PubMed Health⌕ Search

Biomedical subjects

H Staudenmayer

Publications and source records attributed to H Staudenmayer.

At least 19 recordsLinked to original sources
PubMed2001

Idiopathic environmental intolerances (IEI): myth and reality.

The psychogenic theory presupposes that idiopathic environmental intolerance (IEI) is an overvalued idea explained by psychological and psychosocial processes. The polysomatic symptoms are amplifications of complaints common to the general population, psychophysiological manifestations of stress and the stress-response, or symptoms of psychiatric clinical syndromes. The psychogenic theory is supported by provocation challenge studies which demonstrate that appraisals of 'reactions' are unreliable and cognitively mediated. Clinical studies of IEI cases consistently identify greater incidence of current and premorbid lifetime psychiatric disorders and co-morbidity with functional somatic syndromes that are fashionable 'diagnoses'. The toxicogenic theory presupposes low-level chemical sensitivity or intolerance without objective signs to a plethora of diverse chemical agents. Symptoms are synonymous with disease and attributions are synonymous with cause. Hypotheses about physiological processes and mechanisms are implausible and unsupported by evidence. Advocates claim this phenomenon is so ephemeral that the principles and methods of toxicology do not apply and that a scientific paradigm shift is in order.

Animals↗
PubMed1999

Psychogenic chemical sensitivity: psychogenic pseudoseizures elicited by provocation challenges with fragrances.

A middle-aged woman with a 10-year history of disability attributed to chemical sensitivities complained that exposure to specific fragrances immediately elicited seizures. Video-EEG monitoring was performed in a hospital neurodiagnostic laboratory during provocative challenge studies employing fragrances identified by the patient as reliably inducing symptoms. The baseline clinical EEG was normal. Immediately after each provocation with air deodorant and perfume, she consistently showed both generalized tonic/clonic and multifocal myoclonic jerking, at times was nonresponsive, spoke with slurred speech, and complained of right-sided paralysis and lethargy. None of these events were associated with any EEG abnormalities. Psychological assessment (MMPI-2, MCMI-II) revealed personality traits that predisposed her to somatization and beliefs about environmental sensitivities. The convulsions were a manifestation of psychogenic pseudoseizures that had been iatrogenically reinforced.

Adult↗
PubMed1996

Clinical consequences of the EI/MCS "diagnosis": two paths.

There are two distinct paths down which patients "diagnosed" with environmental illness/multiple chemical sensitivities (EI/MCS) can travel. Along the first path, beliefs about low-level, multiple chemical sensitivities as the cause of physical and psychological symptoms are instilled and reinforced by a host of factors including toxicogenic speculation, iatrogenic influence mediated by unsubstantiated diagnostic and treatment practices, patient support/advocacy networks, and social contagion. Intrapsychic factors also reinforce this path through the motivational mechanism of factitious malingering, or unconscious primary and secondary gain, mediated through psychological defenses, particularly projection of cause of illness onto the physical environment. The second path involves restructuring distorted beliefs about chemical sensitivities. Explanations of the placebo effect, the physiology of the stress response, and the symptoms of anxiety and panic facilitate the direction of EI/MCS patients onto this path. A decision model is presented to discriminate among toxicogenic and psychogenic explanations of the EI/MCS phenomenon, based on appraisal of reaction and physiologic and cognitive responses during provocation chamber challenges under double-blind, placebo-controlled conditions. These studies have been helpful therapeutically for some patients in selecting the path that leads to wellness. This paper suggests how various therapeutic techniques can be employed with difficult patients. Often, supportive psychotherapy establishes a therapeutic alliance which facilitates cognitive therapy to restructure distorted beliefs. In the process of finding alternative explanations to chemical sensitivities, the etiology of symptoms is related to stressful life events, including childhood experiences which may have disrupted normal personality development and coping capacity. Furthermore, biological and physiological sequelae stemming from early, chronic trauma have been identified which could explain many of the multisystem complaints. The incidence of childhood abuse reported by EI/MCS patients is strikingly high, and it is recollection of trauma that many EI/MCS patients avoid by displacing the psychologic and physiologic adults sequelae onto the physical environment. The reenactment of these experiences may be necessary in the therapy of some affected individuals. Despite the significant therapeutic effort expanded, some patients who are imprisoned by a closed belief system about the harmful effects of chemical sensitivities are resigned to travel down the path which ultimately leads to despair and depression, social isolation, and even death.

Child↗
PubMed1995

Failure to assess psychopathology in patients presenting with chemical sensitivities.

