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Mental Health and Environmental Exposures

from the Learning and Developmental Initiative, November 2008

This fact sheet discusses the connections between environmental exposures to physical Symptoms and Diagnoses and chemical agents and There is a difference between psychiatric symptoms and symptoms and conditions. While many of us psychiatric diagnoses. Psychiatric symptoms may range recognize that environmental exposures to from relatively minor symptoms such as changes in toxic substances can lead to , patterns or appetite to severe symptoms such as and other medical conditions, the connections , loss or suicidal behavior. to psychiatric conditions are not as well- Diagnoses are medical designations performed by known. However, there is a substantial licensed professionals or trained researchers using amount of scientific evidence that certain validated instruments. A particular diagnosis can require exposures can lead to both temporary and the presence of a group of symptoms and may also take long-term psychiatric symptoms and illness. into account the duration of symptoms, absence of certain other symptoms, or the level of impairment. (See the In this fact sheet, you’ll find a summary of Resources section on page 15 for more information.) This what is known about the connections between fact sheet provides information on how both diagnoses these substances and mental health and symptoms are impacted by exposures to chemicals symptoms, the most common sources of and substances in our environment. exposure, and ways that you might reduce or prevent these exposures. Although developmental delays, mental retardation and learning disabilities are sometimes regarded as psychiatric Prevention ...... 2 disorders, this fact sheet does not discuss these ...... 3 conditions. Other materials from the Learning and lead, , aluminum, arsenic, manganese, Developmental Disabilities Initiative (LDDI), listed in the thalium and tin Resources section on page 15, focus on connections ...... 7 between environmental exposures and these conditions. Solvents ...... 7 A list of all the psychiatric symptoms associated with Toxic Gases ...... 8 environmental exposures discussed in this fact sheet is on PBBs and PCBs...... 9 page 16. Other Chemicals and Compounds...... 10 and recreational , tobacco, boron, Symptoms Often Associated with Some Common carbon dioxide, vinyl chloride, endocrine Psychiatric Conditions disruptors and food additives Disorders Ionizing Radiation ...... 11 includes depressive and bipolar disorders Glossary...... 13 depressed mood Mental health professionals often use a diminished or in all or almost all specific, technical vocabulary when describing activities symptoms. This fact sheet uses this weight loss vocabulary to be as accurate and precise as or possible, even though some terms may not be familiar to our audience. You’ll find many (Continued on page 2) terms defined in the glossary. Page 2 Learning and Developmental Disabilities Initiative

(Continued from page 1) repetitive behaviors or mental acts of worthlessness intense , helplessness, or horror excessive or inappropriate recurrent and intrusive images, thoughts, diminished ability to think or concentrate distressing , as if a traumatic event recurrent thoughts of death is recurring or attempt symptoms of increased persistently elevated, expansive, or irritable mood  difficulty falling or staying asleep inflated self-esteem or  or outbursts of decreased need for sleep  difficulty concentrating more talkative than usual  hypervigilance flight of ideas,  exaggerated startle response distractibility -Deficit and Disruptive Behavior Disorders Disorders includes , obsessive-compulsive and includes attention-deficit/hyperactivity, conduct and posttraumatic disorders oppositional defiant disorders pounding heart, accelerated heart rate inattention sweating hyperactivity trembling or shaking sensations of shortness of breath or smothering to people and animals feeling of choking destruction of property chest or discomfort deceitfulness or theft serious violation of rules feel dizzy, unsteady, lightheaded, faint negativistic, hostile and defiant behavior feelings of unreality or feel detached from oneself Psychotic Disorders fear of losing control or going crazy includes and other psychotic disorders fear of dying numbness or tingling sensations hallucinations chills or hot flushes disorganized speech recurrent and persistent thoughts, impulses or grossly disorganized or catatonic behavior images that cause anxiety or distress flat or inappropriate

workplace, in food and water, and so on. Even our Prevention very neighborhoods may be toxic, with some You can take actions to prevent environmental research showing that residential proximity to exposures to toxic substances that can contribute to industrial activity can have a negative impact on psychiatric symptoms. Identifying and removing the mental health. exposure may improve the symptoms and the Parents and other family members, teachers, quality of life for the affected individuals and their coworkers and health-care providers are families. Unfortunately, some effects of some encouraged to look for physical cues related to exposures are irreversible, and so preventing the mental health issues. However, individual vigilance exposure in the first place is always the best route. can go only so far: prevention of many exposures The Resources section on page 15 lists requires -level policy changes. We need to organizations that have more information about work as a society — through public policy, preventing exposures. regulation and enforcement — to remove toxic Many of the tables in this document provide substances from consumer products, buildings, information about likely places of exposure to toxic workplaces, water, soil and air to prevent unwanted substances, including at home, at school, in the health outcomes. Mental Health and Environmental Exposures Page 3

