-scale, is the primary outcome. Secondary outcomes include somatic and psychiatric symptoms, occupational factors, and related underlying mechanisms (ie, cognitive functioning). Questionnaires are completed at baseline, at 3, 6 and 12-month follow-ups. Data collection will continue until 2017. The study will provide new information on the individual factors related to indoor air-associated symptoms, and on ways in which to support work ability. ETHICS AND DISSEMINATION The Coordinating Ethics Committee of the Hospital District of Helsinki and Uusimaa, Finland, has granted approval for the study. The results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02069002; Pre-results.
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Affiliation(s)
| | - Aki Vuokko
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Markku Sainio
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Kirsi Karvala
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Heli Järnefelt
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tiina Paunio
- Finnish Institute of Occupational Health, Helsinki, Finland
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
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Pacharra M, Kleinbeck S, Schäper M, Juran SA, Hey K, Blaszkewicz M, Lehmann ML, Golka K, van Thriel C. Interindividual differences in chemosensory perception: Toward a better understanding of perceptual ratings during chemical exposures. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2016; 79:1026-1040. [PMID: 27924707 DOI: 10.1080/15287394.2016.1219547] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Perceptions that arise from stimulation of olfactory and trigeminal receptors in the nasal cavity guide the evaluation of chemical environment in humans. Strong interindividual differences in these assessments may be attributed to nonsensory factors such as gender, anxiety, and chemical sensitivity. Knowledge regarding the influence of these factors originates mainly from basic odor research using short-term exposure scenarios. In situations with continuous chemical exposures-common in the working environment-their impact is less clear. To investigate their role during the exposure to workplace chemicals, 4-hour experimental exposure studies (total N = 105) using nine different airborne chemicals were summarized. In each study, subjects evaluated a single chemical in a controlled environment by rating five chemosensory perceptions, including odor intensity, disgust, annoyance, pungency, and burning, several times during occupational limit and low exposures. It was investigated whether the effects of trait-like modulators, such as anxiety and self-reported chemical sensitivity, depend on exposure-related factors and gender. Trait-like modulators markedly affected ratings by women, but not men. Highly anxious women reported more intense annoyance and disgust than less anxious women. Stronger self-reported chemical sensitivity was associated with increased ratings of pungency and burning in women exposed to occupational limit concentrations. This study demonstrates that a complex interplay of exposure-related factors, gender, and trait-like individual differences affects perceptual ratings during continuous chemical exposure. It seems necessary to incorporate the assessment of specific as well as general trait-like modulators into future experimental exposure studies.
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Affiliation(s)
- Marlene Pacharra
- a Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund University (IfADo) , Dortmund , Germany
| | - Stefan Kleinbeck
- a Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund University (IfADo) , Dortmund , Germany
| | - Michael Schäper
- a Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund University (IfADo) , Dortmund , Germany
| | | | - Kathrin Hey
- a Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund University (IfADo) , Dortmund , Germany
| | - Meinolf Blaszkewicz
- a Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund University (IfADo) , Dortmund , Germany
| | - Marie-Louise Lehmann
- a Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund University (IfADo) , Dortmund , Germany
| | - Klaus Golka
- a Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund University (IfADo) , Dortmund , Germany
| | - Christoph van Thriel
- a Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund University (IfADo) , Dortmund , Germany
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Öztürk A, Kiliç A, Deveci E, Kirpinar İ. Investigation of facial emotion recognition, alexithymia, and levels of anxiety and depression in patients with somatic symptoms and related disorders. Neuropsychiatr Dis Treat 2016; 12:1047-53. [PMID: 27199559 PMCID: PMC4857827 DOI: 10.2147/ndt.s106989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The concept of facial emotion recognition is well established in various neuropsychiatric disorders. Although emotional disturbances are strongly associated with somatoform disorders, there are a restricted number of studies that have investigated facial emotion recognition in somatoform disorders. Furthermore, there have been no studies that have regarded this issue using the new diagnostic criteria for somatoform disorders as somatic symptoms and related disorders (SSD). In this study, we aimed to compare the factors of facial emotion recognition between patients with SSD and age- and sex-matched healthy controls (HC) and to retest and investigate the factors of facial emotion recognition using the new criteria for SSD. PATIENTS AND METHODS After applying the inclusion and exclusion criteria, 54 patients who were diagnosed with SSD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria and 46 age- and sex-matched HC were selected to participate in the present study. Facial emotion recognition, alexithymia, and the status of anxiety and depression were compared between the groups. RESULTS Patients with SSD had significantly decreased scores of facial emotion for fear faces, disgust faces, and neutral faces compared with age- and sex-matched HC (t=-2.88, P=0.005; t=-2.86, P=0.005; and t=-2.56, P=0.009, respectively). After eliminating the effects of alexithymia and depressive and anxious states, the groups were found to be similar in terms of their responses to facial emotion and mean reaction time to facial emotions. DISCUSSION Although there have been limited numbers of studies that have examined the recognition of facial emotion in patients with somatoform disorders, our study is the first to investigate facial recognition in patients with SSD diagnosed according to the DSM-5 criteria. Recognition of facial emotion was found to be disturbed in patients with SSD. However, our findings suggest that disturbances in facial recognition were significantly associated with alexithymia and the status of depression and anxiety, which is consistent with the previous studies. Further studies are needed to highlight the associations between facial emotion recognition and SSD.
