title: Pitfalls in clinical assessment of neurotoxic diseases: negative effects of repeated diagnostic evaluation, illustrated by a clinical case.
abstract: Exposure to different toxic substances can have acute and chronic neurological and neuropsychiatric health effects on humans. Patients often report impaired concentration and memory, irritability, fatigue, instability of affect and difficulties in impulse control. The diagnostic process for neurotoxic diseases is complex and relies heavily on the exclusion of differential diagnosis and substantiating the cognitive complaints by neuropsychological assessment. Diagnostic evaluations have the purpose to help the patient by finding an explanation for the symptoms to guide treatment strategy or prevent further deterioration. But what if the diagnostic process in itself leads to problems that can be quite persistent and difficult to manage? The iatrogenic, or sick-making, side effects of the diagnostic process are the main focus of this case study.
authors.affiliation: Department of Medical Psychology, Medisch Spectrum Twente Hospital, Enschede, The Netherlands. Electronic address: m.vanhout@mst.nl.
authors.forename: Moniek
authors.initials: M
authors.lastname: van Hout
authors.affiliation: Department of Neurology, Medisch Spectrum Twente Hospital, Enschede, The Netherlands.
authors.forename: Gerard
authors.initials: G
authors.lastname: Hageman
authors.affiliation: Netherlands Center for Occupational Diseases, Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: van Valen
mesh_terms: D003943:Diagnostic Techniques, Neurological / Q000592:standards*; D006801:Humans; D008297:Male; D008306:Malingering / Q000209:etiology; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000592:standards*; D020258:Neurotoxicity Syndromes / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D009784:Occupational Diseases / Q000139:chemically induced / Q000175:diagnosis*; D016273:Occupational Exposure; D013001:Somatoform Disorders / Q000209:etiology
keywords: Chronic solvent-induced encephalopathy; Malingering; Neuropsychological tests; Neurotoxicity syndromes; Performance validity; Somatoform disorders