Some of the toxic substances listed in this fact exposure early in life has also been connected to sheet are no longer used or may even have been Alzheimer’s disease many years later, and some banned. That does not mean that we are safe from evidence also associates lead with diagnoses of them. Some of these substances remain in , schizophrenia. homes, schools, workplaces, soil and water, where we or our food may come into contact with them. Symptoms Sources of Exposure Occupational exposure is obviously a risk for academic problems leaded paint on walls, workers, but it may put their families at risk as well. or behavior furniture and toys Pesticides, particles or dust, solvents and changes drinking or cooking water other substances are often taken home on clothing, aggression that contacts lead solder shoes, equipment, tools, and even skin and . agitation in plumbing Careful removal of take-home exposures is anger vinyl toys, lunchboxes, especially important when children are involved, for antisocial behavior bibs, miniblinds and they are often more sensitive to exposures than anxiety other objects adults. soil contaminated by auto decreased exhaust or downwind of This fact sheet does not discuss the level of delinquent behavior a smelter exposure that can lead to mental health symptoms, delusions some herbal and folk in part because much more research needs to be remedies done to ascertain specific levels. There are also some paints and pigments substantial differences in individual sensitivity — an hallucinations used in cosmetics or hair exposure that may produce effects in one person impulsivity coloring may not cause any harm in another. insomnia some ceramics or candies, If you suspect that environmental exposures may be irritability especially from outside related to symptoms or conditions described in this the US fact sheet — in yourself or someone close to you — mood lability homemade wine please look for a mental- who is nervousness artist’s paint willing to investigate environmental causes with Occupational exposures: those affected and their families. personality change Exposure to lead is a risk poor concentration in a wide variety of poor memory or occupations involving Metals memory loss ammunition, batteries, suicidal ideation many metals, soldering, Exposure to any of several metals in our tension fertilizers, auto or boat environment can be associated with psychiatric repair, , ceramics, diagnoses and symptoms including dementia, In children, also: inks/printing, electronics, depression, anxiety, confusion, memory loss, poor antisocial construction/demolition, concentration, insomnia and more. The metals most crying jewelry, artificial flowers or commonly associated with these symptoms are distractibility leather, insecticides, paint, lead, mercury and aluminum. Other metals that can hyperactivity varnish, shellac, plastics, cause symptoms include arsenic, manganese, impulsivity rubber, glass, or shoe thallium and tin. lack of attention production or repair. Lead Considerable evidence connects childhood lead The US Agency for Toxic Substances and Disease exposure, including prenatal exposure, to diagnoses Registry (ATSDR) recommends that families with of , criminal behavior and attention lead in their plumbing systems run or flush water deficit hyperactivity disorder (ADHD). Lead that has been standing overnight before drinking or Page 4 Learning and Developmental Disabilities Initiative cooking with it. Also, if your home was built before Mercury has been connected in adults with 1978, it probably contains lead-based paint. Lead , a whose psychiatric symptoms from the paint is likely to contaminate dust include irritability, excitability, timidity and excessive and will coat most surfaces and accumulate in , depression and anxiety. carpets and upholstery. Some neighborhoods have , and children are more susceptible to soil contaminated with lead from industry or auto mercury exposures than adults. Exposures that may exhaust. LDDI recommends removing shoes before cause no symptoms in a can cross the entering your home, washing children’s hands and placenta and concentrate in her , injuring faces often to remove lead dusts and soil, and her child. regularly cleaning the house of dust and tracked-in soil. ATSDR recommends that you carefully handle and dispose of products that contain mercury, such as Mercury thermometers or fluorescent light bulbs. Do not vacuum up spilled mercury, as it will vaporize and Symptoms Sources of Exposure increase exposure. If a large amount of mercury has abusive language fish or shellfish been spilled, contact your health department. Check academic decline contaminated with fish advisories in your area from your or , natural resources department. anxiety/nervousness especially , Aluminum , king crying mackerel, , sea depression bass, Gulf Coast Symptoms Sources of Exposure excessive oysters and others agitation antacids, antidiarrheals and embarrassment vapors in air from spills, anxiety some buffered excitability incinerators or bizarre behavior cosmetics explosive speech industries that burn confusion water from aluminum fatigue mercury-containing depression containers, such as soda hallucinations fuels, including hallucinations cans, water heaters and inability to take orders dental work and medical homicidal coffeepots insomnia treatments insomnia antiperspirants irritability some substances used memory loss dermatological pastes loss of libido in folk or religious mood lability food additives memory loss rituals paranoia some formulas mood lability release of mercury from personality intravenous or fluids dental work and change some teas paranoia medical treatments poor concentration utensils and appliances personality change latex paint made before suicidal Occupational exposures: phobic avoidance 1990 violence manufacturing aircraft, poor attention Occupational autos, explosives, rubber, poor concentration exposures: utensils or electrical contaminated workplace equipment social withdrawal air or skin contact during foundry work suicidal/homicidal use in dental services, timidity health services, painting violence chemical and other grinding industries that use petroleum refining mercury welding waterworks Mental Health and Environmental Exposures Page 5

Aluminum in water has been correlated with use cleaner sources of water and limit contact with dementing , including dialysis dementia. soil. The Learning and Developmental Disabilities While aluminum has been studied as a possible Initiative (LDDI) also recommends that you paint contributor to Alzheimer’s Disease, there is exposed surfaces of CCA-treated wood, such as in controversy regarding a connection. Recent picnic tables, decks or posts, and keep children from research indicates that the connection may be real. climbing or playing on exposed wood.