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Affiliation(s)
- Ahmet Öztürk
- Department of Psychiatry, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Alperen Kiliç
- Department of Psychiatry, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Erdem Deveci
- Department of Psychiatry, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - İsmet Kirpinar
- Department of Psychiatry, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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¿Podemos descartar que la fibromialgia, el síndrome de fatiga crónica y la sensibilidad química múltiple sean enfermedades psicosomáticas? Semergen 2015. [DOI: 10.1016/j.semerg.2015.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cortese BM, Leslie K, Uhde TW. Differential odor sensitivity in PTSD: Implications for treatment and future research. J Affect Disord 2015; 179:23-30. [PMID: 25845746 PMCID: PMC4437877 DOI: 10.1016/j.jad.2015.03.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Given that odors enhance the retrieval of autobiographical memories, induce physiological arousal, and trigger trauma-related flashbacks, it is reasonable to hypothesize that odors play a significant role in the pathophysiology of posttraumatic stress disorder (PTSD). For these reasons, this preliminary study sought to examine self-reported, odor-elicited distress in PTSD. METHODS Combat veterans with (N=30) and without (N=22) PTSD and healthy controls (HC: N=21), completed an olfactory questionnaire that provided information on the hedonic valence of odors as well as their ability to elicit distress or relaxation. RESULTS Two main findings were revealed: Compared to HC, CV+PTSD, but not CV-PTSD, reported a higher prevalence of distress to a limited number of select odors that included fuel (p=.004), blood (p=.02), gunpowder (p=.03), and burning hair (p=.02). In contrast to this increased sensitivity, a blunting effect was reported by both groups of veterans compared to HC that revealed lower rates of distress and relaxation in response to negative hedonic odors (p=.03) and positive hedonic odors (p<.001), respectively. LIMITATIONS The study is limited by its use of retrospective survey methods, whereas future investigations would benefit from laboratory measures taken prior, during, and after deployment. CONCLUSION The present findings suggest a complex role of olfaction in the biological functions of threat detection. Several theoretical models are discussed. One possible explanation for increased sensitivity to select odors with decreased sensitivity to other odors is the co-occurrence of attentional bias toward threat odors with selective ignoring of distractor odors. Working together, these processes may optimize survival.
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Affiliation(s)
| | - Kimberly Leslie
- Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC, US
| | - Thomas W. Uhde
- Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC, US
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Bailer J, Kerstner T, Witthöft M, Diener C, Mier D, Rist F. Health anxiety and hypochondriasis in the light of DSM-5. ANXIETY STRESS AND COPING 2015; 29:219-39. [PMID: 25846805 DOI: 10.1080/10615806.2015.1036243] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD. DESIGN Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case-control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals. RESULTS The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables. CONCLUSION These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.
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Affiliation(s)
- Josef Bailer
- a Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim , University Heidelberg , Mannheim , Germany
| | - Tobias Kerstner
- a Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim , University Heidelberg , Mannheim , Germany
| | - Michael Witthöft
- b Department of Clinical Psychology , Johannes Gutenberg University , Mainz , Germany
| | - Carsten Diener
- c School of Applied Psychology , SRH University of Applied Sciences , Heidelberg , Germany.,d Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health , University of Heidelberg , Mannheim , Germany
| | - Daniela Mier
- a Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim , University Heidelberg , Mannheim , Germany
| | - Fred Rist
- e Department of Clinical Psychology , University of Münster , Münster , Germany
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Skovbjerg S, Christensen KB, Ebstrup JF, Linneberg A, Zachariae R, Elberling J. Negative affect is associated with development and persistence of chemical intolerance: a prospective population-based study. J Psychosom Res 2015; 78:509-514. [PMID: 25758214 DOI: 10.1016/j.jpsychores.2015.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/09/2015] [Accepted: 02/12/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Chemical intolerance (CI) is characterised by negative health effects attributed to a heightened responsiveness to common airborne chemicals. This longitudinal study explored the hypothesised role of negative affect in the development and persistence of CI in a general population. METHODS A general population sample aged 19 to 72 years was examined in 2006-2008 and again in 2011-2012. Longitudinal data on CI were analysed with the purpose of examining baseline negative affect as a risk factor for having developed CI at 5-year follow-up and for reporting persistent CI. Participants were classified as reporting no signs of CI, having symptoms of CI and as being a likely CI case based on self-reported reactions to 11 common chemical exposures, symptoms related to chemical exposures and daily life adjustments attributed to reactions when exposed to chemicals. RESULTS A total of 69.4% of the participants who had reported CI at baseline also reported CI at follow-up. In participants with no baseline CI, 15.5% reported CI at follow-up and 18.1% reported symptoms related to chemicals but no daily life adjustments. Baseline negative affect was positively and statistically significantly associated with both development and persistence of CI. CONCLUSIONS Initial reports of CI were found to be persistent over time, and a considerable proportion of the participants with no CI at baseline reported having developed CI after 5 years. The positive association between negative affect and CI at the 5-year follow-up supports negative affect as a possible risk factor for CI.
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Affiliation(s)
- Sine Skovbjerg
- The Research Centre for Prevention and Health, Capital Region, Copenhagen, Denmark.
| | - Karl Bang Christensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | | | - Allan Linneberg
- The Research Centre for Prevention and Health, Capital Region, Copenhagen, Denmark; Department of Clinical Experimental Research, Copenhagen University Hospital Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Elberling
- The Allergy Clinic, Copenhagen University Hospital, Gentofte, Copenhagen, Denmark
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21
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Frostholm L, Ørnbøl E, Fink PK. Physical symptom attributions: a defining characteristic of somatoform disorders? Gen Hosp Psychiatry 2015; 37:147-52. [PMID: 25677210 DOI: 10.1016/j.genhosppsych.2015.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/04/2014] [Accepted: 01/08/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES We examined whether primary care patients were more likely to perceive a current health problem as 'physical illness only' as opposed to entailing psychological difficulties if they had a comorbid somatoform disorder compared to patients who had (a) both comorbid somatoform disorder and anxiety/depression or (b) comorbid anxiety and/or depression, and a reference group of (c) patients with well-defined physical disease. We examined whether attributions predicted future health expenditures. METHODS A total of 1209 of 1785 patients completed questions on patient-perceived illness. The physicians diagnosed the current health problem. A stratified subsample was interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. Health expenditure was obtained from registers for a 2-year period. RESULTS The belief that the current health problem was only physical was endorsed by 86% of patients presenting physical disease, 58% of patients with somatoform disorders, 29% of patients with both somatoform disorders and anxiety/depression and 24% of patients with anxiety or depressive disorders (χ2=269.2, df=3, P<.0001). In a multiple regression model, a 'physical illness only' perception predicted lower health expenditures [β = -0.31, 95% confidence interval (-0.55; -0.07), P=.013]. CONCLUSIONS The prevalent assumption that physical symptom attributions are a central aspect in somatoform disorders is not supported by the current study.
