title: Psychiatric morbidity and toxic burden in patients with environmental illness: a controlled study.
abstract: OBJECTIVE
  Patients with environmental illness experience a large number of psychological symptoms. The nature of these symptoms and their pathogenesis (toxicogenic versus psychogenic) is controversial. The objective was to (1) characterize the nature of the psychological symptoms according to well-established diagnostic criteria, and (2) to investigate the association between toxicological factors and psychological symptoms.
  
  
  METHODS
  Toxic burden, somatic morbidity, and psychiatric morbidity were assessed in 309 outpatients with environmental illness and 59 semiconductor industry workers matched for age and gender. Psychiatric disorders were assessed by a structured psychiatric interview (SCID), and distress was assessed by the Symptom-Checklist-90-Revised (SCL-90-R). Routine and specific laboratory tests in blood and urine samples were used to assess chemical exposures.
  
  
  RESULTS
  Overall psychiatric morbidity was significantly higher in patients than in controls according to SCID (75% versus 24%). Somatoform, mood, and anxiety disorders were significantly more frequent in patients with environmental illness. They also revealed marked stress on the SCL-90-R somatization subscale and scored significantly higher than controls on most of the other subscales. Industry workers from the control group tended to have higher urine metal concentrations than environmental illness patients and similar concentrations of solvents in blood.
  
  
  CONCLUSIONS
  Our data extend previous findings of high psychiatric morbidity in patients with environmental illness. They do not support the notion of a direct causal link between chemical exposure and the psychological symptoms.
authors.affiliation: Department of Toxicology, II. Med. Clinic, Technical University of Munich, München, Germany. s.bornschein@lrz.tu-muenchen.de
authors.forename: Susanne
authors.initials: S
authors.lastname: Bornschein
authors.forename: Constanze
authors.initials: C
authors.lastname: Hausteiner
authors.forename: Franz
authors.initials: F
authors.lastname: Konrad
authors.forename: Hans
authors.initials: H
authors.lastname: Förstl
authors.forename: Thomas
authors.initials: T
authors.lastname: Zilker
mesh_terms: D018876:Environmental Illness / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D007221:Industry; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced* / Q000209:etiology; D008670:Metals / Q000009:adverse effects / Q000032:analysis; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis*; D016273:Occupational Exposure; D012666:Semiconductors; D012997:Solvents / Q000009:adverse effects / Q000506:poisoning
chemical_list: D008670:Metals; D012997:Solvents