Interdisciplinary clinical assessment of patients with illness attributed to environmental factors.

Patients with health problems attributed to environmental factors such as chemical pollutants and electromagnetic fields often do not present evidence of an environmental aetiology of their symptoms. It has been postulated, that their problems are due to disorders diagnosed by other medical disciplines, especially allergology and psychiatry. Our study was designed to subject these patients to a comprehensive diagnostic program involving several medical disciplines in order to achieve diagnoses appropriate to explain the patients' symptoms. Fifty patients consecutively referred to the department of environmental medicine in the university hospital of Aachen, Germany, were submitted to the following examinations: (i) environmental medicine (history, clinical examination, biological and/or ambient monitoring for environmental agents); (ii) allergological examination (history, clinical examination, skin tests); (iii) psychiatric examination (psychopathological examination, psychometric and neuropsychological testing). In addition, the patients were examined in other hospital departments according to the symptoms presented. The findings were discussed in case conferences attended by the physicians involved in order to achieve individual diagnoses. The numbers of patients to whom diagnoses were given by different medical disciplines are as follows: psychiatry (32 patients), dermatology (4), allergology (2), neurology (2), rheumatology (2), gynaecology (1), haematology (1). The most frequent mental disorders diagnosed by the psychiatrists were somatoform disorders (19), followed by schizophreniform and delusion disorders (7). In spite of extensive diagnostic efforts, patients with health problems attributed to the environment usually do not present sufficient evidence of an environmental aetiology of their symptoms. On the other hand the symptoms often meet the diagnostic criteria of other diseases, especially of mental disorders.

[Coping with stress and self-awareness in idiopathic sudden deafness]. / Stressverarbeitung und Selbstaufmerksamkeit beim idiopathischen Hörsturz.

In the work presented here patterns of stress management and self awareness of patients with sudden hearing loss (n = 50) are studied and compared to a control group. Private self awareness is conceived as a moderator of stress management. Data analysis was performed with special consideration given to gender specificity of patterns investigated. The profile of stress management in patients with sudden hearing loss differs from control groups. As for stress management, gender specific data analysis reveals for male as well as for female patients significant differences when compared to control groups. Beyond that, profiles of stress management differ between males and females. Furthermore, private self awareness in patients with sudden hearing loss exhibit significant differences in mean values when compared to control groups, which is interpreted as a reflection of a lower prevalence of private self awareness. However, gender specific analysis supports this initially significant result only to have tendentious character. With respect to preventive treatment and prophylaxis of relapse, our results suggest that training in stress management should be completed by bodily oriented procedures suited to enhance the perception of body signals.

[Outpatient or inpatient treatment? Analysis of indications in psychosomatic medicine]. / Ambulant oder stationär? Analyse der Indikationsentscheidungen in der Psychosomatik.

This is an empirical study of the criteria which indicate inpatient or outpatient treatment. The two essential elements to the process of indication are, firstly, the recommendation of the outpatient clinic conference and, secondly, the preference of the patient. A specially developed test inventory was used for the statistical evaluation of one hundred case decisions of our outpatient clinic conference. As expected, the indication is not reduced to a one-dimensional schema but is the result of a complex process. Nonetheless, several characteristics can be identified, such as the length of the illness, any psychosomatic pretreatment, the recommendations of the first diagnostician and the patient's own wish for a particular type of treatment. In sum, this study is an example of a descriptive analytical approach for the differential research on indication. Such an approach could be of importance when discussing how to control quality of psychosomatic and psychotherapeutic treatments.