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Affiliation(s)
- Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Noerrebrogade 44, Aarhus University Hospital, DK-8000 Aarhus C, Denmark.
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Noerrebrogade 44, Aarhus University Hospital, DK-8000 Aarhus C, Denmark
| | - Per K Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Noerrebrogade 44, Aarhus University Hospital, DK-8000 Aarhus C, Denmark
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22
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Nordin S, Neely G, Olsson D, Sandström M. Odor and noise intolerance in persons with self-reported electromagnetic hypersensitivity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:8794-805. [PMID: 25166918 PMCID: PMC4198991 DOI: 10.3390/ijerph110908794] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 08/10/2014] [Accepted: 08/19/2014] [Indexed: 11/16/2022]
Abstract
Lack of confirmation of symptoms attributed to electromagnetic fields (EMF) and triggered by EMF exposure has highlighted the role of individual factors. Prior observations indicate intolerance to other types of environmental exposures among persons with electromagnetic hypersensitivity (EHS). This study assessed differences in odor and noise intolerance between persons with EHS and healthy controls by use of subscales and global measures of the Chemical Sensitivity Scale (CSS) and the Noise Sensitivity Scale (NSS). The EHS group scored significantly higher than the controls on all CSS and NSS scales. Correlation coefficients between CSS and NSS scores ranged from 0.60 to 0.65 across measures. The findings suggest an association between EHS and odor and noise intolerance, encouraging further investigation of individual factors for understanding EMF-related symptoms.
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Affiliation(s)
- Steven Nordin
- Department of Psychology, Umeå University, SE-901 87 Umeå, Sweden.
| | - Gregory Neely
- Department of Psychology, Umeå University, SE-901 87 Umeå, Sweden.
| | - David Olsson
- Department of Public Health and Clinical Medicine, Umeå University, SE-901 87 Umeå, Sweden.
| | - Monica Sandström
- Department of Public Health and Clinical Medicine, Umeå University, SE-901 87 Umeå, Sweden.
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Baliatsas C, van Kamp I, Hooiveld M, Yzermans J, Lebret E. Comparing non-specific physical symptoms in environmentally sensitive patients: prevalence, duration, functional status and illness behavior. J Psychosom Res 2014; 76:405-13. [PMID: 24745783 DOI: 10.1016/j.jpsychores.2014.02.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 02/13/2014] [Accepted: 02/21/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Little is known about the potential clinical relevance of non-specific physical symptoms (NSPS) reported by patients with self-reported environmental sensitivities. This study aimed to assess NSPS in people with general environmental sensitivity (GES) and idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) and to determine differences in functional status and illness behavior. METHODS An epidemiological study was conducted in the Netherlands, combining self-administered questionnaires with the electronic medical records of the respondents as registered by general practitioners. Analyses included n=5789 registered adult (≥18 years) patients, comprising 5073 non-sensitive (NS) individuals, 514 in the GES group and 202 in the IEI-EMF group. RESULTS Participants with GES were about twice as likely to consult alternative therapy compared to non-sensitive individuals; those with IEI-EMF were more than three times as likely. Moreover, there was a higher prevalence of symptoms and medication prescriptions and longer symptom duration among people with sensitivities. Increasing number and duration of self-reported NSPS were associated with functional impairment, illness behavior, negative symptom perceptions and prevalence of GP-registered NSPS in the examined groups. CONCLUSION Even after adjustment for medical and psychiatric morbidity, environmentally sensitive individuals experience poorer health, increased illness behavior and more severe NSPS. The number and duration of self-reported NSPS are important components of symptom severity and are associated with characteristics similar to those of NSPS in primary care. The substantial overlap between the sensitive groups strengthens the notion that different types of sensitivities might be part of one, broader environmental illness.
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Affiliation(s)
- Christos Baliatsas
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Irene van Kamp
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Mariette Hooiveld
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Joris Yzermans
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Erik Lebret
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Rief W, Martin A. How to Use the New DSM-5 Somatic Symptom Disorder Diagnosis in Research and Practice: A Critical Evaluation and a Proposal for Modifications. Annu Rev Clin Psychol 2014; 10:339-67. [DOI: 10.1146/annurev-clinpsy-032813-153745] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Winfried Rief
- Department of Psychology, Philipps University of Marburg, D-35032 Marburg, Germany;
| | - Alexandra Martin
- Faculty of Educational and Social Science, University of Wuppertal, D-42097 Wuppertal, Germany;
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Douzenis A, Seretis D. Descriptive and predictive validity of somatic attributions in patients with somatoform disorders: a systematic review of quantitative research. J Psychosom Res 2013; 75:199-210. [PMID: 23972408 DOI: 10.1016/j.jpsychores.2013.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 05/07/2013] [Accepted: 05/12/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Research on hypochondriasis and other somatoform disorders (SFD) has provided evidence that patients with SFD tend to attribute their symptoms to organic dysfunctions or disease. However, recent studies appear to discredit this. There is no systematic evidence on whether patients with SFD predominantly rely on somatic attributions, despite calls to include somatic attributions as a positive criterion of somatic symptom disorder (SSD) in the upcoming Diagnostic and Statistical Manual of Mental Disorders (DSM-5). METHODS This study is a systematic review of quantitative studies which assess the descriptive and predictive validity of somatic attribution in SFD. The literature search was restricted to studies with patients who met the DSM-IV criteria for SFD. RESULTS Somatic attribution style in SFD has acceptable descriptive but insufficient predictive validity. This confirms that the overlap between somatic and psychological attributions is often substantial. Attribution style can discriminate between SFD patients with and without comorbidity. CONCLUSION A somatic attribution style does not qualify as a positive criterion in SSD. However, there is an urgent need for further research on causal illness perceptions in the full spectrum of medically unexplained symptoms in order to confirm this result. Given its high prevalence, research on psychological attribution style is warranted. Re-attribution does not provide a framework sophisticated enough to address the needs of patients in primary care.
