MULTIPLE CHEMICAL-SENSITIVITY MULTIORGAN DYSESTHESIA, MULTIPLE SYMPTOM COMPLEX, AND MULTIPLE CONFUSION - PROBLEMS IN DIAGNOSING THE PATIENTPRESENTING WITH UNEXPLAINED MULTISYSTEMIC SYMPTOMS

Patients are presenting in increasing numbers with multiorgan symptoms allegedly resulting from exposure to environmental chemicals. Among t he symptoms expressed by patients with alleged multiple chemical sensi tivities (MCS) are profound fatigue, mental confusion, myalgia, depres sion, anxiety, dizziness, headache, insomnia, loss of appetite, and nu mbness of the extremities, all in the absence of objective physical si gns. Diagnostic criteria to assess the effects of environmental agents on organ systems are sorely needed because patients with MCS often ha ve no tissue pathology or physiological abnormalities, but often do ha ve diagnosable psychiatric illnesses. In treating patients with MCS, t he physician should first perform a complete history and physical exam ination, including a comprehensive evaluation of chemical exposure. If the findings strongly suggest the presence of disease related to part icular organ systems, further diagnostic evaluation should be undertak en. If abnormal findings are absent, psychiatric advice may be useful. The physician should keep an open mind about MCS but must also rememb er that a cause-effect relationship between exposure to multiple chemi cals and symptoms has not been established.