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One of the significant achievements of modern psychiatry has
been the categorization of symptomatology. We know that
people who experience manic phases, for example, often
respond to treatment with lithium. By classifying symptoms into
common syndromes, each of which has its own recommended
treatment, the physician has a better concept of how to address
a specific constellation of behaviors and mental phenomena he is
presented with.
This same classification system, however, can create a false
sense of certainty, which can lead to misdiagnosis. The
practitioner can fall into the habit of assessing a patient using
Diagnostic and Statistical Manual (DSM) criteria, assigning a
diagnosis, and prescribing in accordance with diagnostic
protocols. While this is an efficient system, the truth is that five
different patients with a diagnosis of depression, for example,
can have symptoms due to five completely different etiologies.
Thus, five different treatment plans may be in order, not a
generic approach based strictly on diagnosis.
Two such etiologies that can deceive a psychiatrist’s diagnostic
eye are allergies and toxins. While treating symptoms
been the categorization of symptomatology. We know that
people who experience manic phases, for example, often
respond to treatment with lithium. By classifying symptoms into
common syndromes, each of which has its own recommended
treatment, the physician has a better concept of how to address
a specific constellation of behaviors and mental phenomena he is
presented with.
This same classification system, however, can create a false
sense of certainty, which can lead to misdiagnosis. The
practitioner can fall into the habit of assessing a patient using
Diagnostic and Statistical Manual (DSM) criteria, assigning a
diagnosis, and prescribing in accordance with diagnostic
protocols. While this is an efficient system, the truth is that five
different patients with a diagnosis of depression, for example,
can have symptoms due to five completely different etiologies.
Thus, five different treatment plans may be in order, not a
generic approach based strictly on diagnosis.
Two such etiologies that can deceive a psychiatrist’s diagnostic
eye are allergies and toxins. While treating symptoms
pharmaceutically may help to some degree, a far more effective
approach for improving wellness would be to identify and treat
the allergy or toxicosis.
Allergies and Mental Health
An allergy is a hypersensitivity disorder of the immune system.
Substances which should be innocuous create a reaction in the
individual ranging from bothersome to life-threatening.
Allergens activate the antibody Immunoglobulin E (IgE), which,
in turn, triggers mast cells and basophils, resulting in an
extreme inflammatory response.
Allergies can affect any or multiple systems of the body,
including digestive, respiratory, cardiovascular, endocrine, and
neurological. Allergic responses differ considerably amongst
individuals. The same substance—latex, for example—that can
cause one person to break out in hives can cause a different
individual to have a panic attack.
An individual can have allergies and not know it. Symptoms
may not be as recognizable as those of allergic rhinitis, with
sniffling and sneezing. Psychiatric symptoms, in particular, even
when they are of strictly physiological origin, may be mistakenly
assigned to life situations, stress, or other blameworthy causes.
Although the most common allergy-related psychiatric
symptoms that have been studied are depression and anxiety,
given the variability of human response to allergies, any
psychiatric symptom, including psychosis, has the potential of
being allergy-induced.
The key element of allergies is exposure. Sporadic exposure
results in intermittent symptom expression. Constant exposure
gives chronic symptoms. Therefore, allergies must be considered
as a potential causative agent, whether a patient has
intermittent symptoms or chronic.
For example, a person sensitive to mold who lives in an area
that had recent flooding may respond with chronic depression
for months if mold spores or mycotoxins are continuously
approach for improving wellness would be to identify and treat
the allergy or toxicosis.
Allergies and Mental Health
An allergy is a hypersensitivity disorder of the immune system.
Substances which should be innocuous create a reaction in the
individual ranging from bothersome to life-threatening.
Allergens activate the antibody Immunoglobulin E (IgE), which,
in turn, triggers mast cells and basophils, resulting in an
extreme inflammatory response.
Allergies can affect any or multiple systems of the body,
including digestive, respiratory, cardiovascular, endocrine, and
neurological. Allergic responses differ considerably amongst
individuals. The same substance—latex, for example—that can
cause one person to break out in hives can cause a different
individual to have a panic attack.
An individual can have allergies and not know it. Symptoms
may not be as recognizable as those of allergic rhinitis, with
sniffling and sneezing. Psychiatric symptoms, in particular, even
when they are of strictly physiological origin, may be mistakenly
assigned to life situations, stress, or other blameworthy causes.
Although the most common allergy-related psychiatric
symptoms that have been studied are depression and anxiety,
given the variability of human response to allergies, any
psychiatric symptom, including psychosis, has the potential of
being allergy-induced.
