Richard G. Petty, MD

Recognizing Restless Legs

I’ve recently written a couple of articles about restless legs syndrome (RLS), following which I got this question:

"Dear Dr. Petty, I’ve thought that I’ve got RLS, and so did my doctor, but I’ve just heard about something called akathisia, and another doctor has told me that I might have that instead. Is there any way to tell them apart? The doctor seemed to think that they were the same thing. Have you heard of akathisia, and are there any tips for working out what I’ve really got?"

Yes, I do indeed know what akathisia is, and this is a good question. I’ve seen  many experts who have mixed up the two conditions. Both may be present in the same person, and there may be some small degree of overlap, but an experienced neurologist should be able to tell them apart without too much trouble.

Akathisia is most commonly seen in people taking certain types of medication that act on the brain. However something indistinguishable from akathisia was described three hundred years before we had any of these medicines. So medications are most certainly not the only cause.

I’d like to direct you to a new article by our friends over at Psychiatric Resource Forum, where you will find an article that goes through the clinical features and causes of akathisia and the nine classical features that distinguish akathisia from RLS.

Let me know if that does not give you the answer that you need, and I’ll happily write a more detailed account of how to distinguish the two.

Good luck, and let me know if I can help you further.

Predicting Osteoporosis

Osteoporosis or thinning of the bones, is an extremely common problem that may lead to bone fractures, particularly in older, postmenopausal women. But sadly we are not good at predicting who will get a fracture. Simply measuring bone density is a long way from being a perfect predictor of who will go on to break bones because of osteoporosis.

A new research study from Melbourne, Australia has just come out in the journal Radiology. The researchers have devised a mathematical formula that is quite good at predicting who will get a fracture over a two-year period. The formula calculate’s a woman’s risk of developing a fracture with 75% accuracy. The fact that it misses 25% may not sound good, but it’s actually a big advance.

The researchers examined 231 women with osteoporosis who had suffered bone fractures and 448 women who had not.They discovered that several factors including bone density levels in the spine and hip, weight, and the number of previous fractures were related to the likelihood of sustaining another fracture. By taking all these measurements into account, the team was able to develop a predictive formula. The formula itself is enough to make your head spin, but it will be very easy to use in practice.

We do have a number of effective treatments, including hormone replacement therapy, vitamin D and calcium supplements, and non-hormonal medicines including the bisphosphonates like sodium alendronate (Fosamax®) 10 mg a day or 70 mg once a week, risedronate (Actonel®) 5mg a day or 35mg once a week or and ibandronate (Boniva® once a month)and parathyroid hormone. There are several other medicines in the pipeline, and there have been claims that homeopathy may also help.

The trouble has been knowing which patients to target. Nobody wants to give everyone medicines if we can avoid it. Hence any form of accurate prediction about who might benefit from what, is to be welcomed.

Remember that there is good evidence that several small lifestyle adjustments can reduce your risk of osteoporosis:

  1. Exercise
  2. A diet rich in calcium, omega-3 fatty acids and green vegetables. Reduce sodium and refined sugar.
  3. Supplemental calcium with vitamin D, magnesium and boron
  4. Do not smoke
  5. Avoid excessive amounts of alcohol

There are seveal medicines and illnesses that can increase the risk of osteoporosis, and a health care provider will know to be particularly careful about monitoring bone mineral density and applying this new formula.

Psychiatric Diagnosis

Several months ago I wrote about the advantages of seeing psychiatric problems on a spectrum rather than independent categories. And that it is also essential to look at the whole person: there is currently a terrible tendency in medicine and in psychiatry to reduce people to the neurotransmitters in their brains, which is not just a very limiting way of seeing an individual, it’s just plain rude.

One of the reasons why it is essential to look at the whole person is that the agenda of a physician and of a person asking – or being sent – for help may be entirely different. A doctor may want the voices to go away, and for the person to stop being fearful about the things that the TV is saying to them. The person may want help with making sense of their experiences. If someone believes that they are feeling this way because they’ve been abandoned by God, you can pour medications into them until you are blue in the face: they will not help the core problem. Yes, of course you can re-balance their dopamine, serotonin, GABA and acetylcholine receptors. But if their core belief has to do with abandonment, your efforts are unlikely to be crowned with success.