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Affiliation(s)
- Athanassios Douzenis
- Second Psychiatry Department, Athens University Medical School, Attikon General Hospital, 1 Rimini St., Athens, 12462, Greece.
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Tran MTD, Skovbjerg S, Arendt-Nielsen L, Christensen KB, Elberling J. Transcranial pulsed electromagnetic fields for multiple chemical sensitivity: study protocol for a randomized, double-blind, placebo-controlled trial. Trials 2013; 14:256. [PMID: 23947742 PMCID: PMC3765111 DOI: 10.1186/1745-6215-14-256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 08/05/2013] [Indexed: 12/17/2022] Open
Abstract
Background Multiple chemical sensitivity (MCS) is a chronic condition of unknown etiology. MCS is characterized by recurrent nonspecific symptoms from multiple organ systems in response to chemical exposures in concentrations that are normally tolerated by the majority of the population. The symptoms may have severe impact on patients’ lives, but an evidence-based treatment for the condition is nonexisting. The pathophysiology is unclarified, but several indicators point towards abnormal processing of sensory signals in the central nervous system. Pulsed electromagnetic fields (PEMF) offer a promising new treatment for refractory depression and can be targeted at the brain, thereby activating biochemical cell processes. Methods/Design In a parallel, randomized, double-blind, placebo-controlled trial conducted at the Danish Research Centre for Chemical Sensitivities, the effects of PEMF in MCS patients will be assessed using the Re5 Independent System. Based on sample size estimation, 40 participants will be randomized to either PEMF therapy or placebo. The allocation sequence will be generated by computer. All involved parties (that is, participants, investigators, the research nurse, and the statistician) will be blinded to group allocation. The participants will receive PEMF therapy or placebo applied transcranially 30 minutes twice a day for 7 days a week over 6 consecutive weeks. Outcomes will be measured at baseline, once weekly during treatment, post treatment, and at 2.5-month and 4.5-month follow-up according to a predefined timetable. The primary outcome will be a measurement of the impact of MCS on everyday life. The secondary outcomes will be measurements of MCS symptoms, psychological distress (stress, anxiety or depressive symptoms), capsaicin-induced secondary punctate hyperalgesia, immunological markers in serum, and quality of life. Discussion This trial will assess the effects of PEMF therapy for MCS. Currently, there is no treatment with a documented effect on MCS, and in terms of healthcare there is very little to offer these patients. There is thus a great need for well-conducted randomized trials aimed at assessing possible treatment effects. A positive outcome will pave the way for improved healthcare and understanding of this very disabling and overlooked condition. Trial registration ClinicalTrials.gov, NCT01834781
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Affiliation(s)
- Marie Thi Dao Tran
- The Danish Research Centre for Chemical Sensitivities, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, Ledreborg Allé 40, 2, th,, DK-2820 Gentofte, Denmark.
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Dupas D, Dagorne MA. Syndrome d’intolérance aux odeurs chimiques (SIOC) : un diagnostic à ne pas manquer. Épidémiologie, diagnostic, traitement. ARCH MAL PROF ENVIRO 2013. [DOI: 10.1016/j.admp.2013.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Barnig C, de Blay F. [Pathophysiology of multiple chemical sensitivity]. Rev Mal Respir 2013; 30:446-50. [PMID: 23835316 DOI: 10.1016/j.rmr.2013.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 02/11/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND BACKGROUND Multiple chemical sensitivity (MCS) is a complex clinical entity that includes a large number of non-specific symptoms, associated in a univocal manner in each patient and triggered by exposure to various chemicals at low concentrations, well below those known to cause toxic effects. However, no objective test exists currently to diagnose this syndrome. One of the main reasons is that the pathophysiology is poorly understood. However, many explanatory hypotheses have been proposed. VIEWPOINTS AND CONCLUSIONS Patients with symptoms of MCS are often encountered by pulmonologists. Their suffering is undeniable but, unfortunately, the lack of understanding of the pathophysiological mechanisms makes treatment difficult and empirical.
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Affiliation(s)
- C Barnig
- Service de pneumologie, d'allergologie et de pathologie respiratoire de l'environnement, pôle de pathologie thoracique, hôpitaux universitaires de Strasbourg, BP 426, 67091 Strasbourg cedex, France.
