Secondary mania in a patient with delayed anoxic encephalopathy after carbon monoxide intoxication

Department of Neurology, Kwandong University College of Medicine, Myongji Hospital, Gyeonggi, Korea

Received 6 July 2005;
accepted 19 October 2005.
Available online 28 August 2006.
Mania is a rare clinical manifestation of delayed anoxic encephalopathy (DAE). Prior case reports on mania after hypoxic injury involved patients with a previous history of mania or depression, potentially reflecting a recurrence of premorbid mood disorders after hypoxia rather than pure secondary mania.
Herein, we report a 55-year-old woman with no past history of neurological or psychiatric illness, who developed mania as a symptom of DAE after carbon monoxide intoxication. Brain magnetic resonance imaging showed diffuse white matter lesions, particularly visible in the frontal white matter. This frontal lesion may have prevented frontal inhibition from being transmitted to the basotemporal limbic area, resulting in mania manifested as a burst of limbic activity

Recognizing Occupational Disease — Taking an Effective Occupational History

Central New York Occupational Health Clinical Center,
State University of New York Health Science Center at Syracuse, Syracuse, New York
Syracuse, New York
Central New York Occupational Health Clinical Center,
State University of New York Health Science Center at Syracuse, Syracuse, New York

Occupational exposures contribute to the morbidity and mortality of many diseases. However, occupational diseases continue to be underrecognized even though they are responsible for an estimated 860,000 illnesses and 60,300 deaths each year. Family physicians can play an important role in improving the recognition of occupational disease, preventing progressive illness and disability in their own patients, and contributing to the protection of other workers similarly exposed. This role can be maximized if physicians raise their level of suspicion for workplace disease, develop skills in taking occupational histories and establish routine access to occupational health resources.

The patient with a possibly work-related illness frequently seeks care initially from a family physician. The physician’s recognition of a possible link between work and disease often determines the diagnostic tests that are performed and the treatment that is recommended. Early diagnosis of an occupational illness may prevent progressive morbidity and disability from conditions such as occupational asthma and may facilitate the reversal of adverse effects from exposures to substances such as lead.1 The identification of an occupational illness in one patient also provides the physician with an opportunity to protect other patients with similar exposures.2 Since much remains to be learned about the effects of toxins on health, the family physician is in a crucial position to contribute new information about occupational disease.

To read full article go here.

Insomnia Related to Chemical Exposure

Sleep Med Rev. 2009 Jun;13(3):235-43. Epub 2009 Feb 7.

Sleep disturbances and occupational exposure to solvents.

Viaene M, Vermeir G, Godderis L.

Department of Occupational, Environmental and Insurance Medicine, Catholic University of Leuven, UZ St. Rafaël, Leuven, Belgium.


A solvent can be defined as “a liquid that has the ability to dissolve, suspend or extract other materials, without chemical change to the material or solvent”. Numerous chemical or technical processes rely on these specific properties of organic solvents in industry. Occupational exposure to solvents is not rare and some activities may cause substantial exposure to these substances in the workforce. Short-term or acute exposures cause a prenarcotic syndrome, and long lasting exposure conditions have been associated with various neurological and neuropsychiatric disorders, e.g., anosmia, hearing loss, colour vision dysfunctions, peripheral polyneuropathy and depression, but most significantly with the gradual development of an irreversible toxic encephalopathy.

For the last 3 decades reports and epidemiological studies have been published reporting sleep disturbances among other complaints, related to long-term exposure to these compounds. In addition, the question has been posed if solvents can be the cause of a sleep apnoea syndrome in exposed workers, or on the contrary, if these workers are misdiagnosed and ‘common’ sleep apnoea syndromes are the cause of their chronic symptoms of fatigue and memory and attentional disturbances.

PMID: 19201227 [PubMed – indexed for MEDLINE]

Arsenic Induced Delirium

J Occup Med. 1987 Jun;29(6):500-3.
Neuropsychological impairment following inorganic arsenic exposure.
Bolla-Wilson K, Bleecker ML.
A 50-year-old chemical engineer, routinely screened for occupational arsenic exposure, was admitted with a delirium for which no known etiology was found. Elevated levels of arsenic were found in the urine and hair. The patient received chelation treatment with British anti-Lewisite; substantial amounts of arsenic were excreted and the toxic encephalopathy improved gradually over the 8-month follow-up period.
The patient was tested at 6 weeks, 4 months, and 8 months postdelirium with a battery of neuropsychological tasks. The pattern of results showed verbal learning and memory to be severely impaired while tests of general intellectual abilities and language remained unaffected. Follow-up examinations with no subsequent reexposure revealed improvements on specific cognitive tasks. It is unclear whether recovery of cortical functions occurred or if compensatory strategies were developed. It is proposed that a subacute exposure to arsenic may have contributed to the neuropsychological deficits.

