Successful Outcome in a Patient With Chemical Sensitivity: Treatment With Psychological Desensitization and Selective Serotonin Reuptake Inhibitor

Stenn, Peter; Binkley, Karen

doi:10.1016/s0033-3182(98)71289-7

Cited by 19 publications

(7 citation statements)

References 9 publications

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“…As yet, the effectiveness of this behavioral treatment package has preliminary support through a few minor treatment studies of MCS cases. 45,54,55 A large-scale treatment study seems to be urgently required, both to assess the validity of the learning model for IEI, and, foremost, in order to establish an effective treatment that can be offered to suffering individuals.…”

Section: Discussionmentioning

confidence: 99%

Personality, mental distress, and subjective health complaints among persons with environmental annoyance

et al. 2007

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The aim of this study was to assess possible early determinants of idiopathic environmental intolerance (IEI), contributing to an integrated model for the development of IEI. Questionnaires concerning personality traits, current mental distress, subjective health complaints, work load and satisfaction, and options for recovery, were given to 84 persons from the general population attributing annoyance to (i) chemicals/smells (smell-annoyed (SA) n= 29); (ii) electrical equipment (electrically annoyed (EA) n= 16); and (iii) both smells and electricity (generally annoyed (GA) n= 39), but otherwise healthy and in active work. Compared to referents ( n= 54), the EA and GA groups showed strongly elevated scores on 5/6 scales within the trait anxiety/neuroticism personality dimension, while the SA group had a slight elevation on only one anxiety scale. Current mental distress and subjective health complaints scores were generally elevated in the EA and GA groups, but only partially in the SA group. Higher proportions of the EA, GA, and SA groups reported low satisfaction with their work situation, including more frequent fatigue after work and a higher, and often unfulfilled, need for recovery. The findings suggest that trait anxiety is prominent already at prodromal stages of IEI, possibly indicating that trait anxiety facilitates the acquisition of attribution of health complaints to environmental factors.

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Section: Discussionmentioning

confidence: 99%

Personality, mental distress, and subjective health complaints among persons with environmental annoyance

et al. 2007

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“…Patients with MCS were also shown to score significantly higher on anxiety traits/neuroticism personality dimensions when compared to referents [24]. There are also several case reports indicating that antidepressants targeting the serotonergic system might be effective in the treatment of MCS [25], [26]. Taken together, these data strongly argue for an engagement of the serotonin system in the pathophysiology of both MCS and harm avoidance.…”

Section: Introductionmentioning

confidence: 81%

Women with Multiple Chemical Sensitivity Have Increased Harm Avoidance and Reduced 5-HT1A Receptor Binding Potential in the Anterior Cingulate and Amygdala

2013

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Multiple chemical sensitivity (MCS) is a common condition, characterized by somatic distress upon exposure to odors. As in other idiopathic environmental intolerances, the underlying mechanisms are unknown. Contrary to the expectations it was recently found that persons with MCS activate the odor-processing brain regions less than controls, while their activation of the anterior cingulate cortex (ACC) is increased. The present follow-up study was designed to test the hypotheses that MCS subjects have increased harm avoidance and deviations in the serotonin system, which could render them intolerant to environmental odors. Twelve MCS and 11 control subjects, age 22–44, all working or studying females, were included in a PET study where 5-HT1A receptor binding potential (BP) was assessed after bolus injection of [11C]WAY100635. Psychological profiles were assessed by the Temperament and Character Inventory and the Swedish universities Scales of Personality. All MCS and 12 control subjects were also tested for emotional startle modulation in an acoustic startle test. MCS subjects exhibited significantly increased harm avoidance, and anxiety compared to controls. They also had a reduced 5-HT1A receptor BP in amygdala (p = 0.029), ACC (p = 0.005) (planned comparisons, significance level 0.05), and insular cortex (p = 0.003; significance level p<0.005 with Bonferroni correction), and showed an inverse correlation between degree of anxiety and the BP in the amygdala (planned comparison). No group by emotional category difference was found in the startle test. Increased harm avoidance and the observed changes in the 5-HT1A receptor BP in the regions processing harm avoidance provides a plausible pathophysiological ground for the symptoms described in MCS, and yields valuable information for our general understanding of idiopathic environmental intolerances.

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“…Patients who accept that panic responses may be at least a contributing factor to their symptoms might be responsive to intervention with psychotherapy to enable their desensitization (deconditioning of responses to odors and other triggers) and/or may be helped by anxiolytic medications, relaxation training, and counseling for stress management. A response to such intervention has been reported anecdotally (39,40,41), although randomized, placebo-controlled studies of such an approach have not been reported. Indeed, although panic responses were common in the group of IEI subjects we studied, only 1 among the 26 study subjects who had panic responses was agreeable to having a referral to a psychiatrist or psychologist.…”

Section: Discussionmentioning

confidence: 99%

Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder.

Tarlo

Poonai

Binkley

et al. 2002

Environ Health Perspect

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Idiopathic environmental intolerance (IEI), also known as multiple chemical sensitivity, is a clinical description for a cluster of symptoms of unknown etiology that have been attributed by patients to multiple environmental exposures when other medical explanations have been excluded. Because allergy has not been clearly demonstrated and current toxicological paradigms for exposure-symptom relationships do not readily accommodate IEI, psychogenic theories have been the focus of a number of investigations. A significantly higher lifetime prevalence of major depression, mood disorders, anxiety disorders, and somatization disorder has been reported among patients with environmental illness compared with that in controls. Symptoms often include anxiety, lightheadedness, impaired mentation, poor coordination, breathlessness (without wheezing), tremor, and abdominal discomfort. Responses to intravenous sodium lactate challenge or single-breath inhalation of 35% carbon dioxide versus a similar breath inhalation of clean air have shown a greater frequency of panic responses in subjects with IEI than in control subjects, although such responses did not occur in all subjects. Preliminary genetic findings suggest an increased frequency of a common genotype with panic disorder patients. The panic responses in a significant proportion of IEI patients opens a therapeutic window of opportunity. Patients in whom panic responses may at least be a contributing factor to their symptoms might be responsive to intervention with psychotherapy to enable their desensitization or deconditioning of responses to odors and other triggers, and/or may be helped by anxiolytic medications, relaxation training, and counseling for stress management.

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Successful Outcome in a Patient With Chemical Sensitivity: Treatment With Psychological Desensitization and Selective Serotonin Reuptake Inhibitor

Cited by 19 publications

References 9 publications

Personality, mental distress, and subjective health complaints among persons with environmental annoyance

Personality, mental distress, and subjective health complaints among persons with environmental annoyance

Women with Multiple Chemical Sensitivity Have Increased Harm Avoidance and Reduced 5-HT1A Receptor Binding Potential in the Anterior Cingulate and Amygdala

Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder.

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