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Psychiatric Fallout From Toxic Exposure

Psychiatric Fallout From Toxic Exposure

  • A growing body of scientific literature associates psychiatric symptoms with man-made toxic substances and environmental exposure. Practical implications for psychiatrists are discussed in this Special Report collection. Scroll through the slides for short- and long-term behavioral and physiological effects of toxins. Descriptions are in the captions, with links to respective articles. To view the information in PDF format, click here.

  • An Update on Psychiatric Effects of Toxic Exposures
    Psychiatric effects of environmental and chemical toxins were described in the medical literature as early as 1850. In the 21st century there has been, sadly, no shortage of victims of environmental disasters to assess and treat according to guidelines presented in this Special Report on environmental and chemical toxins, with an introduction by Chair James S. Brown, Jr, MD, MPH, MS.

  • Neurobiology and Clinical Manifestations of Methamphetamine Neurotoxicity
    The short- and long-term behavioral and physiological effects of methamphetamine neurotoxicity are devastating. Illicit drugs such as “ecstasy” are often adulterated with methamphetamine. Solvent abuse that results in altered mental status and potentially lethal physical abnormalities remains a frequent presentation in the emergency setting. Occupational exposure to various solvents also results in neuropsychiatric injury, often referred to as “chronic solvent encephalopathy.” Contaminants including thallium or infectious agents such as anthrax can be consumed with illicit drugs. Methamphetamines are also considered an “emerging contaminant” of water, a term that describes the increasing number of toxins that enter the human environment—especially surface water. For a mobile-friendly view of the Figure, click here.

  • A significant percentage of methamphetamine users are HIV-positive and are being treated with antiretroviral agents, which may increase methamphetamine concentration in the plasma. Betulinic acid and its derivatives might potentiate neurotoxicity in high-dose methamphetamine users. The Figure represents synergistic neurotoxicity of methamphetamine (METH) and betulinic acid (BA) to monoaminergic terminals in the rat striatum of male late adolescent rats. For a mobile-friendly view of the Figure, click here.

  • Significance for the practicing psychiatrist
    Understanding the relationship between the molecular mechanisms underlying the neurotoxicity of methamphetamine and related clinical manifestations is imperative to provide more effective treatments. This article highlights neurobiology of methamphetamine toxicity, clinical manifestations of methamphetamine neurotoxicity, and implications for treatment of chronic methamphetamine users. For a mobile-friendly view of the Monarch notes, click here.

  • On the Mark: Translating Biomarker Technology to Clinical Neurotoxicity
    Chemicals that receive the most attention are those we are routinely exposed to in our daily lives. The sources of these exposures are as varied as the chemicals themselves: pesticides on produce, flame-retardant compounds on furniture, metals in drinking water, and various chemicals used to manufacture consumer products that have simplified our lives. Research on the impact of these chemicals has highlighted several neurological targets that are disturbed. These findings are further supported through population-based studies that have established some chemicals as significant risk factors for neurological deficits.

  • Significance for the practicing psychiatrist
    The etiopathogenesis of neuropsychiatric disorders is complex. The application and integration of a multidimensional biomarker assessment can significantly improve diagnostic accuracy and assist in formulating a suitable therapeutic intervention strategy. Exposure to neurotoxic chemicals is a significant contributor to a variety of neuropsychiatric. disorders. Such exposures and the subsequent pathogenesis that arises must be delineated from other exogenous or endogenous etiologies to effectively diagnose and treat the disorder. Application of a systems toxicology approach can leverage biomarkers of neurotoxicity and facilitate these processes. For a mobile-friendly view of the Monarch notes, click here.

  • The Influence of Diet on ADHD
    Emerging evidence reveals that aspects of diet can indeed affect ADHD. For example, research has consistently shown that restriction/elimination diets may be effective in reducing ADHD symptoms. In addition, for some youths, a diet free of processed foods containing additives, particularly colorings and preservatives, may improve symptoms. Further, the best established evidence to date indicates that the severity of ADHD symptoms may be reduced by a combination of supplementation with omega-3 fatty acids combined with reducing or removing processed foods, especially those high in food colors and preservatives.

