A Review of Psychological Measures Relevant to Central Nervous System Toxicity, with Specific Reference to Solvent Inhalation

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Abstract
Traditional medical examination of patients having exposure to toxic substances with the potential for CNS injury lacks sensitivity for detecting mild to moderate impairment. This seems true especially when complex mental functions related to comprehension and reasoning are involved. Because these functions are critically important in psychosocial adjustment, including occupational performance, efforts to increase diagnostic sensitivity and precision seem important. In a group of 22 young patients hospitalized for treatment of solvent abuse and having negative medical examinations, 55% had mental-grasp deficiencies by clinical mental status exam. Although this evidence or organic impairment was reversed during a period of no solvent exposure, there remained a troublesome unresponsiveness to therapy which differentiated this group from other young drug abusers with similar levels of psychopathology. This finding may well relate to subtle impairment of complex mental functions, a possibility that is substantially strengthened by findings of a high incidence of impairment by neuropsychological testing. The need for an extensive investigation of toxic exposures should include a very careful mental grasp assessment, measures of psychological status and changes in that status over time, and examination of neuropsychological functions by the extensive Halstead-Reitan battery or its equivalent when persisting dysfunctional states are encountered.

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