Frequency and Predictors of Mass Psychogenic Illness

Morgellons Disease: The Spread of a Mass Psychogenic Illness via the Internet and Its Implications in Hand Surgery

Somatic manifestations of mental illness sometimes occur in patients presenting to hand specialists. These conversion disorders can also occur in groups, a phenomenon known as "mass psychogenic illness." The increasing penetrance of the Internet and social media in modern society has greatly facilitated the interaction of patients with others with similar disorders. One example relevant to hand surgery is "Morgellons disease," a disorder popularized in 2002 and characterized by a firm belief in foreign material extruding from the skin, leading to nonhealing, self-inflicted ulcerations and excoriations. A series of 4 patients collected through an informal survey of hand surgeons regarding experience with Morgellons disease is reviewed and discussed. All patients in the series presented with a chief complaint of foreign material extruding from the hand. In 1 case, the complaint was made by a young patient's mother. In none of the patients were foreign bodies identified, although 2 patients demonstrated significant ulcerations and scars from self-excoriation. Three patients had a somatic condition affecting the hand or upper extremity, 1 directly related to self-excoriation and 2 unrelated. Treatments, workups, and ultimate outcomes varied among patients. Patients presenting with Morgellons disease often undergo multiple unnecessary tests and are at risk of inappropriate procedures. It is therefore important that providers have a compassionate understanding of the involved psychology. Herein, we offer an approach to the recognition of and treatment strategies for these patients.

Stop that! It's not Tourette's but a new type of mass sociogenic illness

We report the first outbreak of a new type of mass sociogenic illness that in contrast to all previously reported episodes is spread solely via social media. Accordingly, we suggest the more specific term ‘mass social media-induced illness’.

In Germany, the current outbreak of mass social media-induced illness is initiated by a ‘virtual’ index case, who is the second most successful YouTube creator in Germany and enjoys enormous popularity among young people. Affected teenagers present with similar or identical functional ‘Tourette-like’ behaviours, which can be clearly differentiated from tics in Tourette syndrome.

Functional ‘Tourette-like’ symptoms can be regarded as the ‘modern’ form of the well-known motor variant of mass sociogenic illness. Moreover, they can be viewed as the 21st century expression of a culture-bound stress reaction of our post-modern society emphasizing the uniqueness of individuals and valuing their alleged exceptionality, thus promoting attention-seeking behaviours and aggravating the permanent identity crisis of modern man. We wish to raise awareness of the current global Tourette-like mass social media-induced illness outbreak. A large number of young people across different countries are affected, with considerable impact on health care systems and society as a whole, since spread via social media is no longer restricted to specific locations such as local communities or school environments spread via social media is no longer restricted to specific locations such as schools or towns.

The transmission of SARS-CoV-2 is likely comodulated by temperature and by relative humidity

Inferring the impact of climate upon the transmission of SARS-CoV-2 has been confounded by variability in testing, unknown disease introduction rates, and changing weather. Here we present a data model that accounts for dynamic testing rates and variations in disease introduction rates. We apply this model to data from Colombia, whose varied and seasonless climate, central port of entry, and swift, centralized response to the COVID-19 pandemic present an opportune environment for assessing the impact of climate factors on the spread of COVID-19. We observe strong attenuation of transmission in climates with sustained daily temperatures above 30 degrees Celsius and simultaneous mean relative humidity below 78%, with outbreaks occurring at high humidity even where the temperature is high. We hypothesize that temperature and relative humidity comodulate the infectivity of SARS-CoV-2 within respiratory droplets.

Mass Psychogenic Illness in Haraza Elementary School, Erop District, Tigray, Northern Ethiopia: Investigation to the Nature of an Episode

Background

Mass psychogenic illness has been documented for more than 600 years in a variety of cultural, ethnic, and religious settings. We aimed to assess the nature and characteristics of mass psychogenic illness and to evaluate community awareness and perception about the treatment they practiced in Haraza Elementary School, Erop district, Tigray, Northern Ethiopia.