ATSDR states that very little aluminum enters your Sources of Arsenic Exposure body from aluminum cooking utensils. However, exposure from eating substances containing high touching, breathing sawdust, or breathing smoke levels of aluminum (such as antacids) can be from wood treated with arsenic (CCA lumber) increased when eating or drinking citrus products adulteration of substances at the same time. ATSDR encourages adults to paints avoid taking large quantities of aluminum- some , pesticides and rodenticides containing antacids and buffered aspirin and to “moonshine” liquors take these as directed. Parents can living near a smelter make sure all medications have child-proof caps so children will not accidentally eat them. ground water in areas where rocks are high in arsenic Arsenic of root vegetables grown in soil that contains occurs infrequently in the United arsenic States but is more common in other countries. Occupational exposures: Psychiatric symptoms of arsenic poisoning may manufacturing soap/detergent, artificial flowers or appear as major depressive or psychotic disorders leather, enamel, rubber and insulators, jewelry, (see the table on pages 1-2 for symptoms of these semiconductors, silicon microfilm, textiles, velvet disorders). or wax bookbinding The US Environmental Protection Agency has set making/using disinfectants, pigment/dye, fertilizer, the arsenic standard for drinking water at .010 , or insecticides parts per million (10 parts per billion) to protect working with metals, including brass and bronze, consumers served by public water systems from soldering or welding the effects of long-term, chronic exposure to copper or arsenic. glassblowing or etching mining Symptoms Related to Arsenic Exposure sheep dipping agitation poor memory and taxidermy anxiety concentration disordered thinking Tin irritability singing muttering suicidal ideation Sources of Tin Exposure paranoia visual hallucinations food stored in unlined tin cans personality change some seafood from contaminated coastal waters some plastics, including polyurethane, plastic If you use arsenic-treated wood in home projects, polymers and silicon-coated baking parchment ATSDR recommends that you wear dust masks, paper gloves and protective clothing to decrease Occupational exposures: exposure to sawdust. If you live in an area with working with organotin chemicals high levels of arsenic in water or soil, you should Page 6 Learning and Developmental Disabilities Initiative

Tin was used for a brief time in medical treatments Manganese is present in pesticides that may be before its toxic properties were discovered. used around the home, so try less toxic pest-control Organotin poisoning is now rare and is mostly seen methods first. If you use toxic pesticides, follow the in industrial or laboratory settings among chemists, precautions on the package during use and keep chemical engineers and other chemical workers. children away from pesticides.

Symptoms Related to Tin Exposures Sources of Manganese Exposure aggression (physical insomnia and other natural manganese deposits can contaminate and sexual) and sleep disturbances surrounding water and soil cognitive dysfunction irritability pesticides such as maneb and mancozeb depression loss of libido Occupational exposures: disorientation loss of motivation Most exposures occur in mining and fatigue/weakness loss of vigilance manufacturing, but use is also a route of hyperactivity memory loss exposure. hyperphagia or psychotic behavior rapid cycles of Thallium inappropriate affect depression and rage Thallium was used for several decades in the 20th indifference century in medical treatments and in pesticides and was the source of hundreds of . Chronic Because tin is more resistant to corrosion than or subacute poisonings are associated with , some steel food cans are lined with tin. Tin prominent psychiatric symptoms. concentrations in canned food increase if food is stored in opened cans, and so ATSDR recommends Symptoms Sources of Exposure that you not store unused portions of food in their anxiety food or soil cans. Move the food to a separate container before confusion contaminated with storing. crying spells thallium Manganese cigarettes dementia sites Symptoms Related to Manganese Exposures depression containing thallium aggression diffuse electroenceph- Occupational compulsive running or walking alogram (EEG) exposures: abnormalities depression (rare) manufacturing hallucinations electronic devices, insomnia switches and closures, irritability hypersomnia or insomnia primarily for the Korsakoff’s syndrome irritability semiconductor nervousness mild industry paranoia minor criminal acts nervousness or anxiety personality changes nightmares poor memory paranoia psychosis personality change rage poor memory and concentration restlessness silliness sleep-wake reversal social withdrawal uncontrollable laughing and/or crying Mental Health and Environmental Exposures Page 7