PMID: 3612324 [PubMed – indexed for MEDLINE]

Toxicant exposure and mental health–individual, social, and public health considerations.

J Forensic Sci. 2009 Mar;54(2):474-7. Epub 2009 Jan 31.

Toxicant exposure and mental health–individual, social, and public health considerations.
Genuis SJ.
Faculty of Medicine, University of Alberta, 2935-66 Street, Edmonton, AB, Canada.
Thoughts and moods are the result of biological processes; disordered thoughts and moods may be the result of disordered biological processes. As brain dysfunction can manifest with emotional symptoms or behavioral signs, the etiology of some mental health afflictions and some abnormal conduct is pathophysiological rather than pathopsychological. Various studies confirm that some chemical toxicants which modify brain physiology have the potential to affect mood, cognitive function, and to provoke socially undesirable outcomes.
With pervasive concern about myriad chemical agents in the environment and resultant toxicant bioaccumulation, human exposure assessment has become a clinically relevant area of medical investigation. Adverse exposure and toxicant body burden should routinely be explored as an etiological determinant in assorted health afflictions including disordered thinking, moods, and behavior. The impact of toxicant bioaccumulation in a patient with neuropsychiatric symptoms is presented for consideration as an example of the potential benefit of recognizing and implementing exposure assessment.
PMID: 19187449 [PubMed – indexed for MEDLINE]

Behavioral approaches to toluene intoxication.

 Environ Res. 1993 Jul;62(1):53-62.
Behavioral approaches to toluene intoxication.
Saito K, Wada H.
Department of Hygiene and Preventive Medicine, Hokkaido University, School of Medicine, Sapporo, Japan.
Toluene is a chemical that is very useful in our lives but harmful to our health. Behavioral toxicology has the merit of providing an accurate indication of functional toxicity to the CNS through the analysis of learned behavior and use of behavioral analysis techniques that give us various learning paradigms for investigating the effects of chemicals on memory, stimulus discrimination, attention, time perception, etc.
Learning is a common ability among various species and it is possible to predict toxicity to human health from animals. Behavioral toxicology is assumed to play an important role in occupational and environmental health. Using typical test batteries such as shuttle, Sidman, and pole-climb avoidance, and FI, FR, DRL, and DMS tasks, the effects of toluene were investigated and the results were reviewed. One important objective of a test battery is to be able to detect already-known toxicity. Behavioral toxicology research indicated such effects of toluene toxicity as hyperactivity, ataxia, addiction, insomnia, and memory disturbances. Some excellent results which might indicate clinically unknown effects of toluene such as hearing loss, impairments of time discrimination, and improvements of STM were also demonstrated.
Introduction of blood and brain toluene levels as an index of toluene exposure and more sophisticated learning tasks which reflect specific higher nervous functions of the CNS has been proposed.
PMID: 8325266 [PubMed – indexed for MEDLINE]

Human Exposure Assessment and Relief From Neuropsychiatric Symptoms: Case Study of a Hairdresser

Stephen J. Genuis, MD, FRCSC, DABOG and Shelagh K. Genuis, BScOT, MLIS

From the Department of Obstetrics and Gynecology (SJG), University of Alberta, Canada (SKG)

Correspondence: Address correspondence to Dr. Stephen Genuis, 2935–66 Street, Edmonton Alberta, Canada T6K 4C1 (E-mail: )


Human exposure assessment and the results of implementing ‘precautionary avoidance’ suggested a relationship between a hairdresser’s neuropsychiatric symptoms and occupational exposure to potentially hazardous chemicals. A variety of investigations in response to patient complaints of depression, emotional instability and various physical symptoms revealed no objective abnormality; the CH2OPD2 mnemonic (community, home, hobbies, occupation, personal habits, diet and drugs) recommended by the Ontario College of Family Physicians was used as a first-line screening tool to assess potential environmental exposure to toxins. After occupational leave of absence, the patient reported cessation of symptoms. Environmental causes for familiar medical problems are frequently undiagnosed; it is recommended that, where appropriate, a screening tool for evaluation of environmental exposure to toxics be incorporated into primary care assessment and management of patients.

