Occupational Diseases

The recently published thesis “Strangled by solvents?”, psychological diagnosis and treatment of Chronic Toxic Encephalopathy (Organic Psycho Syndrome) by Moniek van Hout goes into the diagnosis and treatment of patients with chronic toxic encephalopathy (CTE) as it is performed by the Solvent Teams in Amsterdam and Enschede.

This thesis focuses on the neuropsychological diagnosis and treatment of chronic toxic encephalopathy (CTE) or “painters‘disease”. CTE is a syndrome of cognitive and neurasthenic problems attributed to chronic solvent exposure. Solvent exposure is associated with problems in attention, memory, executive function and visuospatial skills; and with fatigue, instability of affect and difficulties in impulse control.  

The question whether chronic exposure to low doses of organic solvents has lasting neurotoxic effects is still debated. Only a small minority of exposed workers develop CTE. In clinical practice it is difficult to determine whether a patient‘s cognitive and emotional symptoms are solvent-induced. Usually there is no significant neurological or neurophysiological impairment.

CTE is diagnosed by the exclusion of other causes, based on consensus by a multidisciplinary team. Neuropsychological testing is the cornerstone of the diagnosis, but the differential diagnosis is complicated. Moreover, many patients with suspected CTE are engaged in litigation or financial compensation procedures, and in cases of suspected CTE, suboptimal performance on neuropsychological testing due to insufficient effort might be a substantial problem.

This thesis is divided is three sections. After the introduction the first section consists of a general introduction in behavioural neurotoxicology, the second section is devoted to diagnosis of CTE and the third section concerns the psychological treatment of patients with diagnosed CTE. In the final discussion the most important findings and implications of the studies are commented.