Mediating processes can be inferred from self-report data only if it can be assumed that the patient has a valid capacity for introspection. That assumption is invalid when beliefs can be shown to influence sensory perception and symptom reports. Another serious limitation of self-reporting is that the individual has only a limited awareness of his or her psychological state. Also, we cannot ignore the observations that come from the psychodynamic tradition, that unconscious or subconscious ideas also can affect and distort self-reporting. The lack of validity of self-reports is summarized by Brewin: "[T]he value of self-reports would appear to be more in their relation to intentional future actions than in any insight they might provide into complex feeling states or into the contingencies governing past behavior." A more objective procedure for obtaining information about EI/MCS patients' beliefs is clearly needed before their symptom reports can be taken at face value.

Female↗
PubMed1993

Double-blind provocation chamber challenges in 20 patients presenting with "multiple chemical sensitivity".

A clinical algorithm was used to discriminate verifiable chemical sensitivity from psychological disorders in patients referred for evaluation of polysomatic symptoms attributed to hypersensitivity to workplace and domestic chemicals. These patients believed that they were reactive or hypersensitive to low-level exposure to multiple chemicals. Some had previously been evaluated and managed by the tenets of "clinical ecology" and diagnosed as having "multiple chemical sensitivity." Double-blind provocation challenges with an olfactory masker were performed in an environmental chamber on each of 20 patients. A variety of chemicals was employed, one or more per subject, dependent on individual clinical history. Clean air challenges with the olfactory masker were used as placebo or sham controls. As a group, probability analyses of patient symptom reports from 145 chemical and clean air challenges failed to show sensitivity (33.3%), specificity (64.7%), or efficiency (52.4%). Individually, none of these patients demonstrated a reliable response pattern across a series of challenges. Implications for future research in assessment methodology incorporating neurophysiologic and neurobehavioral measures are discussed.

Algorithms↗
PubMed1993

Adult sequelae of childhood abuse presenting as environmental illness.

Sixty-three patients with polysomatic complaints attributed to sensitivity to environmental chemicals had detailed clinical assessments and diagnostic psychologic evaluations. Objective medical parameters failed to substantiate their beliefs that multiple chemicals were the cause of their problems. A group of 64 patients with chronic medical conditions and defined psychologic disorders not attributed to chemical exposure served as controls. Approximately half the patients in each group underwent long-term psychotherapy, and in these patients, the prevalence of physical and sexual childhood abuse was significantly higher (P < .05) among the cohort of women who attributed their symptoms to environmental or chemically related illness. These data suggest that somatization may reflect sequelae of childhood abuse and may play an important role in the illness experienced by women who believe they are sensitive to environmental chemicals.

Adolescent↗
PubMed1991

Assessment of nasal patency by rhinoscopic measurement of cross sectional nasal airway area: correlation with subjective nasal symptoms.

Assessment of nasal patency by the recording of nasal symptom scores was compared with an objective method of determining nasal airway area using a fiberoptic rhinoscope. Sixty patients with active allergic rhinitis and nasal congestion requiring treatment were studied. Nasal symptoms were recorded and nasal airway area was measured before and at fixed time intervals after administration of either pseudoephedrine or oxymetazoline. Both methods detected a decongestant response to both drugs, and the symptom of congestion correlated with the measured nasal airway area. Rhinoscopic measurement of cross sectional nasal airway area is an objective method that may be used to complement other methods for evaluation of nasal patency.

Adult↗
PubMed1990

Neuropsychophysiology during relaxation in generalized, universal 'allergic' reactivity to the environment: a comparison study.

Comparisons were made among a group of patients presenting with universal 'allergic' intolerance to environmental chemicals (universal reactor, n = 58), a group of control subjects without psychologic symptoms (control, n = 55) and a group of outpatients from a psychology practice (psychologic, n = 89) on neuropsychophysiological measures during relaxation. The measures were electroencephalographic (EEG) spectral category for frequencies below 15 Hz, EEG beta activity, scalp electromyography (EMG), peripheral temperature (TEMP), and skin resistance level (SRL). The distributions of subjects in each group across eight EEG spectral categories were significantly different, with the distribution for universal reactors the same as that of the psychologic patients (p = 0.22), and both different from the distribution of controls (p less than 0.001). High levels of EEG beta activity were observed in more universal reactors and psychologic patients than in controls (p = 0.04). High levels of EMG scalp activity were observed in a greater number of universal reactors than in subjects in the other two groups (p less than 0.001). The three groups did not differ in TEMP and SRL. Implications of neuropsychophysiologic stress profiling for the diagnosis and treatment of psychosomatic illness are discussed.