The key element of allergies is exposure. Sporadic exposure
results in intermittent symptom expression. Constant exposure
gives chronic symptoms. Therefore, allergies must be considered
as a potential causative agent, whether a patient has
intermittent symptoms or chronic.
For example, a person sensitive to mold who lives in an area
that had recent flooding may respond with chronic depression
for months if mold spores or mycotoxins are continuously
present. Mold can also exist for years in locations such as
heating, ventilation, and air conditioning systems, causing
continuous exposure at home or work.
Depression and Anxiety
It is well established that inflammation and inflammatory
mechanisms play a critical role in major depression. Elevations
in proinflammatory cytokines and other inflammation-related
proteins are common in depressive disorders (Raedler 2011). It
should not be too surprising then to find that 71% of people with
depression also have a history of allergies (Bell 1991). This is 3.5
times the rate of the general population (Gelfand 2010).
It is also known that depression scores increase with the
exacerbation of allergy symptoms and that cytokines are
elevated in the prefrontal cortex in victims of suicide
(Postolache 2007).
There is an overwhelming preponderance of studies showing
the relationship between allergies and depression (and anxiety).
The causal relationship includes the triggering of the immune
system and cytokines, the impairment of sleep through nasal
obstruction resulting in psychiatric symptoms, and the negative
effect on cognitive function associated with allergies (Sansone
2011).
Gastrointestinal inflammation also may be a significant
contributing factor to depression (Fehér 2011). Food allergies
can play a major role. It has been found, for example, that 25% of
Irritable Bowel Syndrome patients, in whom GI inflammation is
common, are sensitive to cow milk, wheat, egg, tomato, and
chocolate. Symptoms improve on an elimination diet (Carroccio
2011).
Given that allergies commonly impact the respiratory and
cardiovascular systems, it comes as no surprise that restricted
breathing or asthma with accompanying tachycardia, so
frequently found with allergies, is a common trigger for anxiety
heating, ventilation, and air conditioning systems, causing
continuous exposure at home or work.
Depression and Anxiety
It is well established that inflammation and inflammatory
mechanisms play a critical role in major depression. Elevations
in proinflammatory cytokines and other inflammation-related
proteins are common in depressive disorders (Raedler 2011). It
should not be too surprising then to find that 71% of people with
depression also have a history of allergies (Bell 1991). This is 3.5
times the rate of the general population (Gelfand 2010).
It is also known that depression scores increase with the
exacerbation of allergy symptoms and that cytokines are
elevated in the prefrontal cortex in victims of suicide
(Postolache 2007).
There is an overwhelming preponderance of studies showing
the relationship between allergies and depression (and anxiety).
The causal relationship includes the triggering of the immune
system and cytokines, the impairment of sleep through nasal
obstruction resulting in psychiatric symptoms, and the negative
effect on cognitive function associated with allergies (Sansone
2011).
Gastrointestinal inflammation also may be a significant
contributing factor to depression (Fehér 2011). Food allergies
can play a major role. It has been found, for example, that 25% of
Irritable Bowel Syndrome patients, in whom GI inflammation is
common, are sensitive to cow milk, wheat, egg, tomato, and
chocolate. Symptoms improve on an elimination diet (Carroccio
2011).
Given that allergies commonly impact the respiratory and
cardiovascular systems, it comes as no surprise that restricted
breathing or asthma with accompanying tachycardia, so
frequently found with allergies, is a common trigger for anxiety
and panic attacks. As with depression, as allergy scores increase,
so do anxiety symptoms (Postolache 2008).
Additionally, it’s been found that allergic rhinitis worsens
existing psychiatric symptoms. The behavior of somatization,
compulsion, depression and anxiety in patients with a history of
eczema or asthma is much more obvious than in patients
without such a history. Nasal obstruction has a conspicuous
impact on somatization, compulsion, interpersonal sensitivity,
depression, anxiety and psychosis, while nasal itching
contributes to somatization, depression and anxiety (Lv 2010).
Celiac Disease
Although celiac disease (CD) is not an allergy per se, it is often
considered one because it is an autoimmune disorder of the
small intestine caused by a reaction to gliadin, a protein found in
wheat and similar proteins found in other grains. An
inflammatory reaction atrophies the villi lining of the small
intestine, resulting in reduced ability to absorb nutrients,
minerals and the fat-soluble vitamins A, D, E, and K. Typical
symptoms include chronic diarrhea and other GI complaints,
failure to thrive (in children), and fatigue. Standard treatment is
removal of wheat and other offending grains from the diet.