These issues came up again when I had the privilege of speaking to a meeting of the National Alliance of the Mentally Ill in Natchez, Mississippi last week.

There were all the usual questions about advances in mental health, and on the chances for recovery. My answer to that one is always the same: the chances for recovery from any mental illness – including schizophrenia and bipolar disorder – are better than they have ever been. The largest single barrier is expectation. If doctors, psychologists and therapists assume that nothing can be done apart from controlling symptoms, then it is unlikely that people will get better. We all know what will happen if we start the day assuming that’s it’s going to be terrible.

I’d like to highlight two blogs – here and here – that were started by the same person after she had recovered from a psychotic episode. She contacted me after my earlier posts. She has an excellent website which she started after an exchange with two psychiatrists who said essentially the same thing:
“If the person can be cured, then it is NOT schizophrenia. Schizophrenia is a chronic mental illness that has no cure.”

This is not true: but rather than being an indictment of psychiatry, it’s an indictment of bad psychiatry. We have a great deal of evidence that the brain is a highly plastic organ, and that many of the typical changes seen even in unmedicated people with the illness can return toward a normal pattern. This shouldn’t be a surprise: it has been known for many years that at least a third of people who carried a diagnosis of schizophrenia recover completely. To say that the recovery indicates that the original diagnosis was wrong is an extraordinary piece of circular reasoning.

The statement also implies that the writer doesn’t see a difference between healing, treatment and cure, which for me are three different interactions.

There is also another point that I made in Natchez: psychiatric diagnoses are still descriptive and are therefore largely at the level of the rest of the medicine of 100 years ago, when a person might be diagnosed with “dropsy,” “anasarca” or “icterus.” Terms now rarely used because we understand the underlying pathology. In the same way terms like schizophrenia will eventually give way to descriptions based on the biological, psychological, social and spiritual issues going on in a person.

Because the diagnoses are descriptive, getting too worried about the precise one is unlikely to be helpful. I once had a family become very angry with me. Their son had seen many specialists, who had all offered different diagnoses. After many day’s observation and exhaustive investigations, the one that I came up with did not please them. Because I wanted to treat their son as a human being with a problem that had responded to an antipsychotic and therapy, but they wanted him to have a less intimidating diagnosis. I tried in vain to explain that these were all just descriptors, and the important thing was that he was getting better with our treatment.

The reason for making a diagnosis at all is so that we can communicate, that it may guide treatment and allow us to offer some advice about prognosis. If someone has a heart attack, it is usually not too difficult to diagnose it. The reason for the diagnosis is not so that we can write it on a form or so that we can label someone, but because it can help guide us.

I certainly don’t agree with every one of points made in the articles that he’s posted, but that’s just fine. Active debate is always better than ignoring each other. Or as Winston Churchill once said, “Jaw, jaw, is better than war, war.”

On the main points in these blogs, I think that we are in complete agreement:

  1. Even without drugs it is possible to induce mania and psychosis in just about anyone: sleep deprivation, arousal and sensory overload will usually do it in a few days. If someone has a family history of psychiatric problems it will likely take half as long. If they have a personal history it might take a quarter as long.
  2. Recovery should be the aim for anyone with a psychiatric problem.
  3. Recovery is not necessarily the same as cure.
  4. Not all people diagnosed with “psychiatric problems” have them: some are having genuine spiritual experiences: I’ve seen many people going through kundalini and other types of spiritual awakening who had been given psychiatric diagnoses. I used to get some raised eyebrows when I had a string of referrals from clergy and spiritual teachers that usually read something like, “I don’t know if this person is psychotic or possessed. Please could you see them and advise me.”
  5. The quest for meaning and purpose is essential to our humanity. I have seen some of the most damaged of people with large traumatic holes in their brain trying to extract meaning and purpose from what had happened to them. Psychotic, manic, depressed and cognitively impaired, but still trying to work out the meaning for them personally.