Pesticides Pesticides and Symptoms CH Insecticides OP Insecticides Exposure to any of several different types of academic decline academic decline chemicals that are used to kill insects may cause agitation anxiety psychiatric symptoms. Chlorinated hydrocarbon anxiety apathy (CH) insecticides such as DDT have been banned confusion change in libido in the United States and Europe due to health depression confusion effects and their persistence in the environment — fatigue depression they do not easily break down. They are stored in hallucinations dissociation fat cells and accumulate and concentrate in the insomnia excessive dreaming . Organophosphate (OP) insecticides irritability fatigue are chemically related to nerve gas, which was loss of libido giddiness developed for military uses. Carbamates function memory loss hallucinations much like OP insecticides, but the neurologic mood lability hyperactivity impact is less irreversible and, therefore, the nervousness insomnia is less. nightmares irritability Methyl bromide, a colorless, odorless gas, is a personality change memory loss broad-spectrum pesticide used to control insects, poor appetite mood lability weeds, rodents and pathogens. Because it is somatic complaints nightmares considered an -depleting substance, its use paranoia has been reduced but not eliminated in the United Methyl Bromide poor appetite (Fumigant) States. poor concentration anxiety restlessness Pesticide exposure is a risk for those who work in apathy somatic complaints agriculture, landscaping or other settings in confusion suicidal ideation which pest problems are treated with chemicals. A decreased libido 2008 study of farmers found that those with the delusions Carbamates highest number of lifetime exposure days to depression confusion agricultural pesticides were 50% more likely to be euphoria irritability diagnosed with clinical depression than those with hallucinations memory loss the fewest application days and were 80% more homicidal/suicidal mood lability likely if they had applied organophosphates. ideation Commonly used organophosphates have included hypersomnia parathion, malathion, methyl parathion, impotence chlorpyrifos, diazinon, dichlorvos, phosmet, insomnia tetrachlorvinphos and azinphos methyl. irritability mania Drift from aerial spraying of pesticides can also expose those living, working or playing downwind from the spray, and both surface and groundwater paranoia can be contaminated from spray and runoff. While poor concentration fruits and vegetables that are treated with violence pesticides during growth, storage and/or transportation have detectable levels of pesticide residues, there is some controversy whether Solvents these levels are high enough to cause health Solvents are a range of chemicals that extract, effects. dissolve or suspend insoluble materials such as fats Page 8 Learning and Developmental Disabilities Initiative and polymers. Solvents include , Symptoms Related to Solvent Exposures ketones, ethers, esters, glycols, aldehydes, Each type of solvent has its own set of symptoms, saturated and unsaturated aliphatic and aromatic which may include any of these: hydrocarbons, halogenated hydrocarbons, agitation mania , and a variety of petroleum anxiety memory loss byproducts. bizarre behavior mood lability poor concentration Solvents in the Home Solvents can be found in many of these delusions psychosis products: depression restlessness irritability suicidal or homicidal gasoline and other fuels hallucinations attempts automotive and mechanical grease and hilarity/weeping violence lubricants insomnia sexual problems degreasing agents in cleaning products lack of initiative sleep or other paints and wood stains and finishes lethargy sleep disturbances paint stripper and thinner, including turpentine loss of libido polish and polish remover rubbing alcohol glues and adhesives Toxic Gases furniture and floor polishes and waxes spot removers Carbon monoxide and hydrogen sulfide are two toxic metal and wood cleaners gases, either of which may deprive the of oxygen. correction fluid They both are capable of causing psychiatric computer disk cleaners symptoms. dry-cleaning fluid Carbon Monoxide

While exposure to solvents may come from Sources of Exposure to Carbon Monoxide occupational activities or result from burning charcoal, gas, oil or wood in a poorly environmental accidents, exposure may also be ventilated area the result of solvent abuse, such as intentionally automobile exhaust, such as in a garage or in sniffing glues, or gasoline. Solvent enclosed pickup truck beds abuse can result in depression, anxiety, tobacco smoke irritability, mood swings, suicidal ideation, violence, behavior problems, personality Occupational exposures: changes, hallucinations, delusions and academic baking and cooking problems. fire fighting auto repair There is no question that high-dose exposure to forklift operating solvents causes psychiatric symptoms. The foundry working effects of low-level, chronic exposures to mining solvents have not been definitively resolved. welding Most of the recent controlled studies on this working with formaldehyde, Linotype, paper or question indicate that low-level exposures have a petroleum deleterious effect. One study found an increased incidence of schizophrenia in offspring of parents Carbon monoxide is a colorless, odorless gas formed who were dry cleaners and therefore exposed from incomplete combustion. Survivors of carbon regularly to tetrachloroethylene. monoxide poisoning can experience chronic and Mental Health and Environmental Exposures Page 9 progressive neurological and psychiatric deterioration. Sources of Exposure to Hydrogen Sulfide living near contaminated air or water, especially Symptoms Related to Carbon Monoxide from a , hospital, wastewater treatment agitation impulsivity plant, spring, gas and oil drilling inappropriate laughter operation or farm with manure storage or anxiety insomnia livestock-confinement facilities apathy irritability pesticides astasia-abasia Klüver-Bucy syndrome natural gas confabulation loss of concentration sulfur crying loss of libido Occupational exposures: delirium mania working with rayon textiles, propane, wood pulp delusions memory loss or rubber dementia mood changes petroleum and natural gas drilling and refining depression odd behavior working with or near sewers or septic tanks, echolalia paranoia wastewater treatment, manure or landfills excitement mining or iron smelting fatigue poor roofing Gilles de la Tourette's restlessness processing sugar beets syndrome shouting tanning leather hallucinations singing violence/homicide PBBs and PCBs LDDI highly recommends a carbon monoxide detector Polybrominated biphenyls (PBBs) and for homes or workplaces which have any fuel-burning polychlorinated biphenyls (PCBs) were used in a appliances or devices. These may include furnaces, variety of electrical and chemical applications water heaters, fireplaces, gas stoves and ovens, including capacitors, transformers, machine oils, kerosene heaters, grills or clothes dryers. If a house plastics, carbonless copy paper and sealants. In has an attached garage or is close to heavy traffic, 1977, the US Environmental Protection Agency LDDI also recommends a detector. banned further production of PCBs and PBBs. Hydrogen Sulfide However, PCB molecules do not easily break down, persisting in the environment. When Hydrogen sulfide is also colorless, but it has the odor transformers containing PCBs burn, the PCBs are of rotten eggs. It occurs naturally in natural gas and is released and pose a , further contaminating produced by decaying organic matter. Hydrogen soil and water as the chemicals settle. sulfide poisoning remains a hazard in several occupations and environments. Symptoms Related to PBBs and PCBs Symptoms Related to Hydrogen Sulfide amnesia irritability PBBs and/or PCBs PCBs Only anxiety mania decreased libido depression decreased libido nervousness fatigue impotence delusions nightmares irritability insomnia dementia personality change nervousness depression poor concentration poor concentration fatigue poor memory poor memory hallucinations somatic complaints insomnia violence somnolence Page 10 Learning and Developmental Disabilities Initiative

