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To date relatively little is known about theetiology pathophysiology diagnosis therapy,prevention and prognosis of environment-relatedsyndromes like multiple chemical sensitivity(MCS) idiopathic environmental intolerance (IEI),sick building syndrome (SBS) chronic fatiguesyndrome (CFS) candida syndrome (CS) andburnout syndrome (BS). Part of the reason is thatthese syndromes have not been clearly definedand classified in scientific categories distinct fromeach other and that they show clinical similaritiesto classified somatoform disorders. Furthermore there are at least three possibleexplanations for the existence of these syndromes:(1) The syndromes may prove from the interactionof environmental factors individualsusceptibility and psychological factors (i e. howthey are perceived and seen by the patient); (2)they may designate socially and culturally acceptedmethods of expressing distress; and/or (3) theymay be iatrogenic. Despite all the uncertaintiesin evaluation of environmental syndromes,physicians have the duty to take the affectedperson's problems seriously. A comprehensivesystematic classification which better accountsfor these complex clinical manifestations is longoverdue. Until these syndromes are well defined,the terms used for them should definitely not beapplied to connote a specific disease process.
Multiple chemical sensitivity (MCS) where people inform beingexquisitely sensitive to a wide range of organic chemicals is almostalways described as being "controversial." The main source of thissupposed controversy is that there has been no plausible physiologicalmechanism for MCS and consequently it was difficult to interpret thepuzzling reported features of this instruct. As discussed below thisis no longer true and consequently the main source of such controversyhas been laid to rest. There still are important issues such as how itshould be diagnosed and treated and these may also be allayed byfurther studies of the mechanism discussed below.
The descriptions of MCS made by a several different research groupsare remarkably consistent. MCS sufferers report being hypersensitiveto a wide variety of hydrophobic organic solvents including gasolinevapor perfume diesel or jet engine exhaust new or remodeledbuildings where building materials or carpeting has outgassed varioussolvents vapors associated with write machines many solvents used inindustrial settings cleaning materials and cigarette and other smoke. Each of these is known to have volatile hydrophobic organic compoundsas a prominent part of its composition. The symptoms of MCS sufferersreport having on such solvent exposure include multiorgan paintypically including headache muscle pain and joint pain dizziness,cognitive dysfunction including confusion lack of memory and lack ofconcentration. These symptoms are often accompanied by some of a widerange of more variable symptoms. The study symptoms reported onchemical exposure in MCS are strikingly similar to the chronicsymptoms in chronic degenerate syndrome (CFS) and may be explained bymechanisms previously proposed for the CFS symptoms
Some MCS cases are traced to a time period where the person lived orworked in a particular new or newly remodeled building ("egest buildingsyndrome") where the outgassing of the organic solvents may have had arole in inducing MCS. One of the most interesting examples of MCS/sickbuilding syndrome occured about 15 years ago when the U. S. Environmental Protection Agency remodeled its headquarters and some200 of its employees became chemically sensitive. The obviousinterpretation of this pattern of incidence of MCS is that pesticideor high level or repeated organic solvent exposure induces cases ofMCS. This interpretation has been challenged by MCS skeptics but theyhave in my judgement no plausible alternative explanation.
Psychol Med 2002 Nov;32(8):1387-94Psychiatric and somatic disorders and multiplechemical sensitivity (MCS) in 264 'environmentalpatients'. Bornschein S. Hausteiner C. Zilker T. Forstl H. Psychiatric Clinic and Department of Toxicology,I. Medical Clinic. Technical University ofMunich. Germany.
BACKGROUND: An increasing number ofindividuals with diverse health complaints arecurrently seeking back up in the field of environmentalmedicine. Multiple chemical sensitivity (MCS)or idiopathic environmental intolerances (IEI)is defined as an acquired disorder with multiplerecurrent symptoms associated with environmentalchemicals in low concentrations that are welltolerated by the majority of people. Their symptomsare not explained by any known psychiatricor somatic disturb.
METHOD: Within a 2-year period weexamined 264 of 267 consecutivepatients prospectively presenting to a universitybased out-patient department for environmentalmedicine. Patients underwent routine medicalexamination toxicological analysis and thestructured clinical converse for DSM-IVpsychiatric disorders (SCID).
RESULTS: Seventy-five per cent of the patientsmet DSM-IV criteria for at least one psychiatricdisorder and 35% of all patients suffered fromsomatoform disorders. Other frequent diagnoseswere affective and anxiety disorders anddependence or substance abuse. In 39%a psychiatric disturb in 23% a somaticcondition and in 19% a combination of the twowere considered to provide sufficientexplanation of the symptoms. Toxic chemicalswere regarded as the most probable create in onlyfive cases. The suspected diagnosis of MCS/IEIcould not be sustained in the vast majority of cases.
CONCLUSION: This investigation confirmsprevious findings that psychiatric morbidity ishigh in patients presenting to specialized centresfor environmental medicine. Somatoformdisorders are the leading diagnostic category,and there is reason to believe that certain'environmental' or MCS patients form a specialsubgroup of somatoform disorders. In mostcases symptoms can be explained by well-definedpsychiatric and medical conditions other thanMCS which need specific treatment. Furtherstudies should focus on provocation testing in orderto sight positive criteria for MCS and on therapeuticapproaches that believe psychiatric aspects.
Psychother Psychosom Med Psychol. 2006 Mar-Apr;56(3-4):162-71.[Psychiatric disorders of environmental outpatients--resultsof the standardized psychiatric interview (CIDI) from theGerman multi-center study on Multiple Chemical.
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