The major psychiatric illnesses can be very hard to help: I regularly see everyone else’s problems when I travel: 45 countries and 47 states at last count. But it’s very unusual to find someone for whom we can do nothing.

But I never let clinicians give up: the people who come to us for help deserve better than that.

And for people who got through the process on their own, I congratulate you. But I beg you, please don’t suggest to everyone that they can do the same thing. Many need outside help that addresses all five dimensions of their being.

When Is It An Illness?

There’s been a very worrying trend in recent years, and that is constantly to medicalize every kind of behavior: we are no longer allowed to be shy, we have to be “socially phobic;” many things once regarded as vices, like excessive gambling, drinking or eating are now being re-cast as impulse control disorders and adolescent temper tantrums could be “Intermittent explosive disorder.” And I now read a report about giving selective serotonin reuptake inhibitors (SSRI) antidepressants to people with emotional lability.

In April of this year the Public Library of Science published a series of articles on the important topic of “disease mongering,” which two authors define as “the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments.” The authors made the point that some of the medicalization of human behavior is being driven by some pharmaceutical companies. They picked on several conditions or illnesses in which claims of prevalence and severity have been inflated in order, they claimed, to generate a need for medicines. One of their targets was female sexual dysfunction, where there has been a serious attempt to convince the public in the United States that 43% of women live with this condition. Many experts have heavily contested those figures.

One of the big worries about expanding the boundaries of an illness is that it is easy to throw out the baby with the bathwater. To use this last example: saying that the figures for female sexual "dysfunction" are inflated can lead some clinicians to dismiss everyone who has a problem, and then not to treat people with genuine organic difficulties. It is tragic to see people referred to a psychiatrist for a physical problem like low testosterone or undiagnosed diabetes or thyroid disease.

There can also be marked differences of opinion about the nature of illness. “Premenstrual dysphoric disorder,” (PMDD), is a particularly severe premenstrual syndrome, with some additional mood features. The American Psychiatric Association has precise diagnostic criteria for PMDD. The regulatory authorities in the European Union decided that this was not a real illness and declined to let a pharmaceutical company market a medicine for it.

I’m all for doing anything that I can to help people and to alleviate suffering. Part of the problem is that it is acceptable to have a “disorder.” The prevailing attitude is that no one can be blamed for being sick. The reality is that by most estimates, 70% of human illness is caused by lifestyle choices. By turning everything into disorders we take away our responsibility for our actions.

Most people are not looking for the causes of their troubles, they want a quick fix. Changing is hard, it is inconvenient and it is much easier to believe a pill will make everything better.

The second issue is that “better living through chemistry” may not be. There’s been a question rumbling round for some time now: has the over-exposure of young people to antibiotics, analgesics and sleeping tablets, been partly responsible for the rise in asthma and in substance abuse in later life? We don’t know the answer but it is important for us to think about.

The third point is that we need to think about what we are doing to ourselves if we want to medicate our way to happiness. Do we really want to deny ourselves the opportunity for becoming happy by our own actions rather than relying on a pill and being told what is normal?

P.S. Four years ago the Nuffield Council on Bioethics produced an important report entitled Genetics and Human Behaviour: the Ethical Context. It looked at some of the ethical challenges that are coming with the constant new discoveries in biology, and warned against the dangers of widening diagnostic categories, to encourage the use of medication by people who would not necessarily be thought of as exhibiting outside the normal range. It is well worth reading.

How Many Angels Can Dance on the Head of a Needle? Moving Beyond the Metabolic Syndrome

I have written a great deal both on this blog and in scholarly articles, about insulin resistance and the insulin resistance and metabolic syndromes.

You will have noticed that I’ve always used the term insulin resistance syndrome.

This is not a matter of semantics. For years now I’ve been worried about the splitting that’s been going on in the field: we currently have six sets of definitions of the metabolic syndrome. And apart from the fun of going to all those conferences in exotic parts of the world, you have to ask what’s been achieved by these ever more divisive attempts to “define” the medical consequences of insulin resistance.

