A multidisciplinary clinical study of patients suffering from illness associated with release of mercury from dental restorations. Medical and odontological aspects.

OBJECTIVE: To describe medical and odontological aspects of patients who believed their illness was caused by mercury in dental fillings. DESIGN: Comparison of self-reported and assessed medical and odontological variables. SETTING: The School of Dentistry, Karolinska Institute. SUBJECTS: Sixty-seven patients, referred for suspected side-effects of mercury in dental fillings, and 64 matched controls. MAIN OUTCOME MEASURES: Incidence of medical and odontological diagnoses, own perception of health, and incidence of self-reported symptoms. RESULTS: Three quarters of the patients were women. The mean age was 49 years. Thirty-seven patients (55%) and 47 controls (73%) (NS) showed no sign of somatic disease. Half of the patients felt ill or very ill at the time of the examination. Patients reported twice as many symptoms as the controls during a 3-month period. Patients reported a higher prevalence of very low resting saliva secretion rate, and a higher number of decayed tooth surfaces and of instances of temporomandibular joint dysfunction. CONCLUSION: Patients' feelings of ill-health were more likely related to psychiatric than somatic diagnoses. This study underlines the importance of making an overall diagnosis, including both mental and somatic disorders, especially in unclear cases and in self-diagnosed illnesses.

Rehabilitation of young immigrants in primary care. A comparison between two treatment models.

OBJECTIVE: To evaluate the effect on well-being and sickness certification of interviews and three dialogue sessions concerning ideas about pain in young immigrants suffering from longstanding, benign pain. DESIGN: A randomized clinical four-week trial between two treatment groups. SETTING: A primary health care centre, Stockholm, Sweden. SUBJECTS: 92 persons, 25-45 years of age, on sick leave > 6 weeks. MEASURES: Physical and psychiatric examinations and self-ratings of work ability and pain anxiety were made before and after the programme. Sick leave data were studied at three and eight-month follow-ups. RESULTS: 45 immigrants, mean age 38 years, mean sick leave 13 months, completed the programme. There were no significant differences in general or diagnostic data between the treatment groups. All had pain. Three-quarters reported pain anxiety. Nearly half had depressive disorders. Only ten persons had self-rated ability for part-time work. After the programme, there were significant differences in favour of the experimental group in number of participants with pain anxiety (p = 0.01), with diagnosed depression (p < 0.05), with self-rated work ability (p = 0.05), and in the number of participants who had returned to work at the eight-month follow-up (p < 0.05). CONCLUSIONS: This study indicates that, for young immigrants suffering from long-standing benign pain, a structured dialogue with focus on concepts of pain may reduce pain anxiety and depressive mood, improve self-rated work ability, and increase the prospects of successful rehabilitation back to work.

Starting insulin therapy in elderly non-insulin-dependent diabetic patients at a health care centre. Methodological and economic aspects.

OBJECTIVE: To try to start insulin therapy in elderly non-insulin-dependent diabetes mellitus (NIDDM) patients with secondary failure in primary health care, and compare costs for starting treatment in a health care centre and in a day-care clinic in a hospital. DESIGN: Time and costs for start of insulin were calculated. SETTING: A health care centre in Stockholm, Sweden. SUBJECTS: Fourteen consecutive patients in the health care centre and a control group of 14 patients in the day-care clinic. RESULTS: Metabolic control in both groups improved significantly. Total time spent with the district nurse to start insulin treatment was 3 hours during about 7 weeks with a total cost of SEK 1100 in the health care centre. In the day-care clinic patients were admitted 5.6 days with a total cost of SEK 6100-10900. CONCLUSIONS: Elderly patients can learn the injection technique and manage insulin therapy, which results in good metabolic control. Insulin treatment can be started in primary health care. With elderly patients it takes time, but it is far more cost-effective in primary health care than at the hospital.

A multidisciplinary clinical study of patients suffering from illness associated with mercury release from dental restorations: psychiatric aspects.

The aim of this study was to map the psychological/psychiatric, odontological and medical aspects of patients with symptoms allegedly related to the side-effects of mercury in dental fillings. A total of 67 consecutive patients and 64 controls matched for age, sex and residential area were included in the study. The most striking result was the high prevalence of psychiatric disorders in the patients (89%) compared to the controls (6%), predominantly somatoform disorders. The personality traits differentiating the patients according to the Karolinska Scales of Personality (KSP) were somatic anxiety, muscular tension, psychasthenia and low socialization. More patients than controls showed alexithymic traits. The prevalence of diagnosed somatic diseases was higher, but not sufficiently so to explain the large difference in perceived health. The multiple symptoms and signs of distress displayed by the patients could not be explained either by the odontological data or by the medical examination. Our data indicate that the patients show sociodemographic and clinical patterns similar to those of somatizing patients. The medicalization of the suffering of these patients and the neglect of psychiatric problems prevent the use of appropriate psychotherapeutic approaches.

Fatal reactions to drugs. A 10-year material from the Swedish Adverse Drug Reaction Committee.

Drug-induced deaths (n = 274) in Sweden during a 10-year period have been analyzed. The incidence has been remarkably constant, with 25--30 reported cases per year. There is a marked increase with age in the incidence of fatal reactions, more so than for all drug reactions. Women consume more drugs than men and get more reactions, but not more fatal reactions. Anti-inflammatory drugs (antibiotics and sulfonamides) are responsible for 21% of the fatal reactions, followed by oral antidiabetics (9%), oral contraceptives (9%) and antiphlogistic drugs (8%). The blood and the bone marrow are the most susceptible organs, responsible for 40% of the fatal reactions, followed by thromboembolism (10%) and hepatocellular damage (9%). It is important to note that rapid changes have occurred with regard to responsible drugs as well as to the types of adverse reactions encountered.

Drug-induced blood dyscrasias. A ten-year material from the Swedish Adverse Drug Reaction Committee.

Drug-induced dyscrasias (agranulocytosis, aplastic anemia, hemolytic anemia and thrombocytopenia) in Sweden during a 10-year period (1966-75) have been analyzed. The overall occurrence is remarkably constant, although marked changes have occurred with regard to offending drugs. Drug-induced thrombocytopenia and agranulocytosis are about twice as common as hemolytic anemia, which in turn is twice as common as aplastic anemia. There is a marked increase with age in the incidence of all drug-induced cytopenias. Women predominate and make up close to 70% of the material. With regard to responsible drugs, the most remarkable finding is the high frequency with which sulfonamides appear as responsible for all types of drug-induced cytopenia.