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Organic brain syndromes constitute increasing public health, social and economic problems. In the diagnosis of organic brain syndrome no single symptom is pathognomonic. The core features of organic brain syndrome are disturbances in cognitive functions (memory, thinking, perception, and attention). The expression of emotions is altered, and alertness and vigilance are disturbed. The clinical picture is confused by compensatory, protective, and reactive symptoms. The most important psychopathogenetic mechanisms of organic brain syndrome are impaired cerebral function and the subjective meaning of the illness to the individual. According to American Psychiatric Association's classification (DSM-III), organic brain syndromes can be divided into seven purely descriptive clusters; subdivisions into psychotic and nonpsychotic syndromes and into acute and chronic brain syndromes have been omitted. The organic brain syndromes are delirium, dementia, amnestic syndrome, organic delusional syndrome, organic hallucinosis, organic affective syndrome and organic personality syndrome. The differential diagnostic aspects are discussed. Organic brain syndromes caused by industrial chemicals are nonspecific and multifactorial. When long term exposure to organic solvents occurs, the clinical picture is often characterized by tiredness and astheno-emotional or neurasthenic syndrome resembling neurotic states, depressive states, or presenile dementia.
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PMID:Organic brain syndromes from a psychiatric point of view: diagnostic and nosological aspects. 696 56

Long-term exposure to organic solvents can result in damage of the central nervous system. The WHO recognises the following stages: organic affective syndrome, mild chronic toxic encephalopathy (CTE), and severe CTE. There is no golden standard for the diagnosis of CTE. Mild CTE is characterised by fatigue, mood disturbances, memory and attention disorders. In the Netherlands, a so-called 'solvent team' consisting of an occupational physician, a neurologist, a neuropsychologist and an occupational hygienist, assesses patients suspected of having CTE. The diagnostic procedure consists of three steps: (a) interview and blood tests, (b) the computer-based Neurobehavioral Evaluation System, and (c) assessment of an exposure index, neuropsychological investigation, and clinical neurological examination. In the period 1997-1999 approximately 250 patients were assessed yearly in the Netherlands; resulting in 50 diagnoses of mild CTE a year. The real incidence is most likely higher at present, but will decline due to diminished exposure to organic solvents.
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PMID:[Solvent-induced chronic encephalopathy; the 'solvent team' project]. 1123 71

Previous epidemiological and clinical studies of humans exposed to polychlorinated biphenyls (PCBs) indicate that the majority of patients have neurological complaints (e.g., headache, vertigo, paresthesias, poor memory and concentration, fatigue, depression). Since only a small minority of PCB-exposed patients demonstrate abnormalities on objective neurological measures (e.g., CT-scans, EEC, nerve conduction velocity), it is particularly unfortunate that objective neuropsychological data has not been published to substantiate patient complaints. The present study provides neuropsychological test data on two patients exposed to PCBs. In both cases, PCB exposure is documented by an analysis of PCB levels in the patients' work environments. Despite the absence of abnormalities on CT-scans and EEC, both patients displayed a variety of cognitive deficits and emotional disturbance. Serial assessment of one patient with high blood levels of PCBs revealed a dementia (sharing certain features with Alzheimer's disease) and an organic affective syndrome. Assessment of a second patient exposed to PCBs (but with no detectable blood levels of PCBs) suggested that his cognitive impairments were not due to PCB exposure. The present study provides data which points to the importance and sensitivity of neuropsychological examination in cases of PCB-exposure.
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PMID:Dementia as a neuropsychological consequence of chronic occupational exposure to polychlorinated biphenyls (PCBs). 1458 22