The American Diabetes Association has begun to promote the concept of “cardiometabolic risk.” The Association has established a national Cardiometabolic Risk Initiative (CMRI) to stress the association between diabetes, heart disease and stroke. The idea of introducing this umbrella term is to help people better understand and manage all diabetes and cardiovascular risk factors, and to side-step some of the controversy surrounding the definition of insulin resistance or metabolic syndrome and which cluster of variables are in and out.

A new Cardiometabolic Risk (CMR) Calculator to help us evaluate an individual’s risk of diabetes or vascular disease should be available by the end of the year.
The formula already includes factors such as:
1.    Body mass index
2.    Waist circumference ratio
3.    Fasting plasma glucose
4.    HDL-cholesterol
5.    LDL-cholesterol
6.    Triglycerides
7.    Apolipoprotein B
8.    Blood pressure
9.    C-reactive protein
10.  Age
11.  Sex
12.  Race/ethnic origin
13.  Family history
14.  Tobacco use

Part of the reason for this new initiative is the discovery that pre-diabetes, or impaired fasting glucose, where plasma glucose levels are 100-125 mg/dl, is associated with a high prevalence of cardiovascular disease risk factors such as obesity, hypertension and dyslipidemias.

The person who first proposed the insulin resistance syndrome, a.k.a. syndrome X, a.k.a. metabolic syndrome, is Gerald Reaven who first recognized the syndrome in a landmark paper in 1988. He recently gave a lecture entitled; “Insulin Resistance Versus Metabolic Syndrome: Different Names, Different Concepts, Different Goals.” I am in complete agreement with his basic proposition, which is that insulin resistance explains the clustering of all of the components that make up the metabolic syndrome. So Gerry’s position is that there’s no point in trying to make a diagnosis of metabolic syndrome: everything is due to insulin resistance.

So instead of wasting time and resources in trying to diagnose metabolic syndrome, it is much better to understand the pathophysiology: what is going on at the molecular level, how these processes produce risk factors, and whether we can predict others. We should identify and treat each of the underlying processes and the complications of insulin resistance. If we are going to have a syndrome, it should be called insulin resistance syndrome.

And let’s stop these academic debates and get on with the job at hand: there is a 600% variation in peoples’ ability to have insulin transport glucose into cells. More than half the US population is destined to develop at least some degree of insulin resistance, so we need to look for better ways to identify people who have it, and to apply the principles of integrated medicine to keeping them healthy.

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Insulin Resistance, Insulin Resistance Syndrome and Race

I often hear clinicians say that they are not too clear about the differences between insulin resistance and insulin resistance syndrome. Let me define them, and then tell you why they are so important, and why everyone needs to be informed about them.

First, insulin is a hormone produced primarily in the cells of the Islets of Langerhans in the pancreas. It has over 500 functions in the human body, but its main actions are on the regulation of the metabolism of carbohydrates and fats. Insulin enables glucose – one of the major sources of energy – to move into many of the cells in the body. Insulin is also involved in the conversion of glucose to glycogen. These two actions lower the blood glucose level.

Insulin resistance is defined as an impaired biological response to insulin. It is a condition in which many of the cells of the body – mainly in the liver, fat and muscle – become resistant to the effects of insulin. The normal responses to a given amount of insulin are reduced. As a result, higher levels of insulin are needed in order for insulin to have its effects. There are many potential causes of insulin resistance: genetic; an increase in intra-abdominal fat; smoking cigarettes; being of low birth weight; and there are some prescription medicines that can cause insulin resistance. Insulin resistance is one of the underlying causes of type 2 (maturity onset) diabetes mellitus, as well as an array of other illnesses including polycystic ovarian syndrome. Most studies have suggested that around a third of people living in the United States and Western Europe have insulin resistance, and there are marked ethnic differences.