Methods

A school-based cross-sectional study was conducted in Haraza Elementary School from January to February, 2020. Students who were victims of an episode were subjects of the study. A total of twelve students were investigated using a semistructured questionnaire for a quantitative study. Seven key informant interviews were conducted using a guiding questionnaire. Quantitative data was analyzed using XL sheet while qualitative data were analyzed manually.

Results

The mean age of study participants was 14 years (SD ± 1.3). The majority (87%) were teenage female students. The incident was an unspecified disease with psychiatric disorder, migraine, and syncope with no plausible organic causes. An important feature of migraine and syncope was their comorbidity with mass psychogenic illness. The community perceived that evil devil force and blaming the being as an evil eye were common causes of the occurrence of an episode.

Conclusion

Lack of empirical knowledge and awareness about its management and prevention among community members and health professionals resulted exaggerated rumor that would perceive as newly emerging disease that affected school activities. Integrating MPI in PHEM package at health facility level, advocacy workshops for media, and other relevant stakeholders will minimize its impact for the future.

Work-environmental determinants of mass fainting illness among textile factory workers

Purpose

The purpose of this paper is to develop a brief screening instrument to identify risk factors of factory workers experiencing mass fainting illness (MFI) due to work-environmental determinants.

Design/methodology/approach

A factory-based cross-sectional study was conducted among 740 workers in October 2017 and was completed with face-to-face interviews. Data analyses included univariate logistic regression, backward stepwise linear regression and multiple logistic regression. Sum scores on significant items and receiver operator characteristic curves were used to compute potential cut-off points and the sensitivity and specificity rates.

Findings

Significant work-environmental factors were identified as working at very high speeds, having less influence on the choice of working partners, perceived high temperature at work, having less opportunity to do their best at work, and concern about losing a job in the next six months. In developing a screening instrument, a 6.5 cut-off point that corresponded to 99.6 percent sensitivity and 92.2 percent specificity was identified.

Originality/value

The study concludes that this MFI-instrument could potentially be used to prevent MFI. By understanding the policy implications, the government body, employers, workers, development partners and stakeholders should work toward preventing MFI. Implementing a preventive measure is therefore warranted due to the health education impact.

A "fitness" Theme May Mitigate Regional Prevalence of Overweight and Obesity: Evidence from Google Search and Tweets

Taking ecological perspectives to overweight and obesity, the current study applies data mining approach to examine the association between information and social environments and regional prevalence of overweight and obesity. In particular, we focus on online search and social media data since the increasing popularity of location-based geo-targeting could be an influential source of regional differences in health information and social environment. In Study 1, we calculated the correlation between regional overweight and obesity rates with regional Google searches for a time period of 12 years (2004 to 2016). The findings showed that in regions with high overweight and obesity rates, people were looking for and obtaining information on weight-loss and diet;, but in regions with low overweight and obesity rates, people were looking for and obtaining information on fitness services and facilities. In Study 2, we analyzed and compared 4010 tweets from Houston, a city with a high overweight and obesity rate, and 3281 tweets from San Diego, a city with a low overweight and obesity rate. The tweets were collected from August 2015 to August of 2016. We analyzed the textual content of tweets by word frequency analysis and topic modeling. The findings suggest that San Diego has a social environment that focuses on fitness and combining exercising with dieting. In contrast, Houston's social environment emphasizes dieting. The implication of these findings is that health practitioners should push a paradigm shift to a stronger focus on "healthy life" (combining exercising and dieting) in regions with high overweight and obesity rates.