PCBs accumulate in animal fats and fatty tissues, changes in appetite or sleep, compulsive behavior, including tissues. Most environmental irritability, paranoia, aggressiveness and violence. A exposures involve “background” levels of PCBs in detailed discussion of this topic is beyond the scope food. The main food sources of PCBs are fish of this fact sheet. (especially sport fish caught in contaminated lakes Tobacco. Tobacco exposure, both before and after or rivers), meat and dairy products. birth, has been associated with increased risk for Fetuses and newborns are especially susceptible to conduct disorder in children eight to 15 years of age. the effects of PBBs and PCBs, as are adults who An outcome of tobacco use, withdrawal have disease or who use alcohol and drugs. involves symptoms including irritability, anxiety, difficulty concentrating and increased appetite. Other Chemicals and Compounds Boron. Boron is an element found in compounds that are used in glass, ceramics, detergents, Alcohol and recreational drugs. Problem drinking, bleaches, fire retardants, disinfectants, alloys, drinking abuse, and at-risk drinking specialty metals, preservatives, pesticides and are all behaviors that increase the risk of depressive fertilizers. Boron hydrides have been used in rockets symptoms, depression, anxiety, suicide, violence, fuels, and poisoning from these has led to symptoms , dementia and antisocial behavior. Chronic including euphoria, anxiety, depression, personality is associated with Korsakoff’s syndrome. change, inappropriate behavior, agitation, Drinking by pregnant women can lead to fetal restlessness, , memory loss, poor alcohol syndrome (FAS) in the child. The effects of concentration, confusion, hallucinations, alcohol increase with maternal age, and binge somnolence, , insomnia and drinking is more important than average intake. nightmares. Several studies have shown an increased risk for Carbon dioxide. Increased carbon dioxide levels cognitive disorders, psychiatric illness, or seem to play a role in triggering panic attacks in psychological dysfunction among individuals with some individuals. FAS. According to the US Centers for Disease Control and Prevention, the most frequently Vinyl chloride. Vinyl chloride, the base for polyvinyl diagnosed disorders are attention problems chloride (PVC) plastic, is used in a wide variety of including ADHD, conduct disorder, alcohol or drug products, such as building materials (vinyl siding, dependence, depression and psychotic episodes. window profiles, flooring, plumbing pipes and Other psychiatric problems, such as anxiety fixtures), portable electronic devices, signs, toys, disorders, depression, eating disorders and medical equipment (intravenous bags and other posttraumatic stress disorder, have also been devices), shower curtains, car interiors and reported for some . Alcohol exposure before some textiles. birth has also been associated with delinquency in Exposure to vinyl chloride comes from breathing the children 10-18 years old. gases that new products give off, breathing fumes Use by a pregnant woman of marijuana appears to when vinyl products are manufactured or burned, have long-term effects specifically on her child’s skin contact with products during manufacture, and attentional skills. drinking water from contaminated wells. The connections between and Psychiatric symptoms attributed to vinyl chloride psychiatric problems are well-documented. In poisoning include nervousness; euphoria; irritability; addition to serious psychological distress (SPD) and depression; singing, whistling and sardonic or (MDE), there are also careless laughter; memory loss; hallucinations; many psychiatric symptoms associated with insomnia; somnolence; loss of libido; or fatigue. , such as hallucinations, Endocrine disruptors. Major endocrine-disrupting Mental Health and Environmental Exposures Page 11 chemicals (EDCs) include commercial chemicals in addition to those directly from the radiation. such as bisphenol A (BPA), phthalates, nonylphenol, octylphenol, organotins, Psychiatric Symptoms Related to Therapeutic polychlorinated biphenyl (PCB), and other Radiation organohalogens, plus the naturally-occurring radiation necrosis, which may include decreased substances cadmium, genistein and other appetite, weakness, depression, nightmares, phytoestrogens. paranoia, psychosis, mood lability, personality changes, cognitive decline and dementia BPA is a common ingredient of many plastic and resin products including food and drink containers, internal linings of food cans, and dental enamels. Psychiatric Symptoms Related to Nuclear BPA has been found to leach from containers to Bombs or Accidents food, especially when heated. stress symptoms posttraumatic stress symptoms Phthalates are a group of chemicals commonly personality disorders added to plastics (including vinyl), cosmetics, “radiation response syndrome,” including fragrances in many products, lubricants, wood excessive anxiety over symptoms of exposure, finishes and medical devices. They are responsible fear of , or subclinical stress symptoms for the “new car smell” that is most noticeable when a car has been sitting in sunshine. Children are especially vulnerable to the effects of Several lines of evidence suggest a possible role of ionizing radiation, exhibiting an increased risk for endocrine disruption in the origin and development future psychoses, personality disorders and of schizophrenia. Research suggests that an neuroses following exposure. Decreased cognitive mimic or other endocrine signal from some and intellectual performance, mental retardation, source in prenatal life could be reduced, delayed, fatigue and somnolence are also noted after increased, or premature, disrupting brain childhood exposures. development so as to cause schizophrenia. Some professionals have begun to question the Food additives. Observed increases in irritability, recent increased frequency of CT scans for medical restlessness, and sleep disturbance have been diagnosis and treatment. While CT scans provide associated with the ingestion of tartrazine (yellow crucial information for certain types of injuries and dye number 5) in some children. Combinations of conditions, their use is not always called for in place some synthetic food colors and/or the preservative of x-rays, which produce much lower exposures to sodium benzoate have been associated with radiation. LDDI encourages you to verify the increased hyperactivity in children. necessity of a CT over an x-ray if your physician orders one. Ionizing Radiation