  • Environmental Toxicants and Autism Spectrum Disorder
    A growing body of scientific literature associates symptoms of autism spectrum disorder (ASD) with environmental toxin exposure, including exposures from contaminants in herbal remedies, heavy metals (especially during fetal growth), polychlorinated biphenyls, bisphenol A, and organophosphate pesticides. The case vignette in this article describes ASD symptoms from the use of Ayurvedic herbs, which emphasizes the importance of asking patients about herbal use.

  • Understanding the Link Between Lead Toxicity and ADHD
    A report on the current status of lead as a contributor to pediatric psychiatric problems with recommendations on how to counsel families anxious about lead exposure. The author points out that levels above 5 µg/dL require clinical interventions and that levels lower than 1 µg/dL have been associated with behavioral problems. The importance of this finding is reflected by the recent Flint, Michigan, drinking water crisis in which 99,000 residents were potentially exposed to lead-contaminated water between 2014 and 2015.

  • Significance for the practicing psychiatrist
    When ADHD is present, a survey of possible lead exposure should be considered. Lead’s association with ADHD is well-established even at the historically reduced levels currently typical in the US population. Recent evidence supports a causal, not merely correlational, association even at supposedly safe levels of lead exposure. Clinicians can offer many practical steps to parents to mitigate potential harmful effects and risks of low-level lead exposure on brain development. For a mobile-friendly view of the Monarch notes, click here.

To view the information in PDF format, click here.


We have suspected this for far too long and ignored the continued erosion of the possible protections available through the FDA and the EPA (under earlier administrations). Chlorpyrifos, for example, has been suspect for almost two decades and the new, industry friendly, head of the EPA in March 2017 refused to ban it, in spite of more than reasonable (ok, my opinion) evidence that it is neurotoxic. Present in combination with a drug commonly used to delay labor at childbirth (think residue on partner's clothing), it is even more dangerous. Should there be future generations, they will probably consider our love affair with toxins on a par with the possible baleful influence of lead from pipes and a wine sweetener on the late (both senses) Roman Empire. At least the Romans had the excuse of ignorance.
More here: https://www.nytimes.com/interactive/2017/10/21/us/document-EPA-Chlorpyri...

Alex @

I am glad this article is here. My family and I have lived in Tulare, Ca. for over 20 years. It has been identified as having the "worst air" in the entire country. "Entire Country"!? It is in the foothills and some of it used to be underwater. It is hugely agricultural some to do with LA traffic blowing out way. It is scary and a lot of people here have Parkinson's and Alzheimer's eve though it is basically a small town. Scary and true this article. Major plans to move underway!

Patricia @

I have had personal experience with chemical brain Injury. It resembles early dementia. Executive skills are compromised. Short term memory is affected Stresses of everyday life worsens these symptoms There is mood problems and naturally relationship problems. It was occuoationally induced without proper occupational health and safety regulations being followed and before occupational health and safety issues were even regulated. Treatment has been antidepressants, regular blood work, counselling , management of stress. It helps to have been a health professional because I probably would be divorced It is something to keep in mind when working with males in dangerous occupations where relationships are affected and the spouse is either being abused and threatening to leave. She or he needs to be aware that is not them

Brenda E @

Any opinions on small dose tramadol usage.Stoppage of tramadol followed by insomnia >psychosis>depession in an elderly patient with old temporo-frontal cva ??


opiates, even low dose, work as anxiolytics and anti-depressives. The insomnia may be mild withdrawal and insomnia can lead to psychosis
sullivan, FASAM

gerald @

I have some knowledge of Tramadol. I work at a Methadone clinic and sometimes the patient's PCP will prescribe them Tramadol because the Methadone patient does not tell him about his addiction treatment. Tramadol will replace other opiates if taken together causing opiate withdrawals. Tramadol is actually the same thing as a new age anti-depressant. They made it a "Narcotic" because some of the "opiate medication addicts" started abusing the Tramadol. If you are getting off of it, please take as ordered for a week then cut in half for a week and in half every other day and so forth. Never take opiates together with Tramadol. Good luck!

