Syndrome in der Umweltmedizin: Varianten von Somatisierungsstörungen?

Wiesmüller, G. A.; Ebel, Hermann; Hornberg, Claudia

doi:10.1055/s-2001-12681

Cited by 11 publications

(3 citation statements)

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“…Dieses Problem könnte in der Zukunft durch eine einheitliche Basisdokumentation gelöst werden, an der zurzeit der bundesweite Arbeitskreis der universitären umweltmedizinischen Ambulanzen und Beratungsstellen arbeitet [5]. Unter Berücksichtigung der geschlechterbezogenen Datenbetrachtung erwachsener Patienten der UMEB Düsseldorf [41,49,50] [9,76,77,83], Chronic Fatigue Syndrome (CFS) [29,83] und Candida Syndrome (CS) [74,83], die eine umweltbezogene Ätiologie nahe legen, obwohl diese Syndrome allgemein nicht als nosologische Entitäten mit positiven Diagnosekriterien akzeptiert sind [83]. In den Fällen, in denen ein wissenschaftlich plausibler Zusammenhang zwischen Umweltfaktoren und Beschwerden ermittelt werden konnte, fehlen mit Ausnahme einer begründbaren Expositionskarenz zurzeit ausreichend valide therapeutische Konzepte und Angebote [61,84].…”

Section: Diskussionunclassified

Umweltbezogene Gesundheitsst�rungen

Hornberg

Malsch

Weißbach

et al. 2004

Bundesgesundheitsbl - Gesundheitsforsch - Gesundheitsschutz

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Environmental medicine outpatient clinics, counseling centers, and practicing physicians have observed environment-related health disorders in patient groups of mixed age as well as for groups consisting only of adults or children. Practicing physicians suspected correlations between environmental factors and health disorders in 36-45% of cases, environmental medicine outpatient clinics and counseling centers in 4-34% for mixed-age groups, 0-24% for adults, and 9-13% for children. A comparison of these data is difficult due to differences in data acquisition, evaluation methods, and descriptive statistics used. Furthermore, data on children are insufficient. Patient-oriented environmental medicine faces a number of problems regarding determination of exposure, effects, and susceptibility, including a lack of scientifically verified cause-and-effect models as well as incorrect diagnoses, attributions, and conclusions. In view of the scope and intensity of environment-related health disorders, the topic cannot be ignored. A functioning program of environmental medicine counseling and patient care is needed for practicing physicians, universities and/or the public sector to deliver effective primary medical care in this field. As always, the building blocks of environ-mental medicine counseling are medical history, physical examination, differential diagnosis, human biomonitoring, and on-site inspection with environmental monitoring while also taking gender differences into account. Uniform basic documentation procedures and health science analyses will help to optimize patient care in environ-mental medicine. The value of a diagnostic algorithm in the care of patients with environment-related health disorders is beyond dispute. Last but not least, quality assurance and control are a sine qua non of patient-oriented environmental medicine.

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Section: Diskussionunclassified

Umweltbezogene Gesundheitsst�rungen

Hornberg

Malsch

Weißbach

et al. 2004

Bundesgesundheitsbl - Gesundheitsforsch - Gesundheitsschutz

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“…Die Frage nach der Authentizität neuropsychologischer Störungen ist sowohl klinisch wie auch gutachterlich von großer Tragweite, etwa bei der Klärung von Ansprüchen nach fraglichen, trivialen oder leichten Schädel-Hirn-Verletzungen, nach Lösungsmittelexposition, nach Beschleunigungstrauma der Halswirbelsäule, aber auch bei den "neuen Krankheiten" wie Fibromyalgie, multipler chemischer Sensibilität, chronischer Fatigue usw. [14,15,28,29]. Die Bedeutung dieser Fragestellung ist noch dadurch verschärft, dass durch eine Entscheidung des IV.…”

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Neuropsychological assessment of suboptimal performance: the Word Memory Test

Brockhaus

Merten

2004

Nervenarzt

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Although malingering, suboptimal cognitive performance, and negative response bias represent very problematic confounds in diagnostic work with a number of neurological and some psychiatric illnesses, the evaluation of these tendencies has not yet become common practice in German-speaking countries. Only a limited number of adequately validated instruments are available. The German adaptation of the Word Memory Test (WMT), an internationally renowned test for use in the area of neurocognitive disturbances, is presented. The first study compares performance of a healthy experimental group of malingerers ( n=100) with a healthy control group after standard test instructions ( n=27). The WMT achieved a 100% correct identification of group membership. The second study was carried out with a sample of mentally retarded patients ( n=32) and showed that the WMT was likewise able to identify high performance motivation in almost all of the cases. Only one patient was incorrectly classified. These results are commensurate with the highly sensitive parameters that have been reported for the WMT in North America. With the introduction of the WMT into neuropsychological diagnostic work in Germany, it will become easier to meet quality standards that have become customary internationally.

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“…Nach erfolgter Diagnostik durch einen klinisch erfahrenen Arzt und Schaffung eines Vertrauensverhältnisses wurden diese Patienten mit ihrem Einverständnis einem Psychiater vorgestellt. Die Tatsache, dass von unserem Zentrum seltener als an anderen Zentren[1,3,[12][13][14][15][16][17] psychiatrische Diagnosen gestellt wurden, ist wahrscheinlich Folge dieser selektiven Vorgehensweise. Immerhin war eine psychiatrische Ursache bei 7% als kausal für die Beschwerden anzusehen.…”

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Interdisziplinäre Diagnostik in der umweltmedizinischen Ambulanz - ein Erfahrungsbericht über 400 Patienten

Schulze¹,

Hardt²,

Ehret³

2004

Gesundheitswesen

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The medical diagnostics of 400 patients of an interdisciplinary environmental medical centre is presented. The basic diagnostics included a special environmental medical history using a questionnaire, physical examination, allergological examinations and human biomonitoring. The latter was carried out in order to quantify the internal exposure to environmental pollutants. The main focus was on the differential diagnostics which was supported by special medical divisions of the hospital. Allergic illnesses as well as results of human biomonitoring exceeding the reference ranges were found frequently. Unfortunately a link between external exposure, internal dose and symptoms can hardly be established in environmental medicine. However, in several cases we found a considerably increased internal exposure which allowed to identify the sources of exposure (for example, usage of dichlorobenzene, permethrin, pentachlorophenol). Eliminating the sources obviously improved the health status of some of the patients concerned.

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Syndrome in der Umweltmedizin: Varianten von Somatisierungsstörungen?

Cited by 11 publications

References 0 publications

Umweltbezogene Gesundheitsst�rungen

Umweltbezogene Gesundheitsst�rungen

Neuropsychological assessment of suboptimal performance: the Word Memory Test

Interdisziplinäre Diagnostik in der umweltmedizinischen Ambulanz - ein Erfahrungsbericht über 400 Patienten

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