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Wollburg E, Voigt K, Braukhaus C, Herzog A, Löwe B. Construct validity and descriptive validity of somatoform disorders in light of proposed changes for the DSM-5. J Psychosom Res 2013; 74:18-24. [PMID: 23272984 DOI: 10.1016/j.jpsychores.2012.09.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 09/18/2012] [Accepted: 09/20/2012] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Current diagnostic criteria for somatoform disorders demand revisions due to their insufficient clinical as well as scientific usability. Various psychological and behavioral characteristics have been considered for the proposed new category Somatic Symptom Disorder (SSD). With this study, we were able to jointly assess the validity of these variables in an inpatient sample. METHODS Using a cross-sectional design, we investigated N=456 patients suffering from somatoform disorder, anxiety, or depression. Within one week after admission to the hospital, informed consent was obtained and afterwards, a diagnostic interview and a battery of self-report questionnaires were administered. Logistic regression analyses were performed to determine which variables significantly add to construct and descriptive validity. RESULTS Several features, such as somatic symptom severity, health worries, health habits, a self-concept of being weak, and symptom attribution, predicted physical health status in somatization. Overall, our model explained about 50% of the total variance. Furthermore, in comparison with anxious and depressed patients, health anxiety, body scanning, and a self-concept of bodily weakness were specific for DSM-IV somatoform disorders and the proposed SSD. CONCLUSIONS The present study supports the inclusion of psychological and behavioral characteristics in the DSM-5 diagnostic criteria for somatoform disorders. Based on our results, we make suggestions for a slight modification of criterion B to enhance construct validity of the Somatic Symptom Disorder.
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[Multiple chemical sensitivity: a diagnosis not to be missed]. Rev Mal Respir 2012; 30:99-104. [PMID: 23419440 DOI: 10.1016/j.rmr.2012.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 06/26/2012] [Indexed: 11/23/2022]
Abstract
Multiple chemical sensitivity (MCS) is a chronic condition, which belongs to the group of medically unexplained syndromes. Patients (men as well as women) complain of many subjective symptoms such as nose and mouth irritation, sore throat, dyspnea, tiredness, dizziness, headache and concentration difficulties. Patient typically report at least four or five symptoms occurring when they are exposed to particular substances, at a very low concentration that usually does not cause symptoms or harm in normal individuals. The common feature of products that appear to be responsible (either occupational or domestic) is that they have a strong smell and include: solvent, paint, glue, tar, oil, pesticides, perfume, cosmetics and spray products. MCS is nowadays considered to be one aspect of idiopathic environmental intolerance (IEI) whose other main aspect is hypersensitivity to electromagnetic fields. If the diagnosis is suspected clinically it can be confirmed using the Quick Environmental Exposure and Sensitivity Inventory (QEESI(©)) self-questionnaire. MCS is often misdiagnosed as asthma or an allergic conditions which means that patients are frequently referred to respiratory and allergy specialists. Misdiagnosis can lead to many futile medical investigations. Psychotherapy can improve quality of life in some cases. Preventive measures are often ineffective and do not stop the condition worsening: hypersensitivity can spread to common environmental odors so that a few people become severely disabled and limited in their workplace as well as in private life. In France, 435 cases were registered in the university hospital occupational disease departments network (RNV3P) during the period 2007-2010. It is therefore important that every clinician be able to recognize the condition and ensure that their patients could get compensation when unable to go on working.
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Hetherington L, Battershill J. Review of evidence for a toxicological mechanism of idiopathic environmental intolerance. Hum Exp Toxicol 2012; 32:3-17. [PMID: 23060407 DOI: 10.1177/0960327112457189] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Idiopathic environmental intolerance (IEI) is a medically unexplained disorder characterised by a wide variety of unspecific symptoms in different organ systems and attributed to nontoxic concentrations of chemicals and other environmental factors that are tolerated by the majority of individuals. Both exposure to chemicals and behavioural conditioning are considered as possible contributors to the development of IEI. However, owing to the heterogeneity of the condition, it is difficult to separate the toxicological, physiological and psychological aspects of IEI. Here, we review the evidence for postulated toxicologically mediated mechanisms for IEI. Available data do not support either a classical receptor-mediated or an idiosyncratic toxicological mechanism. Furthermore, if there were convincing evidence for a psychological cause for many patients with IEI, then this would suggest that the priority for the future is the development of psychological treatments for IEI. Finally, we advocate genome wide screening of IEI patients to elucidate genotypic features of the condition.
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Affiliation(s)
- Lh Hetherington
- General Toxicology Group, Toxicology Department, Centre for Radiation, Chemical and Environmental Hazards, Health Protection Agency, Didcot, Oxon, UK.
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Hauge CR, Bonde PJE, Rasmussen A, Skovbjerg S. Mindfulness-based cognitive therapy for multiple chemical sensitivity: a study protocol for a randomized controlled trial. Trials 2012; 13:179. [PMID: 23016822 PMCID: PMC3560121 DOI: 10.1186/1745-6215-13-179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 09/13/2012] [Indexed: 11/18/2022] Open
Abstract
Background Multiple chemical sensitivity (MCS) is a condition characterized by recurrent, self-reported symptoms from multiple organ systems, attributable to exposure to a wide range of chemically unrelated substances at low levels. The pathophysiology is unknown, and affected individuals generally favor avoidance of the symptom triggering substances as a coping strategy. The impact of MCS on daily life may thus be severe. An intervention that may effectively reduce the impact of MCS, alleviate the symptoms and the psychological distress associated with the condition is therefore highly needed. In this study we will assess the effects of a mindfulness-based cognitive (MBCT) program on MCS. Methods/Design Using a randomized controlled design (RCT), we will compare MBCT with treatment as usual (TAU). The MBCT intervention will include 8 weekly 2.5 hour sessions, and 45 minutes of mindfulness home practice 6 days each week. Participants will be asked to complete questionnaires at baseline, post-treatment, and at 6 and 12 months’ follow-up. Based on sample size estimation, 82 participants will be randomized to either the MBCT intervention or to TAU. The primary outcome will be a measure of the impact of MCS on the participants’ lives. The secondary outcome measures are physical symptoms of psychological distress, perceived stress, illness perceptions, QOL, and work ability. Lastly, we will assess whether any effect of MBCT on the primary effect measure is mediated by level of mindfulness, self-compassion, perceived stress, and rumination. Discussion This trial will provide important information on the effects of MBCT on MCS. Trials registration Clinical trials identifier NCT01240395
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Affiliation(s)
- Christian Riise Hauge
- The Danish Research Centre for Chemical Sensitivities, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, Ledreborg Alle 40, 2th, Gentofte 2820, Copenhagen, Denmark.