One percent of the population is estimated to have CD and six
times that many are believed to have gluten sensitivity (GS), an
illness distinct from CD that does not include villous atrophy
among its symptoms. Both CD and GS may present with a variety
of neurologic and psychiatric co-morbidities (Jackson 2011).
Ninety-seven percent of CD cases go undiagnosed and 41% of
adult cases and 60% of child cases are asymptomatic (U. Chicago
Facts).
Additionally, like asthma and autism, the percentage of CD
cases is on the rise, increasing nearly fourfold in the past four
decades from 1:501 in 1974 (Catassi 2010) to 1:133 in 2003 (Fasano
2003).
so do anxiety symptoms (Postolache 2008).
Additionally, it’s been found that allergic rhinitis worsens
existing psychiatric symptoms. The behavior of somatization,
compulsion, depression and anxiety in patients with a history of
eczema or asthma is much more obvious than in patients
without such a history. Nasal obstruction has a conspicuous
impact on somatization, compulsion, interpersonal sensitivity,
depression, anxiety and psychosis, while nasal itching
contributes to somatization, depression and anxiety (Lv 2010).
Celiac Disease
Although celiac disease (CD) is not an allergy per se, it is often
considered one because it is an autoimmune disorder of the
small intestine caused by a reaction to gliadin, a protein found in
wheat and similar proteins found in other grains. An
inflammatory reaction atrophies the villi lining of the small
intestine, resulting in reduced ability to absorb nutrients,
minerals and the fat-soluble vitamins A, D, E, and K. Typical
symptoms include chronic diarrhea and other GI complaints,
failure to thrive (in children), and fatigue. Standard treatment is
removal of wheat and other offending grains from the diet.
One percent of the population is estimated to have CD and six
times that many are believed to have gluten sensitivity (GS), an
illness distinct from CD that does not include villous atrophy
among its symptoms. Both CD and GS may present with a variety
of neurologic and psychiatric co-morbidities (Jackson 2011).
Ninety-seven percent of CD cases go undiagnosed and 41% of
adult cases and 60% of child cases are asymptomatic (U. Chicago
Facts).
Additionally, like asthma and autism, the percentage of CD
cases is on the rise, increasing nearly fourfold in the past four
decades from 1:501 in 1974 (Catassi 2010) to 1:133 in 2003 (Fasano
2003).
Remarkably, 35% of biopsy-proven CD cases have a history of
psychiatric illness (Bürk 2009). Logic would then dictate that we
would find an over-representation of CD and GS cases in a
psychiatric population. Indeed, it’s been found that diagnosed CD
is found three times as often among those with schizophrenia
(Eaton 2004).
After reviewing the increase of CD prevalence in a 50-year span,
Mayo Clinic lead researcher and gastroenterologist, Joseph
Murray, M.D., remarked, “Celiac disease is unusual, but it’s no
longer rare.... Until recently, the standard approach to finding
celiac disease has been to wait for people to complain of
symptoms and to come to the doctor for investigation.... We may
need to consider looking for celiac disease in the general
population, more like we do in testing for cholesterol or blood
pressure.” (Mayo Clinic 2009)
Given the high rate of psychiatric symptoms amongst CD
patients and given the above facts and figures, the practitioner
needs to consider:
− Patients with schizophrenia are at least three times more
likely to have CD (meaning 3% of schizophrenia patients)
and, if the same pattern follows, three times more likely to
have GS (18% of patients).
− Odds are 33:1 that a patient with CD is unaware he/she has
it.
− Nearly half of patients with CD will not manifest it yet may
show psychiatric symptoms from it.
− Psychiatric manifestations will vary widely amongst CD
patients.
− A gluten-free (GF) diet of CD and GS patients could eliminate
or dramatically reduce psychiatric symptoms.
Given Dr. Murray’s comments that the general public may need
routine testing for CD, the matter is accentuated in a psychiatric
population. Standard testing includes blood levels of the
antibodies anti-endomysium and anti-tissue transglutaminase. If
psychiatric illness (Bürk 2009). Logic would then dictate that we
would find an over-representation of CD and GS cases in a
psychiatric population. Indeed, it’s been found that diagnosed CD
is found three times as often among those with schizophrenia
(Eaton 2004).