The interplay between human health and the environment is garnering increased attention in the medical literature, at scientific gatherings, and in the popular press. Although it is recommended that medical students attain basic skills in eliciting an exposure history,1,2 environmental history-taking or consideration of environmental causation for common medical problems occurs infrequently in everyday clinical practice.3,4 Because “primary care practitioners often have a low index of suspicion that the source of the patient’s problem may be in their environment or workplace exposure,” multiple referrals are commonly made, frequently without problem resolution.5 In response to accumulating evidence of negative patient outcomes, not only from short-term exposure to toxic agents but also from long-term, low-level exposure,6 it is recommended that physicians consider environmental causation for illness, integrate environmental exposure assessment in clinical practice and “… advance precautionary practice in the presence of scientific uncertainty.”7

Continue reading “Human Exposure Assessment and Relief From Neuropsychiatric Symptoms: Case Study of a Hairdresser”

Occupational Disease manifesting as Psychosis

Psychosis possibly linked to an occupational disease: an e-patient’s participatory approach to consideration of etiologic factors

Summary: The purpose of this narrative-analysis is to: Consider medical conditions and substances that may induce psychotic symptoms; identify some unique challenges that providers and patients dealing with psychotic disorders must overcome in order to establish effective recovery strategies; and to illustrate the benefits of participatory concepts in mental health care. This article describes one patient’s experience with discovering that her psychosis might have been caused by toxic encephalopathy from occupational exposure, and the benefit she gained from becoming an active participant in her own care.

Keywords: psychosis, mental health, mental illness, bipolar disorder, schizophrenia, violent behavior, e-patient, participatory medicine, Psychiatric Advance Directives, PADs, Joint Crisis Plans, JCPs.

Citation: Mangicaro MA.  Psychosis possibly linked to an occupational disease: an e-patient’s participatory approach to consideration of etiologic factors. J Participat Med. 2011 Mar 28; 3:e17.

Published: March 28, 2011.

Competing Interests: The author has declared that no competing interests exist.

The Importance of Patient Empowerment in Mental Health Care

As an individual who has experienced psychotic episodes, I believe that the emergence of participatory concepts in mental health care can empower consumers to become engaged in recognizing symptoms, selecting treatment options, and working in partnership with providers to develop illness self-management recovery programs.[1][2] Patient empowerment is critically needed to strengthen the mental health care system. Innovative strategies targeting informed, safe decisions are needed in order to effectively involve mental health consumers in the prevention and recovery of psychotic disorders.

My journey to becoming an empowered patient started by developing an understanding of psychotic disorders and the dismantling effect they have on one’s life. Psychosis results in loss of contact with reality, sometimes including delusions, insomnia, hallucinations or impaired cognitive functioning.[3] Psychotic behavior affects the ability to manage and maintain personal relationships, employment, medical care, and in some cases, housing.[4][5] A psychotic experience distorts an individual’s belief system and perceptions. Most individuals experiencing a psychosis have poor insight regarding their illness and refuse to acknowledge that a problem even exists.[6]

Involuntary commitment and incarceration often become necessary in cases of severe mental illness.[7][4] During times of psychiatric crisis that results in involuntary commitment, people may experience a frightening loss of choice and self-direction, which can be damaging and traumatic. My experience led me to believe that forced hospitalizations failed to encourage participatory concepts. While intervention may be deemed an absolute necessity during a mental health crisis, coercive psychiatric treatment tends to have an adverse effect on patient empowerment because of the loss of autonomy and exclusion from participation in treatment options.[8]

To help overcome this, many mental health care advocates now recommend Psychiatric Advance Directives (PADs), or Joint Crisis Plans (JCPs). PADs are legal documents allowing individuals to express their wishes for future psychiatric care and to authorize a legally appointed proxy to make decisions on their behalf during incapacitating crises.[9][10] The JCP is a statement expressing a mental health consumer’s preferences for treatment in the event of a future psychotic episode. It is developed with the clinical team and an independent facilitator.[11][12] Use of these documents offers a potential alternative to compulsory treatment. They also act as an innovative tool for patient empowerment regarding treatment options and recovery strategies.[9][10][11][12]

Click here to read the full article at the Journal of Participatory Medicine website.

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