Multiple Chemical Sensitivity (MCS) / Idiopathic Environmental Intolerances (IEI)

Hausteiner-Wiehle C, Wiesmüller GA, Bornschein S, Hornberg C. Multiple Chemical Sensitivity (MCS) / Idiopathic Environmental Intolerances (IEI). In: Letzel S, Nowak D, eds. Handbuch der Arbeitsmedizin. Landsberg: ecomed Medizin; 2012: 1-52

Author Correction: Gender specific somatic symptom burden and mortality risk in the general population.

The original version of this Article contained an error in the spelling of the author Hamimatunnisa Johar, which was incorrectly given as Hamimatunissa Johar. The original Article has been corrected

Stability and predictors of somatic symptoms in men and women over 10 years: A real-world perspective from the prospective MONICA/KORA study.

OBJECTIVE: To assess the stability of somatic symptoms in community-dwelling participants. METHODS: The study included 2472 participants (1190 men, 1282 women; mean age 44.3 ± 10.9) from the prospective population-based MONICA-S3 cohort (1994/95) and the 10-year follow-up KORA-F3 cohort. Somatic symptoms were assessed by an adapted version of the Somatic Symptom Scale-8 (SSS-8a) with scores ranging from 0 to 24. Somatic symptom stability was assessed by weighted kappa values (κ). Generalized Estimating Equation models assessing symptom stability were adjusted for sociodemographic, lifestyle, clinical and psychosocial risk factors, as well as pre-existing medical conditions. RESULTS: The mean (±SD) SSS-8a was lower in men (S3: 6.88 ± 3.87, F3: 6.60 ± 3.86) than women (S3: 8.43 ± 4.0, F3: 8.31 ± 4.2) at both time points. However, somatic symptoms remained moderately stable in both genders over 10 years (κ =0.42 in men and κ = 0.48 in women), with the largest stability observed in trouble sleeping for men (κ =0.41) and pain in the joints for women (κ =0.41). Pre-existing somatic symptoms were significantly associated with increasing symptoms at follow-up [men: β = 0.82 (SE 0.12), women: β = 0.85 (SE 0.12)], followed by age and psychosocial factors, whereas higher education and recent health care utilization were inversely associated with increasing symptoms. Although hypertension and obesity were associated with increasing somatic symptoms in men, pre-existing medical conditions were not associated with increasing somatic symptoms in men nor women. CONCLUSIONS: The current findings indicate that somatic symptoms remain moderately stable in the general population during 10 years of follow-up, mainly driven by sociodemographic and psychosocial factors

Patient-doctor interaction, psychobehavioural characteristics and mental disorders in patients with suspected allergies: Do they predict 'medically unexplained symptoms'?

In approximately 20% of patients with suspected allergies, no organic symptom explanation can be found. Limited knowledge about patients with "medically unexplained symptoms (MUS)" contributes to them being perceived as "difficult" and being treated inadequately. This study examined the psychobehavioural characteristics of patients presenting for a diagnostic allergy work-up. Patients were interviewed and completed various self-rating questionnaires. Patient-Doctor interaction was evaluated, and the organic explicability of the patients' symptoms was rated by allergists. Patients with vs. those without MUS differed in several respects. Mental comorbidity, female sex, dissatisfaction with care, and a problematic countertransference (the interviewer's feelings towards the patient) independently predicted MUS. Patients whose symptoms could be explained organically reported more psychobeha-vioural problems than a control group of immuno-therapy patients. There were no differences in patient-doctor interaction. In patients with suspected allergies, recognition of psychological burden and concurrent mental disorders is important. Mental comorbidity and a difficult patient-doctor interaction may predict MUS

„Medically Unexplained Symptoms“ bei Patienten mit Verdacht auf Allergien: Die Rolle der psychiatrischen Komorbidität und der Arzt-Patienten-Interaktion.

"Medically unexplained symptoms" in patients with suspected allergies: The role of psychiatric comorbidity and patient-doctor-interaction Background: We aimed to describe characteristics of the patient-doctor-interaction in patients with "medically unexplained symptoms (MUS)" attributed to allergies. Methods: 204 patients hospitalized for an allergy work-up were interviewed and completed a set of self-rating questionnaires covering various aspects of illness perception, as well as screening questionnaires for the detection of mental disorders. After the interview, the patient-doctor-interaction was evaluated by the interviewing psychiatrist. Finally, allergists independently reviewed the results of all diagnostic tests and rated organic symptom explicability, and patients with MUS were compared to patients with medically explained symptoms. Results: The presenting symptoms of 148 patients were rated as medically explained and of 56 patients as medically unexplained. In logistic regression analysis, psychiatric comorbidity (OR 3.72; CI 1.77 - 7.79; p = 0.001), female sex (OR 3.02; Cl 1.26 - 7.24; p = 0.01) and dissatisfaction with care (OR 1.08 for each 1-point-increase on the test scale; CI 1.01 - 1.14; p = 0.02) independently predicted MUS. When the psychiatrist's perspective was added to the model, a problematic countertransference independently predicted MUS (OR 1.50 for every 1-point-increase; CI 1.22 - 1.84; p < 0.001). Conclusions: Short screening for mental disorders that tend to present with physical symptoms should become a part of allergy work-ups. A difficult patient-doctor-interaction may predict medically unexplained symptoms. Thus, it should receive more clinical and scientific attention

Initial Responses of Different Health Care Professionals to Various Patients with Headache:Which are Perceived as Difficult?

<p>Background Somatizing patients are considered a challenge to health care professionals.</p><p>Purpose The purpose of this study was to investigate the responses of different health care professionals' to patients with headache with different presentations.</p><p>Method Medical professionals (n=77), clinical psychologists (n=40), and psychology students (n=115) were shown with four different manifestations of headache (neutral, somatic trauma, anxious-depressed, and severe somatizing). Health professionals rated their initial cognitive and emotional responses using a standardized questionnaire.</p><p>Results The severe somatizing and anxious-depressed patients with headache evoked significantly more negative cognitive and emotional responses in all three samples. Even brief exposure to a patient's story yields specific initial responses from various health care professionals irrespective of their disciplines.</p><p>Conclusion Patients with headache and with a distressed presentation evoke significantly more negative cognitive and emotional responses in different health care professionals. Health care professionals should be more aware of their own response to difficult patients; in this way they will be more capable of managing this patient group.</p>