After reviewing the increase of CD prevalence in a 50-year span,
Mayo Clinic lead researcher and gastroenterologist, Joseph
Murray, M.D., remarked, “Celiac disease is unusual, but it’s no
longer rare.... Until recently, the standard approach to finding
celiac disease has been to wait for people to complain of
symptoms and to come to the doctor for investigation.... We may
need to consider looking for celiac disease in the general
population, more like we do in testing for cholesterol or blood
pressure.” (Mayo Clinic 2009)
Given the high rate of psychiatric symptoms amongst CD
patients and given the above facts and figures, the practitioner
needs to consider:
− Patients with schizophrenia are at least three times more
likely to have CD (meaning 3% of schizophrenia patients)
and, if the same pattern follows, three times more likely to
have GS (18% of patients).
− Odds are 33:1 that a patient with CD is unaware he/she has
it.
− Nearly half of patients with CD will not manifest it yet may
show psychiatric symptoms from it.
− Psychiatric manifestations will vary widely amongst CD
patients.
− A gluten-free (GF) diet of CD and GS patients could eliminate
or dramatically reduce psychiatric symptoms.
Given Dr. Murray’s comments that the general public may need
routine testing for CD, the matter is accentuated in a psychiatric
population. Standard testing includes blood levels of the
antibodies anti-endomysium and anti-tissue transglutaminase. If
these are positive, an endoscopic biopsy of the small intestine is
done to confirm the diagnosis (U Chicago Tests).
However, recent research has indicated that positive blood
tests alone (known as “potential CD”) may indicate the need for a
GF diet because these patients show many of the markers of CD
patients and may simply be in a pre-villous-atrophy stage
(Bernini 2011).
Poisons and Toxins
A poison is a substance that can cause disturbance to an
organism through chemical reaction or other activity on a
molecular scale. A toxin is a poisonous substance produced
within living cells or organisms. The adjective “toxic” refers to
poisons and toxins. Thus, mercury is a poison and mycotoxins—
metabolites produced by molds—are toxins. Both are toxic.
Poisons and toxins can create virtually any neuropsychiatric
symptom from depression and suicidality to focus problems (as
in ADHD) to paranoia and psychosis. It is incumbent upon the
practitioner to consider this factor when a patient presents with
psychiatric symptoms. An in-depth intake assessment can often
help narrow the possibilities. The patient may even suspect a
toxic influence. Of particular importance is occupation (e.g.,
exposure to industrial chemicals, mercury in a laboratory, or
pesticides), hobbies (e.g., working with lead toy soldiers or
chemicals in a workshop), and location of his/her habitat and
workplace (e.g., mold in flooded regions or air pollution in urban
areas). A particularly revealing question is, “Does anyone in your
(neighborhood, factory, home, etc.) have similar symptoms?”
Certain classic neurotoxins, such as lead, mercury, and
pesticides, are well known. Most medical students are told how
the phrase “mad as a hatter” comes from the fact that mercury
used by hat makers of old commonly resulted in a deteriorating
psychosis. However, the list of substances that cause psychiatric
symptoms is actually quite long—with new ones being
done to confirm the diagnosis (U Chicago Tests).
However, recent research has indicated that positive blood
tests alone (known as “potential CD”) may indicate the need for a
GF diet because these patients show many of the markers of CD
patients and may simply be in a pre-villous-atrophy stage
(Bernini 2011).
Poisons and Toxins
A poison is a substance that can cause disturbance to an
organism through chemical reaction or other activity on a
molecular scale. A toxin is a poisonous substance produced
within living cells or organisms. The adjective “toxic” refers to
poisons and toxins. Thus, mercury is a poison and mycotoxins—
metabolites produced by molds—are toxins. Both are toxic.
Poisons and toxins can create virtually any neuropsychiatric
symptom from depression and suicidality to focus problems (as
in ADHD) to paranoia and psychosis. It is incumbent upon the
practitioner to consider this factor when a patient presents with
psychiatric symptoms. An in-depth intake assessment can often
help narrow the possibilities. The patient may even suspect a
toxic influence. Of particular importance is occupation (e.g.,
exposure to industrial chemicals, mercury in a laboratory, or
pesticides), hobbies (e.g., working with lead toy soldiers or
chemicals in a workshop), and location of his/her habitat and
workplace (e.g., mold in flooded regions or air pollution in urban
areas). A particularly revealing question is, “Does anyone in your
(neighborhood, factory, home, etc.) have similar symptoms?”
