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Multiple chemical sensitivity: treatment and followup with avoidance and control of chemical exposures.

Reducing unnecessary chemical exposures, particularly pesticides and other petrochemicals, shows promise for reducing illness episodes in the chemically sensitive. Because similar types of exposures have been associated with the onset of chemical sensitivity, such precautions could have wider preventive value for the rest of society as well. Many uses of chemicals have dubious social benefits, and reduced use should be achievable. The chemical industry will likely bitterly contest the reduced use of chemicals because it stands to lose substantial sales. Compensation and liability insurance carriers also stand to lose if the environment is found problematic, rather than individual psychology, for example. Professionals should also recognize conflicts of interest for the chemical and insurance industries by openly acknowledging funding sources for research. The author believes that research on chemical sensitivity that blames the psyche of the victim rather than the chemical will more likely be funded by the insurance or chemical industry than will other research. Study designs should be developed in an atmosphere removed from financial conflicts of interest. This means a substantially larger role for government funding of research on chemical sensitivity to avoid biasing the knowledge base by financially interested parties. The time is critical for government funding of research on chemical sensitivity because the illness is being defined and characterized. If preliminary research is flawed by improper design and focus, our understanding of the problem could be delayed for years.

Adult↗
PubMed2004

[Symptom Validity Testing (SVT) in the suspicion of a simulation or exaggeration of neurocognitive symptoms--a case report].

The significance of malingering or symptom exaggeration and its appropriate assessment have become increasingly recognised on an international scale. In the field of neurocognitive disorders, not only medicolegal cases, but also a number of clinical conditions are considered especially pertinent for assessment. This case report deals with a 22-year old patient who had suffered a moderately severe brain injury in a car accident almost three years before. In the context of seeking financial compensation from an insurance company, he claimed complete retrograde amnesia for all events and information prior to the accident. Moreover, he presented a Ganser-like response pattern (subsequent near misses) when trying to solve mathematical problems. Therefore, forced-choice symptom validity testing was performed with simple maths tasks. His response pattern was clearly less than random, indicating controlled incorrect responses and, thus, negative response behaviour. When confronted with this interpretation, he relinquished symptom exaggeration and was able to solve these tasks appropriately. While symptom validity techniques belong to the repertory of neuropsychologists in a number of countries, this is not yet true for Germany. However, their application will increasingly be encouraged to meet quality standards of medicolegal assessment.

Adult↗
PubMed2006

Assessing mental disability in minors.

Forensic psychiatry devotes a great deal of attention to the "imprecise" and "insufficiently scientific" nature of psychiatric disability assessment, and, for this reason, it is vitally important to establish a reliable method of assessing different levels of disability. The assessment of mental disability in minors is unique in that it involves developmental aspects, which affect the formation and outcome of the disability. The relationship between disability and development is reciprocal: disability can affect development, thereby intensifying the degree of disability, while development affects integration of the disability into the personality and self-image, thereby preventing or reducing the transformation of disability into handicap. Only an understanding of both the psychopathological structure and its interaction with developmental elements can lead to an accurate assessment of the degree of disability. Such an understanding is vital to the proper practice of forensic psychiatry. We hereby propose a new formula for disability quantification which provides an arithmetical means for the calculation of disability percentages in minors, and we recommend its use in the assessment of demands for National Insurance benefits and compensation claims. The relationship between this new formula and the existing Children's Global Assessment Scale (CGAS) functional scale, when tested retrospectively on 50 clinical reports composed by the writers of this article, showed a good correlation in the results obtained independently by each writer. Two case studies are presented here. A further evaluation by objective evaluators is necessary in order to construct a model for a final objective evaluation of disability in children and adolescents.

Adolescent↗
PubMed1988

Transsexual surgery in the genetic female.

The increasing acceptance of the transsexual patient by society as well as a willingness of insurance companies to compensate for associated surgical procedures will result in an increase in patients presenting for sex reassignment. Data from gender identity centers suggest that the multidisciplinary approach leads to the best therapeutic results. Significant advances in phalloplasty techniques are yielding genitalia with more normal function and appearance.

Breast↗