accepted 19 October 2005.
Available online 28 August 2006.
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.
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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. firstname.lastname@example.org
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.
PMID: 19201227 [PubMed – indexed for MEDLINE]
PMID: 3612324 [PubMed – indexed for MEDLINE]
J Forensic Sci. 2009 Mar;54(2):474-7. Epub 2009 Jan 31.
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: email@example.com )
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
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.
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. 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. Psychotic behavior affects the ability to manage and maintain personal relationships, employment, medical care, and in some cases, housing. 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.
Involuntary commitment and incarceration often become necessary in cases of severe mental illness. 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.
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. 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. 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.
Click here to read the full article at the Journal of Participatory Medicine website.