Mrs. Fairfax.
T.P. is a 36-year-old woman who was employed from 25 to 33 years as a welder, using styrene, in a plastic tank factory.
About a year after starting to work, she became pregnant and was down to 27 years old, as the law marks.
As the patient was again exposed to styrene for professional reasons, she began to enjoy the subjective effects of volatile solvents, including styrene and acetone.
When the patient was 32 years old, the company's doctor recommended that she be removed from her job after the results of urine tests, which indicated high levels of styrene metabolites.
After one year, the patient decided to leave the facility.
However, their addictive behaviour had not only persisted but had spread to domestic alcoholic detergents, hair sprays and motor fuels.
The symptoms of acute anxiety appeared suddenly for the first time at work when the patient was 28 years old.
Her first panic-like attack included v tremors, mental weakness and paresthesias.
Acute anxiety episodes were repeated and resulted in frequent absences from work for several days to recover from residual symptoms, such as headache and veiled symptoms.
After leaving work she was depressed for a few months, so she was treated with antidepressant drugs.
Even though she suffered from a mental disorder, she experienced residual anxiety symptoms associated with agoraphobia.
Finally, the patient suffered duodenal ulcer at 35 years of age.
The main chronological relationships between professional exposure, substance abuse behavior, anxiety symptoms and vital events are shown in Figure 1.
1.
When she came to the consultation, the patient was inhaled and separated from her husband, lived with her child in her mother's house, had fluctuating anxiety and persistent symptoms of mild depression, and reported volatilous abstinence.
The most prominent mental disorders during the examination included vindication of mental and somatic tension, paresthesias, weakness in mental disorders and light now.
The patient was not satisfied with the antidepressant treatments prescribed (maprotiline i.v., paroxetine v.o.) and depended on anxiolytic drugs alprazol.
Psychiatric and psychological assessment
Table I refers to the scores and indices of the SCL-90-R.
In particular, the patient scored positive all the symptoms listed in the anxiety dimension in the last 7 days, and all less two (palpitations and tremor) obtained maximum scores; on the contrary, the patient obtained a low score.
1.
We also administered the WAIS and the Rorschach test, since anomalies in performance were found in these instruments when exposed to medium concentrations of styrene (Jégaden et al 1993).
Our patient showed an unequal profile of intellectual abilities in the Wechsler scale, with obviously lower scores in two subtests: arithmetic and number series (mainly in the possible organic damage series), apart from the possible organic damage.
The Rorschach revealed a personality handicap to emotional pain, somatization, insecurity and depressed mood; the ego structure, although fragile, was well preserved; the possible organic signs were below the threshold.
In general, psychological assessment was consistent with neuroticism, but showed no brain damage.
Neuroimaging
Axial and coronal magnetic resonance imaging (MRI) was obtained after injection of medium contrast (gadolinium-DTPA).
Tman2 and MRI in subjects who abused inhaled agents showed: a moderate variable degree of brain damage (Y poor differentiation between grey matter and white matter, increased intensity in the periventricular signal and hypointense basal ganglia).
No signs of intraparenchymal intensity alterations or intracranial hypersignal areas were observed in our patient, so it was concluded that there was no cerebral alteration.
