William J. Rea, MD, FACSCDirector Environmental Health Center-Dallas, Dallas, TX
Joel R. Butler, PhDCNorth Texas State University, Denton, TX
John L. Laseter, PhDCCenter for Bio-Organic Studies of the University of New Orleans, where this work was done
Iildefonso R. DeLeon, BSCEnviro-Health Systems, Inc., New Orleans, LA
Address all correspondence to: WJ Rea, MD, 8345 Walnut Hill Ln, Suite 205, Dallas, TX 75231
Source: Rpt. from Clinical Ecology, Vol. II, No. 3, Summer 1984, pp. 145-150.
Key words: pesticides
The Minnesota Multiphasic Inventory (MMPI) is an empirically derived objective measure of psychological pathology containing nine clinical scales and three validity scales. The reliability is 0.77 over all scales.5 The Wechsler Adult Intelligence Scale-Revised (WAIS-R)6 is an individually administered, standardized, objective measure of intelligence and cognitive function. It is divided into the two major sectionsCverbal and performance. Test reliability of the WAIS-R is 0.97.
The Bender-Gestalt7 consists of nine geometric designs which the patient is asked to reproduce. The Bender is objectively scored by the Embree/Butler8 method to serve as a nuerological screen (reliability, 0.91).
The patients were administered psychological/brain-function tests (MMPI, WAIS-R, and Bender-Gestalt) at the beginning of treatment and retested at the end of the treatment phase. All tests were scored by standardized techniques, by qualified examiners.
Blood pesticide levels were measured before and after treatment. Sign and symptom scores were obtained before and after treatment.
Chlorinated pesticides measured were:
Endosulfan I Aldrin
Heptachlor Epoxide DDE
Pesticides were measured in serum using high resolution
glass capillary gas chromatographic methods following extraction with residue
analysis grade hexane. Detection was by elecron capture. Confirmatory gas
chromatography-mass spectrometry analyses were performed in 10% of the
extracts. Glassware and solvent blanks were analyzed to insure proper quality
control. An internal standard method was employed for quantitation of identified
pesticides by Laseter et al.4
Blood Pesticide Decrease with ECU Treatment Measured Individually (by Chi-Square) and Overall (by t-test)
Magnitude of Change after Treatment
t<0.001 overall change
All other figures not statistically significant even though decreased, due to small total sample size.
Symptoms and sign scores were reduced 80% over admission. The various body systems affected by pesticides may be seen in Table II. All 40 patients demonstrated brain/neurological effects, and more than half showed cardiovascular disturbances.
Systems Affected by Pesticides
The clearing of pesticides from the blood under environmentally controlled conditions may be used as an indicator with a high degree of accuracy of levels of pesticides in other tissue resulting in improvement of the patient. Not shown in the present study (due to too few numbers) was the observation that blood pesticide levels would frequently increase after institution of enivronmental control. The patients= clinical condition appeared to worsen during this period suggesting at least in part that they were adversely responding to the increase in chemical load in their blood stream. This again would suggest that blood pesticide levels would influence clinical symptoms. There appeared to be a varied rate of clearing of some pesticides. Several pesiticides seemed to be removed more eaily from the body. For example, heptachlor (X2=7.54) was removed much faster than ß-BHC (X2=1.02). The reasons for this are unclear. However, animal data would suggest that microsomal enzyme induction varies with the type of chlorinated pesticides ingested, thus theoretically changing clearing rates.
One puzzling fact occurred: 55% of the patients showed different pesticides in the blood after treatment over a period of 11 months. This could be due either to new pesticides from external exposure or more likely due to sequestered pesticides coming out of the tissue. The latter conclusion is more likely in humans, since the patients were taking care to minimize re-exposure by taking less contaminated food, water, and airCand also were continually improving symptomatically. There are some animal data to support this last concept. For example, the body will preferentially store dieldrin over DDT, while DDT will suppress heptachlor storage in rats.23
In the present study, chlorinated hydrocarbon pesticides are strongly correlated with a changed psychological/brain-function condition. A previous study from this group (and others)4 has shown that these pesticides affect the central nervous system, maintaining a body burden. In terms of psychological/brain-function behavior associated with pesticide poisoning, the clinical factors are somewhat worse that those of environmental patients who may seem to (but do not) represent a neuroticsomatoform disorder. Chlorinated pesticides appear to be associated with a more serious psychological profile in which the patient shows more indications of major variance of behavior such as depression with obsessive-compulsive patterns of coping, and of symptoms such as emotional sensitivity (an apparent overreaction to emotional stimuli), often with feelings of being rather overwhelmend by adversityCsometimes to the point of having persecutory thoughts that lead to unreasonably angry responses. Further, this patient profile suggests feelings of alienationCof not understanding one=s own attitude or behavior (Athis is not true of me@) and of distancing one=s self from others (even significant others). There are also indications of some tendency toward diminished ego control in dealing with reality along with a sense of strangeness in bodily reactions.
While the clinical patterns of these patients were usually similar, not all of the patients showed all of the symptoms. They exhibited central and peripheral nervous system (cognitive, perceptual, motor) symptoms and signs including recent-memory deficits, paresthesias, headache, dizziness, and motor instability. There was consistent and significant improvement in these parameters as the patients cleared pesticides from the blood. These reactive profiles are consistent with (but not totally inclusive of) what is known about accidental poisoning by the pesticides, with the highest frequency of detection being BHC, DDT, heptachlor epoxide, hexachlorobenzene, and dieldrin.
Fein25 and her associates have concluded that evidence of poisoning may appear in subtle behavioral alterations and in emotional or sensorimotor difficulties discernable only when the individual is observed systematically over time in carefully designed assessment situations. At low levels of exposure, the effects may differ in different individuals due to genetic deficits, heavy stress, or other variables. Behavioral changes could promote interpersonal difficulties because of the affected individual=s depression, irritability, activity rate, etc. There may be a long latency of reaction (weeks to years) for those persons exposed to chemicals, and reactions may take different forms in different systems. These range from emotional lability to impaired learning ability and can affect the unborn child.
The incidence of blood pesticide levels is associated
with a more serious psychological pattern of brain function variance, which
may be reflective of the general response to chemical contamination. The
effects of chemical-toxic reaction in the validity of objective standardized
test patterns will require systematic observation of repetitive design
to ensure predictive accuracy in the interpretation of behavior. Chemical/pesticide
effects on emotions and intellect are apparent, but precision in determining
the multiple interactions remain to be discovered.
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The authors wish to express their appreciation for the assistance of Sharon G. Wright, MS, and Melody J. Milam, PhD, of North Texas State University.