Toxicological and neuropsychological findings in patients presenting to an environmental toxicology service

Patients presenting to an environmental toxicology service are frequently convinced that their multiple symptoms are caused by exposure to environmental toxicants. In order to evaluate the patients' hypotheses, 120 consecutive patients referred by health care providers to the environmental toxicology service for various symptoms were included in an open prospective study. The basic diagnostic procedure included an environmental toxicology questionnaire, psychological tests, a 45 minute interview, a physical examination and standard biomonitoring for cadmium, mercury, lead, lindane, hexachlorobenzene, DDT, DDE, DDD, and pentachlorophenol and a salivary test for mercury released from amalgam. Allergic disease was found in 42 patients. Nineteen of the 42 patients also had psychosomatic disorders. An unusually high release of mercury from amalgam fillings in the saliva test was found in six patients. An environmental toxic exposure was demonstrated in 19 patients (4 lead, 8 DDE, 6 mercury--most likely from broken thermometers, 1 neurotoxic alkyl naphtol derivatives). Ten of the 19 patients had psychosomatic disorders and six had medical/neurological disorders. Only two patients had symptoms attributable to environmental exposure alone. Rather classical psychosomatic disorders were diagnosed in 83 patients. Of the 37 patients without identifiable neuropsychological dysfunction, 18 had allergic disorders and 12 had other medical diagnoses. The diagnosis of a toxic environmental exposure should be performed in an integrated diagnostic approach covering environmental toxicology and medicine as well as psychosomatic medicine.