Psychiatric Manifestations of Neurotoxins

Contents

Preface: Neurotoxicology: The Ties that Bind Us ix

Daniel E. Rusyniak and Michael R. Dobbs

Neuropsychiatric Symptom Assessments in Toxic Exposure 201

Lisa H. Mason, Melissa J. Mathews, and Dong Y. Han

The goal of this review is to provide guidelines for evaluating psychiatricand mood changes that result from neurotoxicity. Mood changes thatare often seen to varying degrees in neurotoxicity include increased anxi-ety, depression, irritability, impulsiveness, and psychosis. Some commonagents that induce neurotoxicity include drugs, heavy metals, and organ-ophosphates with presentations varying somewhat depending upon themechanism of toxicity. The authors discuss in detail psychiatric assess-ment for patients with suspected of having neurotoxicologic syndrome.

Emerging Toxic Neuropathies and Myopathies 209

Hani A. Kushlaf

Psychiatrists in practice encounter patients abusing alcohol and streetdrugs such as cocaine that can lead to toxic myopathies or neuropathies.Psychiatrists also encounter patients with neuropsychiatric systemic lupuserythematosus who are treated with myotoxic medications (e.g., Hydrox-ychloroquine). Thus a well-rounded knowledge of toxic myopathies andneuropathies is extremely useful. The differential diagnosis of toxic myop-athies and neuropathies is expanding rapidly and practical knowledge ofthese entities is becoming important.

Neurotoxic Emergencies 219

J. Dave Barry and Brandon K. Wills

This article is intended for clinicians treating neurotoxic emergencies. Pre-sented are causative agents of neurotoxic emergencies, many of which areeasily mistaken for acute psychiatric disorders. Understanding the widevariety of agents responsible for neurotoxic emergencies and the neuro-transmitter interactions involved will help the psychiatrist identify and treatthis challenging population.

Antidepressant Overdose^induced Seizures 245

Bryan S. Judge and Landen L. Rentmeester

Treating patients with psychiatric problems can present numerous chal-lenges for clinicians. The deliberate self-ingestion of antidepressants isone such challenge frequently encountered in hospitals throughout theUnited States. This review focuses on 1) the classes of antidepressants,their pharmacologic properties, and some of the proposed mechanism(s)for antidepressant overdose-induced seizures; 2) the evidence for seizurescaused by antidepressants in overdose; 3) management strategies for

Contentsvi

patients who have intentionally or unintentionally overdosed on an antide-pressant, or who have experienced an antidepressant overdose-inducedseizure.

Neurologic Manifestations of Chronic MethamphetamineAbuse 261

Daniel E. Rusyniak

The drug with perhaps the greatest impact on the practice of Psychiatry isMethamphetamine. By increasing the extracellular concentrations of do-pamine while slowly damaging the dopaminergic neurotransmission,Meth is a powerfully addictive drug whose chronic use preferentiallycauses psychiatric complications. Chronic Meth users have deficits inmemory and executive functioning as well as higher rates of anxiety, de-pression, and most notably psychosis. It is because of addiction andchronic psychosis from Meth abuse that the Meth user is most likely tocome to the attention of the practicing Psychiatrist/Psychologist. Under-standing the chronic neurologic manifestations of Meth abuse will betterarm practitioners with the diagnostic and therapeutic tools needed tomake the Meth epidemic one of historical interest only.

Toxic Leukoencephalopathies 277

Laura M. Tormoehlen

Leukoencephalopathy is a syndrome of neurologic deficits, including alter-ation of mental status, caused by pathologic changes in the cerebral whitematter. The term, toxic leukoencephalopathy, encompasses a wide varietyof exposures and clinical presentations. The diagnosis in these Frontiers inClinical Neurotoxicology syndromes is made by careful attention to thehistory, clinical features, and radiologic findings. This article details threeof the best-defined toxic leukoencephalopathies: delayed posthypoxicleukoencephalopathy, including delayed neurologic sequelae after carbonmonoxide poisoning; heroin inhalation leukoencephalopathy; and poste-rior reversible encephalopathy syndrome.

TolueneAbuse andWhite Matter: A Model of Toxic Leukoencephalopathy 293

Christopher M. Filley

The brain is the primary target of toluene (methylbenzene), the major sol-vent in spray paint and a constituent of many other easily obtained com-mercial and industrial products. The effects of acute intoxication can bedramatic and the lasting adverse effects of inhalants may be highly injuri-ous. Mental status alterations range from acute confusional state to coma.Toluene abuse effects on white matter are demonstrable neuroradiologi-cally and neuropathologically, and have important neurobehavioralconsequences.

Index 303