Spatial differences in ambient coarse and fine particles in the Monterrey metropolitan area, Mexico: Implications for source contribution

The ambient air of the Monterrey Metropolitan Area (MMA) in Mexico frequently exhibits high levels of PM₁₀ and PM_2.5. However, no information exists on the chemical composition of coarse particles (PM_c = PM₁₀ - PM_2.5). A monitoring campaign was conducted during the summer of 2015, during which 24-hr average PM₁₀ and PM_2.5 samples were collected using high-volume filter-based instruments to chemically characterize the fine and coarse fractions of the PM. The collected samples were analyzed for anions (Cl^-, NO₃^-, SO₄^2-), cations (Na⁺, NH₄⁺, K⁺), organic carbon (OC), elemental carbon (EC), and 35 trace elements (Al to Pb). During the campaign, the average PM_2.5 concentrations did not showed significance differences among sampling sites, whereas the average PM_c concentrations did. In addition, the PM_c accounted for 75% to 90% of the PM₁₀ across the MMA. The average contribution of the main chemical species to the total mass indicated that geological material including Ca, Fe, Si, and Al (45%) and sulfates (11%) were the principal components of PM_c, whereas sulfates (54%) and organic matter (30%) were the principal components of PM_2.5. The OC-to-EC ratio for PM_c ranged from 4.4 to 13, whereas that for PM_2.5 ranged from 3.97 to 6.08. The estimated contribution of Secondary Organic Aerosol (SOA) to the total mass of organic aerosol in PM_2.5 was estimated to be around 70-80%; for PM_c, the contribution was lower (20-50%). The enrichment factors (EF) for most of the trace elements exhibited high values for PM_2.5 (EF: 10-1000) and low values for PM_c (EF: 1-10). Given the high contribution of crustal elements and the high values of EFs, PM_c is heavily influenced by soil resuspension and PM_2.5 by anthropogenic sources. Finally, the airborne particles found in the eastern region of the MMA were chemically distinguishable from those in its western region. Implications: Concentration and chemical composition patterns of fine and coarse particles can vary significantly across the MMA. Public policy solutions have to be built based on these observations. There is clear evidence that the spatial variations in the MMA's coarse fractions are influenced by clearly recognizable primary emission sources, while fine particles exhibit a homogeneous concentration field and a clear spatial pattern of increasing secondary contributions. Important reductions in the coarse fraction can come from primary particles' emission controls; for fine particles, control of gaseous precursors-particularly sulfur-containing species and organic compounds-should be considered.

Implementing Fall Prevention Guidelines with Vulnerable Older Adults: The Social Work Role

Falls are the leading cause of injury among the older adult population, resulting in costly and devastating aftermaths. National fall prevention guidelines (FPGs) have been established to assist healthcare professionals with addressing fall risk, but little is understood about the extent to which FPGs have been implemented by social workers. Social workers, however, may beuniquely positioned to implement FPGs with older adults due to their expertise in care coordination and home- and community-based service settings. This conceptual paper addresses the timely issue of fall prevention and social workers' potential role in implementing FPGs to address fall risk.

Does influenza vaccination status change physician ordering patterns for respiratory viral panels? Inspection for selection bias

Purpose: Hospitalized patients with an acute respiratory illness (ARI) were compared to determine if demographic characteristics, timing or influenza vaccination biased who received clinical respiratory viral panel (RVP) testing.

Methods: 171 enrollees in an influenza vaccine effectiveness study and a sample of non-enrollees (N = 1029) admitted to a community hospital with ARI during December 2015 through April 2016 comprised the study sample. Those who received clinical RVP testing (n = 292) were compared to those who did not by age, sex, influenza vaccination status, and period (pre-peak influenza season vs. peak/post peak influenza season), using Chi square- and t-tests, and logistic regression.

Results: Mean age of participants was 70 years, 58% was female and 45% had been vaccinated against influenza in the 2015–2016 season. Those with clinical RVP testing were significantly younger (67 years) than those without RVP (71 years; P < 0.001), but did not differ with respect to sex or vaccination status. The odds of clinical RVP testing were significantly (P = 0.004) related to younger age (< 65 years) (Odds ratio (OR) = 1.51; 95% CI = 1.14–2.00) and to later period (peak/post peak influenza season; OR = 2.64; 95% CI = 1.84–3.79) but were unrelated to influenza vaccination status or the interaction of time and vaccination status.