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The feasibility of aromatherapy massage to reduce symptoms of Idiopathic Environmental Intolerance: a pilot study. Complement Ther Med 2012; 20:400-8. [PMID: 23131370 DOI: 10.1016/j.ctim.2012.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/23/2012] [Accepted: 07/26/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Idiopathic Environmental Intolerance (IEI) is an acquired disorder with multiple recurrent symptoms, which is associated with diverse environmental factors that are tolerated by the majority of people. IEI is an illness of uncertain aetiology, making it difficult to treat using conventional medicine. Therefore, there is a need for novel therapies to control the symptoms of IEI. The objective of this study was to evaluate the feasibility and impact of aromatherapy massage for individuals with IEI. DESIGN Non-blinded crossover trial. SETTING IEI patients who attended a clinic in Sapporo city were recruited, and sixteen patients were enrolled. Participants were clinically examined by an experienced medical doctor and met the criteria included in the working definition of IEI disorder. INTERVENTIONS During the active period, participants received four one-hour aromatherapy massage sessions every two weeks. During the control period, the participants did not receive any massages. MAIN OUTCOME MEASUREMENTS Scores on the IEI-scales trigger checklist, symptoms, life impact, and the State Anxiety Inventory were assessed before and after each period. Short-term mood enhancement was evaluated using the Profiles of Mood Status (POMS) before and after sessions. RESULTS Due to period effects, evaluation of the results had to be restricted to the first period, and the result showed no effect of intervention. All six sub-scales of the POMS improved after each session (mean score differences: 4.89-1.33, P<0.05). CONCLUSIONS Aromatherapy was well tolerated by subjects with IEI; however, aromatherapy, as applied in this study, did not suggest any specific effects on IEI condition.
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Katerndahl DA, Bell IR, Palmer RF, Miller CS. Chemical intolerance in primary care settings: prevalence, comorbidity, and outcomes. Ann Fam Med 2012; 10:357-65. [PMID: 22778124 PMCID: PMC3392295 DOI: 10.1370/afm.1346] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 09/20/2011] [Accepted: 10/11/2011] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This study extends previous community-based studies on the prevalence and clinical characteristics of chemical intolerance in a sample of primary care clinic patients. We evaluated comorbid medical and psychiatric disorders, functional status, and rates of health care use. METHODS A total of 400 patients were recruited from 2 family medicine clinic waiting rooms in San Antonio, Texas. Patients completed the validated Quick Environmental Exposure and Sensitivity Inventory (QEESI) to assess chemical intolerance; the Primary Care Evaluation of Mental Disorders (PRIME-MD) screen for possible psychiatric disorders; the Dartmouth-Northern New England Primary Care Cooperative Information Project (Dartmouth COOP) charts for functional status; and the Healthcare Utilization Questionnaire. RESULTS Overall, 20.3% of the sample met criteria for chemical intolerance. The chemically intolerant group reported significantly higher rates of comorbid allergies and more often met screening criteria for possible major depressive disorder, panic disorder, generalized anxiety disorder, and alcohol abuse disorder, as well as somatization disorder. The total number of possible mental disorders was correlated with chemical intolerance scores (P <.001). Controlling for demographics, patients with chemical intolerance were significantly more likely to have poorer functional status, with trends toward increased medical service use when compared with non-chemically intolerant patients. After controlling for comorbid psychiatric conditions, the groups differed significantly only regarding limitations of social activities. CONCLUSIONS Chemical intolerance occurs in 1 of 5 primary care patients yet is rarely diagnosed by busy practitioners. Psychiatric comorbidities contribute to functional limitations and increased health care use. Chemical intolerance offers an etiologic explanation. Symptoms may resolve or improve with the avoidance of salient chemical, dietary (including caffeine and alcohol), and drug triggers. Given greater medication intolerances in chemical intolerance, primary care clinicians could use the QEESI to identify patients for appropriate triage to comprehensive nonpharmacologic care.
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Affiliation(s)
- David A Katerndahl
- University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.
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Evaluation of the quick environmental exposure and sensitivity inventory in a Danish population. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2012; 2012:304314. [PMID: 22529872 PMCID: PMC3317206 DOI: 10.1155/2012/304314] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 11/18/2011] [Accepted: 12/03/2011] [Indexed: 11/17/2022]
Abstract
Objectives. To evaluate a Danish translation of the Quick Environmental Exposure and Sensitivity Inventory (QEESI). Methods. The study included two groups: one comprised a random sample of 2000 individuals drawn from the Danish Civil Registration System; the other comprised 315 patients with chemical intolerance. Results. The evaluation suggested good reliability for the four QEESI scales in terms of internal consistency and coefficients between test and retest scores. The discriminatory validity was the largest for the Chemical (inhalant) Intolerance and Life Impact Scales. Using combined cut-off scores for these two scales provided a sensitivity of 92.1 and a specificity of 91.8 and yielded a prevalence of 8.2% in the population group. Conclusions. The Danish translation of the QEESI showed overall good reliability and validity. We recommend the use of the combined Chemical (inhalant) Intolerance and Life Impact Scales in future studies.