Exposure to ionizing radiation from atomic bombs, Sources for this Fact Sheet nuclear accidents or medical treatments can lead to The information in this fact sheet draws a variety of psychiatric symptoms. Cranial radiation substantially from Environmental and Chemical therapy can cause mild, acute reactions which can and Psychiatric Illness by James S. Brown progress to a condition known as postirradiation Jr., MD, published 2002 by American Psychiatric syndrome. Symptoms include tingling, , Publishing, Inc. , irritability and somnolence. Other sources: Symptoms from exposures due to nuclear bombs or accidents are confounded with symptoms from The website of the Agency for Toxic Substances trauma. Victims may exhibit typical stress symptoms and Disease Registry (ATSDR), a federal public Page 12 Learning and Developmental Disabilities Initiative health agency of the US Department of Health and mpounds/phthalates/phthalates.htm, viewed 20 Human Services, http://www.atsdr.cdc.gov/ November 2008. Practice Prevention columns from the Institute for Department of Health and Human Services, Children’s , Substance Abuse and Mental Health Services http://www.iceh.org/resources.html Administration (SAMHSA), Office of Applied Studies (OAS). Results from the 2007 National Survey on The website of the US Centers for Disease Control Drug Use and Health: National Findings, Chapter 8. and Prevention, http://www.cdc.gov/ http://www.oas.samhsa.gov/NSDUH/2k7NSDUH/2k 7results.cfm#Ch8, viewed 31 October 2008. Wikipedia, http://en.wikipedia.org Downey L, Van Willigen M. Environmental Baker EL, Feldman RG, White RF, Harley JP. The : the mental health impacts of living near role of occupational lead exposure in the genesis of industrial activity. Journal of Health and Social psychiatric and behavioral disturbances. Acta Behavior. 2005 Sep;46(3):289-305. Psychiatrica Scandinavica Supplementum. 1983;303:38-48. Haig S. Avoiding unnecessary CT scans. Time. 2007 Dec 24. www.time.com/time/health/ Bazargan-Hejazi S, Bazargan M, Gaines T, article/0,8599,1698163,00.html, viewed 13 October Jemanez M. Alcohol misuse and report of recent 2008. depressive symptoms among ED patients. The American Journal of Emergency . 2008 McCann D, Barrett A, Cooper A, Crumpler D, Dalen Jun;26(5):537-44. L, Grimshaw K, Kitchin E, Lok K, Porteous L, Prince E, Sonuga-Barke E, Warner JO, Stevenson J. Food Beseler, CL, Stallones L, Hoppin JA, Alavanja MCR, additives and hyperactive behaviour in 3-year-old Blair A, Keefe T, Kamel F. Depression and pesticide and 8/9-year-old children in the community: a exposures among private pesticide applicators randomised, double-blinded, -controlled enrolled in the Agricultural Health Study. trial. Lancet. 2007 Nov 3;370(9598):1560-7. Environmental Health Perspectives. www.ehponline.org/members/2008/11091/11091.pd National Center for Chronic Disease Prevention and f, viewed 13 October 2008. Health Promotion, Division of Adolescent and School Health. Healthy Youth! Alcohol & Drug Use. Braun JM, Froehlich TE, Daniels JL, Dietrich KN, http://www.cdc.gov/HealthyYouth/alcoholdrug/, Hornung R, Auinger P, Lanphear BP. Association of viewed 2 November 2008.. environmental and conduct disorder in U.S. children: NHANES 2001-2004. Environmental Needleman H, Riess J, Tobin M, Biesecker G, Health Perspectives. 2008 Jul;116(7):956-62. Greenhouse J. Bone lead levels and delinquent behavior. Journal of the American Medical Braun JM, Kahn RS, Froehlich T, Auinger P, Association. 1996 Feb 7;275(5):363-9.. Lanphear BP. Exposures to environmental toxicants and attention deficit hyperactivity disorder in U.S. Needleman HL, McFarland C, Ness RB, Fienberg children. Environmental Health Perspectives. 2006 SE, Tobin MJ. Bone lead levels in adjudicated Dec;114(12):1904-9. delinquents. A case control study. Neurotoxicology and Teratology. 2002 Nov-Dec;24(6):711-7. Brown JS Jr. Effects of bisphenol-A and other endocrine disruptors compared with abnormalities Opler MG, Brown AS, Graziano J, Desai M, Zheng of schizophrenia: an endocrine-disruption theory of W, Schaefer C, Factor-Litvak P, Susser ES. schizophrenia. . 2008 Jan 31. Prenatal lead exposure, delta-aminolevulinic acid, and schizophrenia. Environmental Health Colburn T, Dumanoski D, Myers, JP. About Perspectives. 2004 Apr;112(5):548-52. phthalates. Our Stolen Future. updated 6 November 2006. Perrin MC, Opler MG, Harlap S, Harkavy-Friedman http://www.ourstolenfuture.org/NEWSCIENCE/onco J, Kleinhaus K, Nahon D, Fennig S, Susser ES, Mental Health and Environmental Exposures Page 13