Certain classic neurotoxins, such as lead, mercury, and
pesticides, are well known. Most medical students are told how
the phrase “mad as a hatter” comes from the fact that mercury
used by hat makers of old commonly resulted in a deteriorating
psychosis. However, the list of substances that cause psychiatric
symptoms is actually quite long—with new ones being
discovered continuously—and far too extensive for us to cover in
this brief publication, though we can give some examples.
Hydrogen sulfide—common to volcanic eruptions, tanneries,
and some paper mills—can affects mood states and the
psychological stress response. In animal studies, it has been
shown to alter levels of the neurotransmitters serotonin,
norepinephrine, dopamine, aspartate and glutamate. Carbon
disulfide, also a neurotoxin, has been linked to personality
changes, mood disorders and suicides in occupational settings. A
Duke University study, looking into why two neighborhoods in
North Carolina had 10 times the state’s suicide rate and 6.4 times
the rate of primary brain cancers, found that a local asphalt
plant emitted these and other neurotoxic compounds into the
atmosphere. Hydrogen sulfide levels reached as much a ten
times the acceptable standard (Duke Medicine 2004).
When farm workers receive what they consider to be a toxic
level of exposure to pesticides with organophosphates, it has
been found they have nearly six times the rate of depression as
the general public (Stallones 2002).
Particulate air pollution, a pervasive exposure in modern urban
environments, has been found to alter brain structure and cause
cognitive impairment and depressive symptoms. Mice exposed
to pollutants at the same levels of modern city inhabitants were
found to have not only depressed states, but elevated cytokine
expression in the hippocampus and altered dendrite growth
(Fonken 2011).
Electromagnetic fields (EMF), though not a toxin or poison by
definition, are nonetheless an environmental exposure found to
have serious impact on mental health for some individuals.
Electrical utility workers have double the suicide rate, for
example, possibly due to melatonin depletion triggered through
EMF exposure (van Wijngaarden 2000).
The treatment for toxic exposure will vary depending on the
substance but the first line of defense would be, if possible,
removal of the offending material. In the case of occupational or
this brief publication, though we can give some examples.
Hydrogen sulfide—common to volcanic eruptions, tanneries,
and some paper mills—can affects mood states and the
psychological stress response. In animal studies, it has been
shown to alter levels of the neurotransmitters serotonin,
norepinephrine, dopamine, aspartate and glutamate. Carbon
disulfide, also a neurotoxin, has been linked to personality
changes, mood disorders and suicides in occupational settings. A
Duke University study, looking into why two neighborhoods in
North Carolina had 10 times the state’s suicide rate and 6.4 times
the rate of primary brain cancers, found that a local asphalt
plant emitted these and other neurotoxic compounds into the
atmosphere. Hydrogen sulfide levels reached as much a ten
times the acceptable standard (Duke Medicine 2004).
When farm workers receive what they consider to be a toxic
level of exposure to pesticides with organophosphates, it has
been found they have nearly six times the rate of depression as
the general public (Stallones 2002).
Particulate air pollution, a pervasive exposure in modern urban
environments, has been found to alter brain structure and cause
cognitive impairment and depressive symptoms. Mice exposed
to pollutants at the same levels of modern city inhabitants were
found to have not only depressed states, but elevated cytokine
expression in the hippocampus and altered dendrite growth
(Fonken 2011).
Electromagnetic fields (EMF), though not a toxin or poison by
definition, are nonetheless an environmental exposure found to
have serious impact on mental health for some individuals.
Electrical utility workers have double the suicide rate, for
example, possibly due to melatonin depletion triggered through
EMF exposure (van Wijngaarden 2000).
The treatment for toxic exposure will vary depending on the
substance but the first line of defense would be, if possible,
removal of the offending material. In the case of occupational or
habitat exposures, difficult choices may be involved requiring
finding new employment or changing living quarters.
Summary
With allergies increasing and toxic exposures on the rise in our
increasingly industrialized world, psychiatric symptoms from
these environmental causes are also becoming more prominent.
A wise physician, on the lookout for such risk factors, could save
a patient years or even a lifetime of misdiagnosis and add years
of more healthful living to what might otherwise be an existence
of slow and mysterious decline.
finding new employment or changing living quarters.
Summary
With allergies increasing and toxic exposures on the rise in our
increasingly industrialized world, psychiatric symptoms from
these environmental causes are also becoming more prominent.
A wise physician, on the lookout for such risk factors, could save
a patient years or even a lifetime of misdiagnosis and add years
of more healthful living to what might otherwise be an existence
of slow and mysterious decline.
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