Conclusion: RVP testing was significantly higher among younger hospitalized patients with an ARI and during the peak and post peak influenza periods than earlier in the season, but influenza vaccination status was not a significant factor. Studies that enroll based on clinical RVP testing should account for potential differences by age.

HPV vaccine confidence and cases of mass psychogenic illness following immunization in Carmen de Bolivar, Colombia

We report the case of multiple adverse reactions following HPV vaccination in Colombian adolescents in Carmen de Bolivar. In August 2012, the country introduced a school-based HPV immunization programme which successfully reached over 90% of the target population in the first year. In 2014, between May 29th and June 2nd,15 adolescent girls in one school presented adverse reactions after vaccination and were admitted to the local hospital. Soon, videos of girls fainting, twitching, and arriving unconscious at emergency rooms started to appear in national news media as well as on social media platforms such as YouTube. The viral spread of these videos and disturbing images were followed by the viral spread of symptoms, with over 600 cases reported across Colombia. Thorough epidemiological investigation by Colombian health authorities found no organic association between the teenagers' symptoms and the HPV vaccine, concluding this was a case of mass psychogenic reaction to vaccination. Scientific evidence did not appease the anxious public whose confidence in HPV immunization dropped dramatically. By 2016, HPV vaccine uptake among eligible girls declined to 14% for the first dose and 5% for the complete course, down from 98% and 88%, respectively, in 2012. We document this case and discuss the role of news and social media, particularly YouTube, as a driver of contagious psychogenic reactions. We also discuss the role of health authorities and government, and the importance of acting rapidly and appropriately to contain the spread of such symptoms and maintain public confidence in vaccines.

Anxiety-related adverse events following immunization (AEFI): A systematic review of published clusters of illness

BACKGROUND

Clusters of anxiety-related adverse events following immunization (AEFI) have been observed in several countries and have disrupted country immunization programs. We conducted a systematic literature review to characterize these clusters, to generate prevention and management guidance for countries.

METHODS

We searched seven peer-reviewed databases for English language reports of anxiety-related AEFI clusters (≥2 persons) with pre-specified keywords across 4 categories: symptom term, cluster term, vaccine term, and cluster AEFI phenomenon term/phrase. All relevant reports were included regardless of publication date, case-patient age, or vaccine. Two investigators independently reviewed abstracts and identified articles for full review. Data on epidemiologic/clinical information were extracted from full text review including setting, vaccine implicated, predominant case-patient symptoms, clinical management, community and media response, and outcome/impact on the vaccination program.

RESULTS

Of 1472 abstracts reviewed, we identified eight published clusters, from all six World Health Organization (WHO) regions except the African Region. Seven clusters occurred among children in school settings, and one was among adult military reservists. The size and nature of these clusters ranged from 7 patients in one school to 806 patients in multiple schools. Patients' symptoms included dizziness, headache, and fainting with rapid onset after vaccination. Implicated vaccines included tetanus (2), tetanus-diphtheria (1), hepatitis B (1), oral cholera (1), human papillomavirus (1), and influenza A (H1N1)pdm09 (2). In each report, all affected individuals recovered rapidly; however, vaccination program disruption was noted in some instances, sometimes for up to one year.

CONCLUSIONS

Anxiety-related AEFI clusters can be disruptive to vaccination programs, reducing public trust in immunizations and impacting vaccination coverage; response efforts to restore public confidence can be resource intensive. Health care providers should have training on recognition and clinical management of anxiety-related AEFI; public health authorities should have plans to prevent and effectively manage anxiety-related AEFI clusters. Prompt management of these occurrences can be even more important in an era of social media, in which information is rapidly spread.

Acute Health Effects After the Elk River Chemical Spill, West Virginia, January 2014

OBJECTIVES

On January 9, 2014, approximately 10 000 gallons of a mixture of 4-methylcyclohexanemethanol and propylene glycol phenyl ether spilled into West Virginia's Elk River, contaminating the potable water supply of about 300 000 West Virginia residents. This study sought to describe acute health effects after the chemical spill.