The insulin resistance syndrome has several other names: Metabolic syndrome; (Metabolic) Syndrome X; Dysmetabolic syndrome; Reaven’s syndrome; multiple metabolic syndrome. There are several sets of criteria for defining the insulin resistance syndrome. In the USA it is usually defined as the presence of 3 or more of the following:
1. Abdominal obesity (Waist circumference >40 inches in men; >35 inches in women
2. Glucose intolerance (fasting glucose ≥110 mg/dL)
3. Elevated blood pressure ≥130/85 mmHg
4. Triglycerides >150 mg/dL
5. Low HDL (Men: <40 mg/dL; women: <50 mg/dL)

There is a constant debate in the medical literature about whether insulin resistance syndrome is an illness, and what should be included in it. It is important, because it appears to predict the development of diabetes and coronary artery disease, and between 20 and 25% of the population of the Western world has it. So what normally happens is that a person develops insulin resistance, which eventually evolves into the insulin resistance syndrome, before diabetes and heart disease appears. There can be as long as twelve years between the development of insulin resistance, and the diagnosis of diabetes, and we have very good evidence that lifestyle changes can dramatically reduce the risk of moving from insulin resistance to the insulin resistance syndrome and diabetes.

It has become quite well-known that people of African and Asian Indian heritage are at increased risk of developing insulin resistance, and some of the sequelae of insulin resistance: insulin resistance syndrome, diabetes mellitus, hypertension and gout. These may in turn lead to increased rates of myocardial infarction and strokes. A study presented last Monday at ENDO 2006, the annual meeting of the Endocrine Society in Boston helps further clarify some of these ethnic differences. Researchers analyzed data from the Insulin Resistance Atherosclerosis Study (IRAS), designed to assess relationships between insulin resistance and cardiovascular disease in a large multi-ethnic population.

The investigators divided data from female IRAS participants into different groups based on body mass index (BMI), a measure of body fat based on height and weight. A BMI of less than 25 is usually considered "normal." The analysis revealed that 47 percent of black women of normal weight had insulin resistance, compared to less than 20 percent of the Hispanic or White women. Both insulin resistance and the likelihood of developing type 2 diabetes increase as obesity increases. It had long been suspected that there was an independent effect of race, but this study not only shows that race alone may influence insulin resistance, but that we may therefore need to change the definition of obesity in women of African heritage.

The news reports on this important finding failed to mention that previous research has found something very similar in Asians from India, China and Japan. Each of these ethnic groups may develop insulin resistance, insulin resistance syndrome and diabetes without being obese, though obesity dramatically increases their risks of running into trouble.

It is relatively simple and inexpensive to measure insulin resistance, and many metabolic experts, including your humble reporter, have, for more than a decade, been measuring it in high-risk individuals. Clearly we cannot do anything much about an ethnic or genetic risk, but we can alter the way in which the body responds to that risk. If a person is insulin resistant, diet, exercise, specific nutritional and herbal interventions and occasionally medications, may all reduce the risk of developing diabetes and heart disease.

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Diagnosing Illnesses

I am pleased to say that my recent item about Categorical and Dimensional ways of looking at illnesses has provoked some spirited correspondence and questions. Far from indicating that the art of diagnosis is arbitrary and vague, it reflects clinical reality. I get a great many magazines and articles from supporters of alternative medicine, and some have so misunderstood the principles of diagnosis that they think that illnesses don’t exist! One of the reasons for this flawed thinking is that we all have a bad case of physics envy. The success of Newtonian physics and Humean philosophy has seduced us into thinking that everything has a single cause, and that every item and every event has clearly defined boundaries.

We are complex and ever-evolving individuals and we are also members of of constantly changing groups, so we have to be seen not only as "objects" wth diagnostic labels, but also as people with a time and developmental dimension: you and your life challenges will change over time as you continue to develop and evolve. As the great Scottish poet Robert Burns said: Nature‘s mighty law is change.”

I think that is important to let you know how this field is developing, and why it is that we cannot always come up with a cut and dried answer to the question "Well, what has he got then?"

On May 24th, I wrote a short article about the inter-relationships between schizophrenia and bipolar disorder that you may find interesting. It develops some of the points that I made in my previous article.

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Categorical and Dimensional Diagnoses

I recently had the great pleasure and privilege of speaking to a group of health care providers in Monteagle Tennessee, and an interesting question came up. The sick citizens of Tennessee are having a hard time now because of the problems with TennCare. This problem is not new, and is not only happening in Tennessee. There is no malice or lack of compassion involved, it is simply a matter of $$$.

