Press Release details. Embargoed until 11.00 am hours Wednesday 11 November 1998.
OP SHEEP DIP PATIENTS ARE UNWELL AND MUST BE TREATED SYMPATHETICALLY, SAYS REPORT.
A report published today says that patients suffer genuine and often very severe symptoms associated with exposures to organophosphate (OP) sheep dip*, and they must be taken seriously and treated sympathetically by doctors. The joint report from the Royal Colleges of Physicians and Psychiatrists took evidence from patients and patient groups which showed that they felt strongly that hospitals, doctors and the regulatory authorities had not managed their illnesses appropriately.
The working party, which included representatives from patient groups, collected evidence from patients and doctors in order to be able to advise on the clinical management of patients with symptoms which may be attributable to chronic OP sheep dip exposure.
The conclusions and recommendations of the report are as follows:
Evidence received concerning symptoms.
The working party received evidence from sufferers who described a wide range of symptoms, many of which were severe; for example, headaches, limb pains, excessive tiredness, sleep disturbances, poor concentration, mood changes and suicidal thoughts. The symptoms were often so distressful that sufferers were forced to stop working with serious consequences for them and their families.
Analysis of clinical symptoms
The symptoms and the distress are genuine and can continue for a long time; of particular concern is that some individuals seriously consider suicide. Other patients experience memory loss and poor concentration. Further studies will be needed to understand the cause of their symptoms, but it is essential now to provide an adequate level of care for sufferers.
Evidence received concerning diagnosis and management
Existing clinical services do not, in the main, provide satisfactory management for those with symptoms associated with OP sheep dip exposure, maybe partly because of uncertainty as to the cause of the symptoms. However, many patients have benefited from the support of self help groups.
We currently lack objective evidence of the value of some of the treatments offered by NHS practitioners or by those in the private sector, although some sufferers were helped by them.
OP REPORT RECOMMENDATIONS
The initial consultation requires sympathetic handling; the patients symptoms must be treated seriously.
Detailed clinical history and examination are essential; basic laboratory tests are useful. Further investigation should depend on the specialist's assessment of the findings. As many of these patients are found not to have abnormalities on specialised testing, it is important at the outset to discuss expectation and thus avoid later disappointment and frustration.
Open minded, practical approach to management is recommended. This can follow principles used in a range of other poorly understood medical disorders. Management must begin by establishing a therapeutic alliance with the patient and agreeing goals. Specific symptoms, such as depression, fatigue, sleep disorder and suicidal thoughts should be managed with, where appropriate, anti-depressants as well as cognitive behavioural techniques. This is to counteract beliefs and subsequent behaviour which may develop in the aftermath of an acute illness and serve to perpetuate it. Preventing a recurrence of symptoms which might result from re-exposure to OP chemicals is an area which requires careful handling and would particularly benefit from well designed studies.
Existing clinical services for patients with symptoms associated with OP sheep dip exposure are unsatisfactory. The patient's GP should in most cases be responsible for diagnosis and management, but specialist referral may be needed in some cases. Consideration should be given to setting up groups of specialists (forming a "virtual" centre) to complement existing National Poisons Information Services treatment centres.
The working party recommended epidemiological studies aimed at developing means of quantifying OP sheep dip exposure and relating this to clinical symptoms, and prospective trials to assess the effectiveness of possible treatments.
Professor John Newsom-Davis, Chairman of the joint working party said:
"I hope that this report will result in greatly improved medical care for those unfortunate sufferers from OP sheep dip exposure and that it will prompt further research."
* Acute severe exposure to OPs is known to cause specific neurological syndromes because these compounds interfere with nerve function. Low dose (intermittent or continuous) exposure is associated with a variety of symptoms, but how OPs might cause those effects is presently unknown.
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