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Synthetic food coloring and or feeling behavior: a dose response effect in a double-blind, astasia-abasia: the inability to stand or walk placebo-controlled, repeated-measures study. normally as a symptom of conversion hysteria Journal of . 1994 Nov;125(5 Pt 1):691-8. : a gross lack of coordination of muscle Schonfeld AM, Mattson SN, Riley EP. Moral movements maturity and delinquency after prenatal alcohol catalepsy: a condition characterized by lack of exposure. Journal of Studies on Alcohol. 2005 response to external stimuli and by muscular rigidity Jul;66(4):545-54. conduct disorder: a behavior disorder of childhood Stein J, Schettler T, Rohrer B, Valenti M. or characterized by a pattern of Environmental Threats to Healthy Aging. Greater conduct in which either the basic rights of others or Boston Physicians for Social Responsibility and the societal norms or rules appropriate for a certain and Environmental Health Network. 2008. age are violated US Centers for Disease Control and Prevention. confabulation: creating false Useand Risk for HIV/AIDS. http://www.cdc.gov/hiv/resources/factsheets/PDF/m conversion hysteria: a in which eth.pdf, viewed 2 November 2008. physical symptoms, as paralysis or blindness, occur without apparent physical cause and instead appear US Centers for Disease Control and Prevention. to result from psychological conflict or need Smoking & Tobacco Use Fact Sheet: Cessation. http://www.cdc.gov/tobacco/data_statistics/fact_she delinquent behavior: failing to do what law or duty ets/cessation/cessation2.htm, viewed 2 November requires 2008. delirium: a state of mental confusion and Williams JH, Ross L. Consequences of prenatal fluctuating characterized by anxiety, exposure for mental health in children and disorientation, hallucinations, delusions and adolescents: a systematic review. European Child & incoherent speech Adolescent . 2007 Jun;16(4):243-53. delusions: a false belief strongly held in of Wright JP, Dietrich KN, Ris MD, Hornung RW, invalidating evidence Wessel SD, Lanphear BP, Ho M, Rae MN. depression: a condition of general emotional Association of prenatal and childhood lead dejection and withdrawal concentrations with criminal arrests in early adulthood. PLoS Medicine. 2008 May 27;5(5):e101. derealization: the feeling that things in one’s surroundings are strange, unreal or somehow altered, as seen in schizophrenia Page 14 Learning and Developmental Disabilities Initiative disordered thinking: a failure to be able to “think asleep for an adequate length of time straight”; thoughts may come and go rapidly Klüver-Bucy syndrome: a rare behavioral disorientation: mental confusion or impaired impairment that causes individuals to put objects in awareness, especially regarding place, time or their mouths and engage in inappropriate sexual personal identity behavior dissociation: a psychological defense mechanism Korsakoff’s syndrome: a brain disorder caused by in which specific, anxiety-provoking thoughts, the lack of (vitamin B1) in the brain, often or physical sensations are separated from due to chronic alcoholism or ; the the rest of the syndrome is marked by amnesia, confabulation, apathy, , ataxia, paralysis of muscles echolalia: the uncontrollable and immediate controlling the eye, lack of to the condition repetition of words spoken by another person and erethism: an unusual or excessive degree of lethargy: a state of sluggishness, inactivity, and irritability or in an organ or tissue apathy euphoria: a feeling of great or well-being libido: sexual instinct or sexual drive Gilles de la Tourette’s syndrome (or just Tourette major depressive episode: a period of at least two syndrome): a disorder which weeks when a person experienced a depressed causes a person to make repeated and involutary mood or loss of interest or pleasure in daily movements and sounds (vocalizations) called tics activities and had at least four of the seven : a of sensory (visual, additional symptoms reflecting the criteria for major auditory, tactile, olfactory or gustatory) experiences depressive disorder without an external and with a compelling mania: a condition characterized by profuse and of their rapidly changing ideas; exaggerated sexuality, hyperphagia: abnormally increased appetite for gaiety or irritability; and decreased sleep and consumption of food menalcholia: a mental disorder characterized by hyperreligiosity: a condition in which the outward severe depression, guilt, hopelessness and forms and other aspects of religion become life withdrawal disabling; an ill-fitting grasp of the role of religion mood lability: changing moods and God in one’s life; a disability that can lead to from others because one thinks God is necrosis: death of cells or tissues through injury or vengeful and punishing disease, especially in a localized area of the body hypersexuality: excessively interested or involved neurosis: a relatively mild in sexual activity typified by excessive anxiety or indecision and a degree of social or interpersonal maladjustment hypersomnia: a condition in which one sleeps for an excessively long time but is normal in the waking paranoia: extreme, irrational of others intervals paraphilias: any of a group of psychosexual hypervigilance: condition of maintaining an disorders characterized by sexual fantasies, abnormal awareness of environmental stimuli feelings or activities involving a nonhuman object, a nonconsenting partner such as a child, or pain or hysteria: an uncontrollable outburst of emotion or of oneself or one’s partner fear, often characterized by , laughter, weeping, etc. paresthesias: a skin sensation, such as burning, prickling, itching or tingling, with no apparent insomnia: chronic inability to fall asleep or remain physical cause Mental Health and Environmental Exposures Page 15 phobic avoidance: a condition in which individuals Tool for Family Physicians, avoid entering specific fear-provoking situations http://www.aafp.org/afp/981101ap/carlat.html psychosis: a severe mental disorder characterized For more information about the connection by derangement of personality and loss of contact between environmental exposures and with reality psychiatric symptoms: schizophrenia: any of a group of psychotic National Association for the Dually Diagnosed disorders usually characterized by withdrawal from Environmental Health Project, reality, illogical patterns of thinking, delusions and http://www.envhealthproject.org/ hallucinations, and accompanied in varying degrees by other emotional, behavioral or intellectual Environmental and Chemical Toxins and Psychiatric disturbances Illness by James S. Brown Jr., MD, published 2002 by American Psychiatric Publishing, Inc. serious psychological distress: an overall indicator of past year psychological distress Clinical Environmental Health and Toxic Exposures by John Burke Sullivan and Gary R. Krieger, : a temporary suspension of breathing published 2001 by Lippincott Williams & Wilkins occurring repeatedly during sleep A Small Dose of by Steven G. Gilbert, sleep-wake reversal: a condition in which sleep published 2004 by CRC Press (covers all heath patterns have been disrupted; people fall asleep at effects, including psychiatric) inappropriate times and then cannot sleep when they should For more information about reducing or preventing environmental exposures: somatic complaints: of the body; physical Practice Prevention columns and fact sheets from somnolence: sleepiness; drowsiness the the Learning and Developmental Disabilities subacute: less than acute; between acute and Initiative and the Institute for Children’s chronic Environmental Health, http://www.iceh.org/resources.html subclinical: having no noticeable clinical symptoms Alternatives to pesticides from Beyond Pesticides, suicidal ideation: thinking about suicide http://www.beyondpesticides.org/alternatives/facts tension: a state of mental or emotional strain or heets/index.htm suspense CHE and Disease Database, Resources http://database.healthandenvironment.org/ Environmental Working Group, http://www.ewg.org/ For more information about psychiatric symptoms and disorders: US Environmental Protection Agency Office of Children’s Health Protection, http://www.mentalhealth.com/ http://yosemite.epa.gov/ochp/ochpweb.nsf/content Diagnostic and Statistical Manual of Mental /homepage.htm Disorders, Fourth Edition, Text Revision, Healthy Child, Healthy World, http://www.behavenet.com/capsules/disorders/ds http://www.healthychild.org/ mivtrcodes.htm Database of environmental health resources from http://www.mentalhelp.net/ the Institute for Children’s Environmental Health, New York Online Access to Health, http://www.iceh.org/cgi-bin/searchresources.cgi http://www.noah-health.org/en/mental/ Environmental Working Groups’s Fish List, The Psychiatric Review of Symptoms: A Screening http://www.ewg.org/safefishlist Page 16 Learning and Developmental Disabilities Initiative