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Factors associated with prospective development of environmental annoyance. J Psychosom Res 2010; 69:9-15. [PMID: 20630258 DOI: 10.1016/j.jpsychores.2009.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 11/24/2009] [Accepted: 12/01/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Idiopathic environmental intolerance (IEI) has in cross-sectional studies been associated with emotional problems and psychiatric disorders. However, in the absence of prospective studies it has not been possible to determine whether emotional problems precede the onset of IEI, or are a consequence of IEI. The purpose of this study was to address this issue in a prospective panel study design. METHODS The study sample (n=10 275) responded to a postal survey that included five questions regarding annoyance from environmental factors, at baseline and at follow-up five years later. Associations between a number of self-rating scales of stress, subjective health, and working conditions at baseline on one hand, and development of environmental annoyance from baseline to follow-up on the other, were examined. RESULTS Participants having developed environmental annoyance between baseline and follow-up had at baseline reported more subjective health complaints, higher levels of stress, strain, and lack of recovery, more dissatisfaction with their work situation, and lower personal social support, compared to participants not developing environmental annoyance. CONCLUSION Elevated subjective health complaints, high stress in daily life and a strained work situation, all possible signs of sustained arousal, increase the risk of developing annoyance to environmental factors. The results fit the hypothesis that reduced subjective health, over the course of time, may be attributed to environmental factors.
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Skovbjerg S, Zachariae R, Rasmussen A, Johansen JD, Elberling J. Repressive coping and alexithymia in idiopathic environmental intolerance. Environ Health Prev Med 2010; 15:299-310. [PMID: 21432559 DOI: 10.1007/s12199-010-0143-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 03/23/2010] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To examine if the non-expression of negative emotions (i.e., repressive coping) and differences in the ability to process and regulate emotions (i.e., alexithymia) is associated with idiopathic environmental intolerance (IEI). METHODS The study included participants who had previously participated in a general population-based study and reported symptoms of environmental intolerance (n = 787) and patients with IEI (n = 237). The participants completed questionnaires assessing IEI, namely, a measure of repressive coping combining scores on the Marlowe-Crowne Social Desirability Scale (MCSDS) and the Taylor Manifest Anxiety Scale (TMAS), the Toronto Alexithymia Scale (TAS-20), and a negative affectivity scale (NAS). Multiple, hierarchical linear regression analyses were conducted using IEI variables as the dependent variables. RESULTS The TMAS and MCSDS scores were independently associated with the IEI variables, but there was no evidence of a role of the repressive coping construct. While the total alexithymia score was unrelated to IEI, the TAS-20 subscale of difficulties identifying feelings (DIF) was independently associated with symptoms attributed to IEI. Negative affectivity was a strong independent predictor of the IEI variables and a mediator of the association between DIF and IEI. CONCLUSION Our results provide no evidence for a role of repressive coping in IEI, and our hypothesis of an association with alexithymia was only partly supported. In contrast, strong associations between IEI and negative emotional reactions, defensiveness and difficulties identifying feelings were found, suggesting a need for exploring the influence of these emotional reactions in IEI.
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Affiliation(s)
- Sine Skovbjerg
- The Danish Research Centre for Chemical Sensitivities, Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Ledreborg Alle 40, 2.th, 2820, Gentofte, Denmark.
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Witthöft M, Hiller W. Psychological Approaches to Origins and Treatments of Somatoform Disorders. Annu Rev Clin Psychol 2010; 6:257-83. [DOI: 10.1146/annurev.clinpsy.121208.131505] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Michael Witthöft
- Department of Clinical Psychology and Psychotherapy, Johannes Gutenberg-University, D55122 Mainz, Germany;
| | - Wolfgang Hiller
- Department of Clinical Psychology and Psychotherapy, Johannes Gutenberg-University, D55122 Mainz, Germany;
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Skovbjerg S, Zachariae R, Rasmussen A, Johansen JD, Elberling J. Attention to bodily sensations and symptom perception in individuals with idiopathic environmental intolerance. Environ Health Prev Med 2009; 15:141-50. [PMID: 19953345 DOI: 10.1007/s12199-009-0120-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 10/30/2009] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Idiopathic environmental intolerance (IEI) is characterized by non-specific symptoms attributed to exposure to environmental odours or chemicals at levels below those known to induce adverse health effects. A clarification of whether psychological processes involved in sensory perceptions are associated with IEI would add to our understanding of this complex disorder. PURPOSE To examine if measures of somato-sensory amplification, autonomic perception and absorption are associated with IEI. METHODS The study included individuals with self-reported or physician-diagnosed IEI. Participants (n = 732) completed questionnaires that included items on descriptive variables of IEI, the Somato-Sensory Amplification Scale (SSAS), the Autonomic Perception Questionnaire (APQ), the Tellegen Absorption Scale (TAS) and a Negative Affectivity Scale (NAS). RESULTS Multiple, hierarchical linear regression analyses revealed significant positive associations between SSAS, APQ, and IEI, while small and inverse associations were seen between TAS and IEI. CONCLUSIONS The association with SSAS and APQ suggests that perceptual personality characteristics are important in understanding this disorder.
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Affiliation(s)
- Sine Skovbjerg
- The Danish Research Centre for Chemical Sensitivities, Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Ledreborg Alle 40, 2.th, 2820, Gentofte, Denmark.
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Hojo S, Sakabe K, Ishikawa S, Miyata M, Kumano H. Evaluation of subjective symptoms of Japanese patients with multiple chemical sensitivity using QEESI(c). Environ Health Prev Med 2009; 14:267-75. [PMID: 19603254 PMCID: PMC2728252 DOI: 10.1007/s12199-009-0095-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 06/09/2009] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The Quick Environment Exposure Sensitivity Inventory (QEESI(c)) has been used as a questionnaire to evaluate subjective symptoms of patients with multiple chemical sensitivity (MCS), also known as idiopathic environmental intolerance, in Japan. However, no cutoff value for Japanese subjects has yet been established. We designed this study to establish a cutoff value for Japanese subjects using QEESI(c) for screening of MCS patients. METHODS A questionnaire using the QEESI(c) was administered to 103 MCS patients and 309 healthy control subjects matched for age and sex. QEESI(c) scores of the two groups were compared using logistic regression analysis, receiver operating characteristic analysis, and the Mann-Whitney test. RESULTS Cutoff values for Japanese subjects were determined for the Chemical Intolerance subscale (40), Symptom Severity subscale (20), and Life Impact subscale (10). The subjects whose scores exceeded the cutoff values in any two subscales accounted for 88.4% of the patients but only 14.5% of the controls. CONCLUSIONS Our results suggest that subjects meeting two out of three subscale criteria can be screened as "patients suffering from a low level of environmental chemicals such as MCS" in Japan.