METHODS

We conducted a descriptive analysis using 3 complementary data sources: (1) medical records of patients who visited an emergency department during January 9-23, 2014, with illness potentially related to the spill; (2) West Virginia Poison Center caller records coded as "contaminated water" during January 9-23, 2014; and (3) answers to household surveys about health effects from a Community Assessment for Public Health Emergency Response (CASPER) questionnaire administered 3 months after the spill.

RESULTS

In the 2 weeks after the spill, 2000 people called the poison center reporting exposure to contaminated water, and 369 people visited emergency departments in the affected area with reports of exposure and symptoms potentially related to the spill. According to CASPER weighted cluster analyses, an estimated 25 623 households (21.7%; 95% confidence interval [CI], 14.4%-28.9%) had ≥1 person with symptoms who felt that they were related to the spill in the 3 months after it. Reported health effects across all 3 data sources included mild skin, respiratory, and gastrointestinal symptoms that resolved with no or minimal treatment.

CONCLUSIONS

Medical records, poison center data, and CASPER household surveys were inexact but useful data sources to describe overall community health effects after a large-scale chemical spill. Analyzing multiple data sources could inform epidemiologic investigations of similar events.

From Me to You

The social context in which people take medicines can strongly influence the drug response in both positive and negative ways. We first examine the role of social modeling in influencing treatment outcomes through modifying placebo and nocebo responses, and then explore possible mechanisms for these effects. Viewing another person show improvement after taking a drug can increase the placebo component of the medicine and thus the overall potency of the treatment. Likewise, seeing another person who has taken the same medicine report side effects can substantially increase adverse effects. Such effects can also occur on a wider scale following changes in medicine formulations or from vaccinations programs, when the media transmit adverse effects from these treatments to a wider audience. Females seem to be more susceptible than males to the social modeling of adverse effects of treatments. A greater awareness of the effects of social modeling has potential to improve the effectiveness of medical treatments, minimize side-effect burden, and also lead to more effective management of health scares.

Outbreak of Mysterious Illness Among Hospital Staff: Poisoning or Iatrogenic Reinforced Mass Psychogenic Illness?

BACKGROUND

Hospitals are rarely reported as settings for mass psychogenic illness (MPI). The present report scrutinizes an outbreak of probable MPI among hospital staff, with medical intervention reinforcing the course of the illness.

CASE REPORT

Four of seven staff members in an emergency department became acutely ill with nonspecific symptoms. After uneventful observation they were discharged, but symptoms worsened at reassembly for debriefing. Poisoning with hydrogen sulfide was suspected, and the victims were transferred by helicopter for hyperbaric oxygen (HBO) treatment. During the following 9 days, 14 possible poisoning victims were identified, 6 of whom were transferred for HBO. After hospital stays with repeated HBO treatment and examinations without identification of significant physical disease, the majority of the 10 HBO-treated victims remained symptomatic, some on prolonged sick leave. The ward was closed for several weeks during comprehensive but negative investigations for toxic chemicals. Clinical data and lack of indication of chemical exposure, together with an attack pattern with only some individuals becoming ill in a shared environment, suggest MPI. Iatrogenic influence from dramatic intervention was probably a strong driving force in the outbreak. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Awareness of MPI may prevent unnecessary and potentially harmful treatment as well as improve health care resilience, particularly with respect to preparedness. Outbreaks of illness in a group of symptomatic victims without indication of significant physical disease should be managed by observation and limited intervention.

Mental health consequences of chemical and radiologic emergencies: a systematic review

This article reviews the literature pertaining to psychological impacts in the aftermath of technological disasters, focusing on the immediate psychological and mental health consequences emergency department physicians and first responders may encounter in the aftermath of such disasters. First receivers see a wide spectrum of psychological distress, including acute onset of psychiatric disorders, the exacerbation of existing psychological and psychiatric conditions, and widespread symptomatology even in the absence of a diagnosable disorder. The informal community support systems that exist after a natural disaster may not be available to communities affected by a technological disaster leading to a need for more formal mental health supportive services.

