J Med Toxicol. 2011 Jun;7(2):109-17. doi: 10.1007/s13181-011-0136-8.
A multidisciplinary team assessed five patients who alleged chronic medically unexplained multiorgan system symptoms described by idiopathic environmental intolerance allegedly triggered by exposure to solvents used in membrane roofing repair work on an office building. The event precipitated an incident of mass psychogenic illness (MPI). Treating physicians diagnosed irritant-associated vocal cord dysfunction (IVCD) and reactive airways disease syndrome (RADS) resulting from exposure. The authors conducted medical, psychological, and industrial hygiene evaluations. Air monitoring data for total volatile organic compounds obtained during the 2-day exposure period, measurements of emissions during membrane roofing repair at a similar site, mathematical modeling of air contaminant concentrations, and injection of tracer gas into the incident building revealed exposure levels well below those doses anticipated to cause clinical symptoms. There was no objective medical evidence validating symptoms. Review of the medical records indicated that the video laryngoscopy data, pulmonary function tests, and medical examinations relied upon by the treating physicians were inconsistent with published criteria for IVCD and RADS. Psychological evaluation identified defensiveness and self-serving misrepresentations of exaggerated health concerns associated with somatization and malingering. Each case had personality traits associated with at least one personality disorder. Social histories identified premorbid life events and stressors associated with distress. This is the first study to assess psychological predisposition, social interaction among the plaintiffs, and iatrogenic reinforcement of beliefs by diagnoses of pseudo-disorders associated with patient misrepresentation of exaggerated health concerns in an incident of MPI.
一个多学科团队评估了五名患者，他们声称患有慢性医学无法解释的多器官系统症状，这些症状据称是由暴露于办公大楼膜屋顶修复工作中使用的溶剂引起的特发性环境不耐受引起的。该事件引发了群体性心因性疾病（MPI）。治疗医生诊断为暴露引起的刺激性相关声带功能障碍（IVCD）和反应性气道疾病综合征（RADS）。作者进行了医学、心理学和工业卫生评估。在暴露的 2 天期间获得的总挥发性有机化合物的空气监测数据、在类似地点进行的膜屋顶修复时的排放测量、空气污染物浓度的数学建模以及示踪气体注入事件建筑揭示了暴露水平远低于预期引起临床症状的剂量。没有客观的医学证据证明症状的存在。对病历的审查表明，治疗医生依赖的视频喉镜数据、肺功能测试和体检与 IVCD 和 RADS 的公布标准不一致。心理评估确定了防御性和自我服务的夸大健康问题的代表性，这些问题与躯体化和装病有关。每个病例都有至少一种人格障碍相关的人格特征。社会史确定了与痛苦相关的发病前生活事件和压力源。这是第一项评估心理倾向、原告之间的社会互动以及与患者对夸大健康问题的虚假陈述相关的伪障碍诊断对 MPI 中信念的医源性强化的研究。