Environmental Exposures and Psychiatric Symptoms

Mental health symptoms associated with environmental exposures, grouped by type: Mood Cognitive Behavior Perceptual anger academic decline or abusive language delusions anhedonia problems aggression disordered thinking anxiety amnesia agitation hallucinations apathy cognitive dysfunction antisocial paranoia depression confabulation behavior changes psychosis euphoria confusion bizarre or odd behavior excitability delirium compulsive running or giddiness dementia walking inappropriate affect disorientation crying mania dissociation delinquent behavior melancholia distractibility excessive mood lability Korsakoff’s syndrome embarrassment mood swings lack of attention or poor excitement nervousness attention explosive speech neurosis loss of vigilance hilarity silliness memory loss homicidal poor concentration hyperactivity poor memory hyperreligiosity suicidal ideation hysteria impulsivity Other rage inability to take orders restlessness anorexia or decreased impotence indifference shouting appetite insomnia irritability shyness astasia-abasia Klüver-Bucy syndrome lack of initiative singing catalepsy learning problems laughing sleepwalking derealization lethargy (inappropriately) social withdrawal diffuse electroenceph- loss of libido loss of motivation suicidal alogram abnormalities nightmares minor criminal acts tension echolalia muttering timidity excessive dreaming paraphilias personality change violence fatigue poor appetite phobic avoidance weeping Gilles de la Tourette's sexual problems poor hygiene whistling syndrome sleep apnea hyperphagia somatic complaints hypersexuality somnolence hypersomnia weakness

For more information or for other Practice Prevention columns, visit the Institute for Children’s Environmental Health (ICEH) online at www.iceh.org/resources.html or call 360-331-7904.

ICEH serves as the national coordinator for the Collaborative on Health and the Environment's Learning and Developmental Disabilities Initiative.