And because we need to have a diagnosis in order to apply for reimbursement, the discussion soon turned to the matter of psychiatric diagnosis. It’s pretty well known that I have lectured on the subject of psychiatric diagnosis all over the world: it was actually one of the reasons that I was first invited to come to the United States. The problem is this. When we classify an illness, we can either think of it as a “category,” like strep throat or a heart attack: an illness that has clearly defined margins. Or we can think about it as a “dimension.” So instead of seeing illness as a separate entity, we think of health and illnesses as lying on a spectrum, running all the way from being healthy and well, through mild degrees of just not feeling “right,” to being severely ill. Reimbursement requires categorical diagnoses, even if they do not reflect clinical reality.

This second – dimensional – way of thinking is particularly useful when we are thinking about psychological problems. The world is full of people who are a little bit obsessive, or who get bad mood swings. But they are not bad enough to be called an “illness.” In fact, having some of these traits can be enormously beneficial: they have continued in the population because they have a survival advantage. If I need to have surgery, I sincerely hope that my surgeon will be mildly obsessive, rather than discovering a few weeks later that he had forgotten to do something he should have!

When I am teaching about schizophrenia and bipolar disorder, I discuss how they lie on a spectrum that passes through so-called schizoaffective disorder, cluster A personality disorders – schizoid, schizotypal and paranoid – to schizophrenia. (You may be interested in looking at the blog entry for May 24th here). I also make the point that I can make just about anyone psychotic. Come and live in my research center for a week, where you will not be allowed to eat or sleep; you will have to drink 30 cups of coffee a day and take up smoking. I can guarantee that most people will develop some symptoms. If you have a family history of mental illness it would not take a week, but perhaps 3-4 days. And if you have a personal history of mental illness, it could take no more than a day or two. The key is arousal. People experiencing high levels of arousal may well start to experience manic, depressive or psychotic phenomena. The types of symptoms that are experienced are determined by background, environment and genes. This sort of “reactive” psychosis is completely different from the other end of the spectrum, where, particularly in males, there are demonstrable abnormalities in the brain – shifts in laterality and progressive loss of grey matter in specific regions, with swelling in other – many of which are present before the onset of full-blown psychosis, and before exposure to medications. Though some of the older antipsychotic medicines may make the situation much worse.

In January of 2005, some of my colleagues in Edinburgh, Scotland, published an important paper after studying people at high risk of developing schizophrenia. Many of these high-risk people did not develop the illness, although some had transient and partial symptoms. We know that some family members – the carriers of the genes – may also suffer from some symptoms of the illness. This shows us how genes do not control everything: many people suffer from mild cases because their environment or personality helped protect them from developing a full-blown illness. In other words: biology is not destiny. These findings also give us important clues as to how we may be able to reduce the risk of an illness expressing itself.

Diagnoses are not always cut and dried. Medical professionals are sometimes unable to reach a definitive diagnosis, needing to wait and see how things develop. Having specialized in the diagnosis and treatment of tough cases, family members sometimes become very upset because their loved one does not have a clear diagnosis. Psychiatric diagnosis is still primarily clinical and often needs time to clarify. Although there are many demonstrable neurological disturbances in people with schizophrenia and bipolar disorder, even the most sophisticated brain scans are still not at the stage where we can make diagnoses.

If we think in terms of dimensional diagnoses that reflect clinical reality, it helps us to understand the range of symptoms that people can experience. It also speaks to the point that I have made time and again: symptoms are signs, and they are signs that can be generated in the body, in the mind, in relationships (not just because some might be stressful), and they may have subtle system or spiritual origins. Successful treatment needs us to identify the origins in an individual and to work with all the five main dimensions of the individual.

And by the way, we have succeeded in helping virtually all of our seriously mentally ill patients back to living the kind of lives that they want: jobs, relationships and so on. So this is not an academic discusssion, but instead something supremely practical

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Sick Building Syndrome

Sick building syndrome (SBS) was first recognized in 1982, and is a combination of symptoms associated with an individual’s place of work – most often an office building -though there have also been instances of SBS in residential buildings. A 1984 World Health Organization report into the syndrome suggested up to 30% of new and remodeled buildings around the world might be linked to symptoms of SBS.