Adult↗
PubMed1987

Vocal cord dysfunction: the importance of psychologic factors and provocation challenge testing.

We present three case reports involving patients with vocal cord dysfunction. The onset of symptoms in one case was coincident with a generalized cutaneous reaction to penicillin with laryngeal involvement. The other cases had been misdiagnosed as food allergy and chemical sensitivity. We describe the psychologic factors in these cases in terms of the primary and secondary gain operative in the somatoform disorder of conversion reaction and emphasize the importance of belief and learned sensitivity in the induction of symptoms. The necessity of considering psychologic factors and the use of blinded, controlled, provocation challenges to evaluate subjective symptomatology is underscored. This study emphasizes the heterogenicity of clinical presentations involving vocal cord dysfunction and illustrates the value of fiberoptic-assisted examination of laryngeal function in conjunction with provocation challenge testing in establishing causal relationships for specific clinical symptoms.

Adult↗
PubMed1985

Inhaled metabisulfite sensitivity.

Sensitivity to an inhaled sulfite-containing solution was evaluated in 13 asthmatics and ten nonasthmatic controls. Three of the 13 asthma patients were known to be sensitive to ingested sulfite and ten were not sensitive. All three sulfite-sensitive patients developed bronchospasm following sulfite inhalation challenges. Four of the ten asthmatics not sensitive to ingested sulfite developed bronchospasm following sulfite inhalation. The control subjects showed no reaction to inhaled sulfite. This study demonstrated that all asthmatics sensitive to ingested sulfite developed bronchoconstriction with inhaled sulfite. Furthermore, sensitivity to inhaled sulfite was more common than sensitivity to ingested sulfite in asthmatic patients. Possible reasons for this difference are discussed.

Administration, Oral↗
PubMed1985

The practical approach to the evaluation of suspected environmental exposures: chemical intolerance.

The purpose of this article is to encourage allergists to expand their interest in environmental intolerance to include chemicals found in everyday exposure. By incorporating controlled challenge procedures into outpatient practice capabilities, the practicing allergist can expand both clinical interest and practice potential. By merging scientific principles of toxicology and psychology with the traditional investigative skills of the well-trained clinical allergist, we believe that discipline of allergy/immunology can realize a rather remarkable new dimension.

Bronchial Provocation Tests↗
PubMed1982

Medical manageability and psychosocial factors in childhood asthma.

Five psychosocial factors were empirically derived from a questionnaire administered to 175 asthmatic children who were taken from three subsamples representing hospitalized inpatients, outpatients and private practice patients. The scales included three measures of anxiety labeled Despair Over Social Debilitation, Quality of Life, and Dread of Illness, one attitude scale labeled Orientation Towards Compliance, and one scale labeled Family Communication. These scales correlated with measures of debilitation during the 6 month period prior to treatment, which included the number of asthma attacks, emergency room visits, days hospitalized, days of school missed and parental ratings of interference in physically strenuous activities. Two groups of children were defined for each psychosocial factor by a mean split of the scores. The incidence of children with relatively much anxiety as defined by three of these scales and a poor attitude about compliance was greatest in the inpatient subsample and least in the private practice subsample. Inpatients also experienced the most debilitation during the 6 month period before testing. Follow-up measures of debilitation were recorded for the 6 month period post discharge. The relationship between the debilitation experienced by the children and their anxiety was evaluated. Patient groups with much and little anxiety both showed comparable and significant reductions in debilitation post hospital treatment. The results were interpreted to indicate that the anxiety assessed upon admission was the consequence of a history of poor medical manageability. The anxiety assessed did not appear to contribute to poor control of this illness.

Adolescent↗
PubMed1981

Evaluation of a self-help education-exercise program for asthmatic children and their parents: six-month follow-up.

A program evaluation was conducted on a sample of 40 families with asthmatic children who were managed in private practice and participated in a self-help education-exercise program in Denver. Baseline measures were collected for the six-month period before the program, and follow-up measures were collected for the six-month period following completion of the eight-week program. The results indicated that a significant number of children experienced less debilitation after completing the program and also had less need of medical services. The interpersonal relations between the child and the parents were judged to have improved in a significant number of families, and a significant number of mothers reported that they experienced less emotional distress in getting a significant number of parents to quit smoking. Additional evaluations are recommended with a sample of asthmatic children who are more severely debilitated and more difficult to manage.

Adolescent↗