Patricia @

All what is written and commented below are man-made disasters! Dr. Naseem Akhtar Qureshi MD, PhD

Naseem @

'Ayurvedic herbs use connected to ASD', OK, which one/s? This sounds as inaccurate as 'breathing causes disease'! Thank U!

Jose @

Why mercury is not discussed?

Aloyzio @

Seems the geoengineering is much more hazardous to all our health, before or after the GMO foods?

Cindy @

Neurotoxicity from fluoroquinolone antibiotics is a growing concern and must be ruled out. A differential diagnosis of mental illness includes asking which antibiotics the patient has taken in the last ten years.

In its most recent escalation of black box warnings, the FDA states "These medicines are associated with disabling and potentially permanent side effects of the tendons, muscles, joints, nerves, and central nervous system that can occur together in the same patient." CNS side effects include anxiety, confusion, depression, hallucinations, and suicidal thoughts, especially in the elderly. "The side effects occurred within hours to weeks after starting the fluoroquinolone, and at the time we received the reports, the side effects had continued for an average of 14 months to as long as 9 years after stopping the medicines." FDA, 7/26/2016. FDA ucm511530 .

"The FDA Adverse Event Reporting System (FAERS) included 210,705 adverse events and 2,991 fatalities for FQs. Levofoxacin and ciprofoxacin toxicities were neurologic (30% and 26%, respectively), tendon damage (8% and 6%), and psychiatric (10% and 2%)." Kaur, et al., 2016. Fluoroquinolone-related neuropsychiatric and mitochondrial toxicity. PMID: 26955658

"In my 40+ years in pharmacovigilance, FQs surpass Vioxx and thalidomide in the degree of permanent harm done." Cohen JS, 2014. Fluoroquinolone Toxicity Syndrome: A Letter to the Senate Committee on Health, Education & Labor. http://www.medicationsense.com/articles/2014/letter.php

For those who've been floxed, this first-persons report is devastatingly riveting. Boomer, 2007.
The Flox Report - My Quin Story .

Karen @

From what I understand, a 'citizens' petition' to the FDA resulted in re-evaluation of side-effects of the entire fluoroquinolone class of antibiotics, and increased scrutiny of pharmacovigilance data with regard to one of the most widely used and available antibiotics since its approval. (Remember when ciprofloxacin was available as a prophylaxis for traveler's diarrhea for those traveling to third-world countries when there was some concern about the potable water supply?)

Pharmacists have been warning the public for DECADES about almost indiscriminate prescribing and use of antibiotics, not only for the emergence of drug-resistant microorganism, but as in this case, we don't always know what the long, long-term effects of any exposure to ingested chemicals! ---so, (why does the mainstream media keep pushing for and advocating for access to 'medical marijuana'??)

As a pharmacist, I have seen elderly patients (especially women because of higher incidence of chronic urinary tract infections than their male counterparts) in the ER with new-onset delirium because a new prescription for a fluoroquinolong was prescribed INCORRECTLY (not taking into consideration of interacting medications or medical conditions or the diminished renal function in the elderly). In those whose processing and elimination of drugs can be a distinct problem, such as in those with diminished renal function; the elderly, those with diabetes, and concomitantly interacting syndromes such as taking other medications, or not--dehydration, or liver or kidney disease.

In any case, use of fluoroquinolones as in the citizen report suggest might better be served with addition of a new Black Box Warning for possible psychiatric adverse events “toxic psychoses, hallucinations, paranoia, suicidal thoughts or acts, loss of consciousness, delirium, depressed level of consciousness, amnesia, coma, and memory impairment” as well as a judicious use of ANY ingested chemical.

I would rather be suspicious of added pesticides, antibiotics, hormones, vaccines added to pig and chicken feed than the genetic-modified critters. And, Monsanto and DuPont merger has a lot to answer for in political might when it comes to meat sourced from the USA but processed in countries without animal additive regulations.

Catharine @

Alcohol use and abuse (even AFTER one has stopped) also has long term chemical neurological brain injury effects (no matter how minimal it may seem) that affects health and relationships. We must remember that, when dealing with our families and for understanding of ourselves.

Brenda E @

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