Preparedness for a major incident: creation of an epidemiology protocol for a health protection register in England

Large incidents and natural disasters are on the increase globally. They can have a major impact lasting many years or decades; and can affect large groups of people including those that are more susceptible to adverse consequences. Following a major incident, it may be considered necessary to establish a register of those people affected by the incident to provide appropriate advice on relevant immediate and longer-term public health interventions that may be required, provide reassurance to the public that their care is paramount, to reassure the worried well to avoid them inappropriately overwhelming local services, and to facilitate epidemiological investigations. Arrangements for the prompt follow-up of populations after large incidents or disasters have been agreed in England and a protocol for establishing a register of individuals potentially affected by a large incident has been developed. It is important for countries to have a protocol for implementing a health register if the circumstances require one to be in place, and are supported by Public Health Authorities. Health registers facilitate the initial descriptive epidemiology of exposure and provide the opportunity of carrying out long term analytical studies on the affected population. Such epidemiological studies provide a greater understanding of the impact that a large incident can have on health, which in turn helps in the planning of health care provision. Registers can also assist more directly in providing access to individuals in need of physical and mental health interventions. The challenge that still remains is to formally pilot the register in the field and refine it based on that experience.

George A, Waller K, Cakic V. The pattern of complaints about Australian wind farms does not match the establishment and distribution of turbines: support for the psychogenic, 'communicated disease' hypothesis

BACKGROUND AND OBJECTIVES

With often florid allegations about health problems arising from wind turbine exposure now widespread, nocebo effects potentially confound any future investigation of turbine health impact. Historical audits of health complaints are therefore important. We test 4 hypotheses relevant to psychogenic explanations of the variable timing and distribution of health and noise complaints about wind farms in Australia.

SETTING

All Australian wind farms (51 with 1634 turbines) operating 1993-2012.

METHODS

Records of complaints about noise or health from residents living near 51 Australian wind farms were obtained from all wind farm companies, and corroborated with complaints in submissions to 3 government public enquiries and news media records and court affidavits. These are expressed as proportions of estimated populations residing within 5 km of wind farms.

RESULTS

There are large historical and geographical variations in wind farm complaints. 33/51 (64.7%) of Australian wind farms including 18/34 (52.9%) with turbine size >1 MW have never been subject to noise or health complaints. These 33 farms have an estimated 21,633 residents within 5 km and have operated complaint-free for a cumulative 267 years. Western Australia and Tasmania have seen no complaints. 129 individuals across Australia (1 in 254 residents) appear to have ever complained, with 94 (73%) being residents near 6 wind farms targeted by anti wind farm groups. The large majority 116/129(90%) of complainants made their first complaint after 2009 when anti wind farm groups began to add health concerns to their wider opposition. In the preceding years, health or noise complaints were rare despite large and small-turbine wind farms having operated for many years.

CONCLUSIONS

The reported historical and geographical variations in complaints are consistent with psychogenic hypotheses that expressed health problems are "communicated diseases" with nocebo effects likely to play an important role in the aetiology of complaints.

The nocebo effect: patient expectations and medication side effects

Expectation of treatment side effects is consistently linked with those symptoms being realised. Patient expectations, including those generated by the informed consent process, can have a large influence on the side effects that patients feel after starting a new medical treatment. Such symptoms may be the result of the nocebo effect, whereby the expectation of side effects leads to them being experienced. Side effects may also be due to the misattribution of pre-existing or unrelated symptoms to the new medication. Medical professionals' own negative beliefs about a treatment, especially generic drugs, may further enhance patients' expectations of adverse effects. The news media may also influence expectations, particularly when media attention is directed towards a health or medication scare. This field of research has ethical and clinical implications for both medical professionals and the news media with respect to the level and type of information about treatment side effects that is provided to patients or members of the public.