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Affiliation(s)
- Sachiko Hojo
- Department of Environmental Science, Shokei Gakuin University, 4-10-1 Yurigaoka, Natori, Miyagi, 981-1295, Japan,
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Skovbjerg S, Brorson S, Rasmussen A, Johansen JD, Elberling J. Impact of self-reported multiple chemical sensitivity on everyday life: a qualitative study. Scand J Public Health 2009; 37:621-6. [PMID: 19411319 DOI: 10.1177/1403494809105430] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Multiple chemical sensitivity (MCS) is a descriptive term covering symptoms attributed to exposure to common airborne chemicals. There are no internationally accepted criteria, but it has been suggested that MCS is a chronic and disabling condition. However, details of the impact of MCS on everyday life are limited. OBJECTIVE To describe the impact of MCS on everyday life, strategies for managing the condition, and experiences with healthcare management. METHODS A focus group study was conducted, including two interviews with a sample of six women and six men between 27 and 78 years of age, a duration of MCS of at least 1 year, and with different occupational conditions. RESULTS MCS may severely influence different aspects of everyday life, including lifestyle, social relations, and occupational conditions. Avoiding common airborne chemicals was the most prevalent coping strategy, which implied creating a chemical-free living space and limiting social activities. Experiences with healthcare management were overall reported as negative in terms of not receiving acknowledgement of the reported symptoms. CONCLUSIONS MCS may have serious implications for daily functioning. Further research on individual consequences and the social and psychological factors that may be associated with MCS is needed in order to add to our understanding of this condition and to the provision of more satisfactory healthcare.
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Affiliation(s)
- Sine Skovbjerg
- Danish Research Centre for Chemical Sensitivities, Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
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Skovbjerg S, Johansen JD, Rasmussen A, Thorsen H, Elberling J. General practitioners' experiences with provision of healthcare to patients with self-reported multiple chemical sensitivity. Scand J Prim Health Care 2009; 27:148-52. [PMID: 19452353 PMCID: PMC3413186 DOI: 10.1080/02813430902888355] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To describe general practitioners' (GPs') evaluation of and management strategies in relation to patients who seek medical advice because of multiple chemical sensitivity (MCS). DESIGN A nationwide cross-sectional postal questionnaire survey. The survey included a sample of 1000 Danish GPs randomly drawn from the membership list of GPs in the Danish Medical Association. SETTING Denmark. RESULTS Completed questionnaires were obtained from 691 GPs (69%). Within the last 12 months 62.4% (n = 431) of the GPs had been consulted by at least one patient with MCS. Of these, 55.2% of the GPs evaluated the patients' complaints as chronic and 46.2% stated that they were rarely able to meet the patients' expectations for healthcare. The majority, 73.5%, had referred patients to other medical specialties. The cause of MCS was perceived as multi-factorial by 64.3% of the GPs, as somatic/biologic by 27.6%, and as psychological by 7.2%. Partial or complete avoidance of chemical exposures was recommended by 86.3%. Clinical guidelines, diagnostic tools, or more insight in the pathophysiology were requested by 84.5% of the GPs. CONCLUSION Despite the lack of formal diagnostic labelling the patient with MCS is well known by GPs. The majority of the GPs believed that MCS primarily has a multi-factorial explanation. However, perceptions of the course of the condition and management strategies differed, and many GPs found it difficult to meet the patients' expectations for healthcare. The majority of the GPs requested more knowledge and clinical guidelines for the management of this group of patients.
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Affiliation(s)
- Sine Skovbjerg
- Department of Dermatology, the Danish Research Centre for Chemical Sensitivities, Gentofte Hospital, University of Copenhagen, Denmark.
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Bailer J, Witthöft M, Rist F. Modern health worries and idiopathic environmental intolerance. J Psychosom Res 2008; 65:425-33. [PMID: 18940372 DOI: 10.1016/j.jpsychores.2008.05.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 04/10/2008] [Accepted: 05/06/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We conducted two studies to test whether modern health worries (MHWs) were associated with central features of a condition called idiopathic environmental intolerance (IEI) and medical care utilization. METHODS In Study 1, 474 Internet users completed an Internet-based questionnaire that assessed MHWs, IEI features, and medical care utilization. In Study 2, the diagnostic specificity of MHWs was investigated by comparing the level of MHWs of three diagnostic groups: 46 people with IEI, 38 people with somatoform disorder but without IEI, and 46 people with neither IEI nor somatoform disorder. RESULTS The good psychometric properties of the MHW scale were confirmed. MHWs were related to various features of IEI, and people who met IEI case criteria showed consistently higher levels of MHWs compared with people without IEI. The link between MHWs and number of doctor visits was mediated by perceived IEI complaints. In Study 2, the MHW scale effectively discriminated the IEI group from the non-IEI groups. CONCLUSIONS These results suggest that MHWs may contribute to the development of IEI. However, only prospective longitudinal studies will enable us to determine the predictive importance of MHWs for later development of IEI.
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Affiliation(s)
- Josef Bailer
- Department of Clinical Psychology, Central Institute of Mental Health, Mannheim, Germany.
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