Many symptoms have been associated with SBS, including:

  • Headache
  • Dry or itchy skin
  • Chronic fatigue
  • Irritation of the eyes nose or throat, sometimes with a dry coughs
  • Dizziness
  • Nausea
  • Difficulties in memory and concentration
  • Extreme sensitivity to smells or bright lights

For SBS to exist, these symptoms must disappear soon after the occupants go outside.

There have been many explanations for these symptoms, primarily related to environmental pollutants. But I have something to add to that list. Some time ago I spent a happy year working at the Charing Cross Hospital in London during which I made an odd observation. On days that I worked in the laboratory on the tenth floor, I would be exhausted by the middle of the day, while on days when I worked in the outpatient clinic in the basement, I could easily get through a 5 hour clinic without difficulty. I mentioned it to a neurophysiologist friend who told me something very interesting: it had been discovered that on days when the wind blew at 5-10 miles an hour, the building began to vibrate like a giant tuning fork, and that the vibration was at its worst between the tenth floor and the top of the hospital. The vibration was imperceptible to most people, but I clearly had the misfortune to be sensitive to it. Yet without this experience, I might never have known of the potential adverse effects of vibration of the human body.

I have been consulted by a number of corporations and government organizations that have had trouble with people getting sick in certain buildings. Until now we have thought that it was all environmental, and that it could be anything from vibration to poor ventilation, chemicals, molds and many things in between. So I was very surprised to see a report published in the journal Occupational and Environmental Medicine from a first rate research group at University College London.

The British Inland Revenue Service demolished an entire 19-storey building in Bootle, Merseyside, after almost half of the employees had developed illnesses compatible with SBS. In a study published two and a half years ago, it was claimed that adding ultraviolet light to ventilation systems to kill microbes could vanquish the symptoms of SBS. But this new research suggests that the cure may actually be better management.

The new study included 4,052 civil service workers between the ages of 42 and 62 who were enrolled in a larger general health study. The men and women in the study worked at 44 different office buildings around London. The workers completed surveys designed to assess their general health and whether they had symptoms linked to SBS. They were also asked questions about the physical properties of the offices that they worked in and the stresses associated with their jobs.

As in earlier studies, women tended to have more symptoms associated with SBS than did men. Younger workers also had more of the symptoms than older workers. Almost one in five women and one in seven men reported five or more symptoms associated with sick building syndrome.

Now here was the surprise: the authors found little association between physical work environment and the symptoms. But there was a strong association between the symptoms and feelings of having high job demands and little support in the workplace. They also found that the more control people have over their workstation, the fewer symptoms were reported.

Though the findings fail to support "sick buildings" as a common cause of worker illness, the study should not be interpreted as meaning that the physical quality of the workplace is unimportant. It is most likely that we are dealing with a combination of physical and work related factors.

As I was reading the report and reviewing the rather vague but often quite severe symptoms, I was reminded of some recent work that I have been doing on burnout: I’ve just published an article about it. My interpretation of this study is that many cases of SBS are likely a form of burnout that is partially modulated by physical factors in the environment.

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Personal Evaluation of Wellness

As a physician, I am trained to know what questions to ask in order to diagnose health problems and understand what course of action needs to be prescribed to alleviate or cure the problem.  I can be a nightmare for my secretary if she makes my schedule tight because I can spend over an hour with a patient on a first visit.  She would argue that it is more like two hours, but I will admit that I take whatever time I need to gather the pertinent information.

I recently wrote an article that allows one to conduct a personal evaluation of his or her own wellness.  Click here to be taken to it.  It is based on my many years of experience and research.  You will notice that the questions cover the 5 main areas (Physical, Psychological, Social, Subtle and Spiritual) that are key to achieving an overall feeling of wellness and good health.

Keep in mind that this is a bit of a shortened version, there are many more questions that can be helpful.  However, this should get you started about thinking of ways to improve your own sense of health, meaning and purpose.

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