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Immunologic testing failed to confirm findings from earlier uncontrolled studies, militating against proposed immunologic mechanisms. The decreased memory and concentration frequently described in multiple chemical sensitivity were not confirmed by brief neuropsychological testing. Psychological symptoms, although not necessarily etiologic, are a central component of chemical sensitivity.

The level of satisfaction with telepsychiatry evaluations was determined in a sample of 43 forensic psychiatric patient inmates in a large urban jail. A forensic psychiatrist interviewed 20 patients in person, the other 23 remotely via interactive video. Demographic characteristics, physical health status, and psychiatric symptom severity on the Global Severity Index of the Brief Symptom Inventory were comparable in the two groups. Patient satisfaction with the evaluations was moderately high for patients in both groups, with no significant differences between them.

Unless factors unique to serious mental illness can be specifically associated with behavior leading to incarceration, the criminalization hypothesis should be reconsidered in favor of more powerful risk factors for crime that are widespread in social settings of persons with serious mental illness.

We investigated repetitive transcranial magnetic stimulation (rTMS) as a treatment for major depression. The experimental design comprised 15 medication-free subjects with major depressive disorder who were randomly assigned to receive 10 sessions of active or sham 10-Hz rTMS to the left dorsolateral prefrontal cortex at 110% motor threshold. Depression severity was measured by the Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI). Nonresponders to sham were allowed to receive active rTMS with the same parameters. Response to treatment was analyzed using a random regression model including episode duration and number of prior antidepressant treatments as covariates. Treatment (rTMS vs. sham) did not significantly predict changes in depression severity. Shorter duration of episode and more lifetime treatment trials significantly predicted improvements in BDI but not HDRS scores. Data from all subjects who received active rTMS (n = 14) showed that those with a depressive episode duration of shorter than 4 years had a mean HDRS decrease of 52% compared to 6% in those with an episode duration longer than 10 years. Active rTMS was well tolerated and was not associated with neuropsychological decrements when compared to sham. No significant antidepressant effects were found for 2 weeks of rTMS compared to sham. Among all subjects receiving rTMS those with a shorter duration of the current episode showed a greater response. Patients may need more than 10 treatments to obtain full benefit from rTMS. The design of future rTMS studies should consider these issues.

Objectives-It is plausible that neurodegenerative processes of aging might have a contributing role in the development of chronic eVects of exposure to organic solvents. This study evaluated the risk for neuropsychological deficits among retired workers, relative to their histories of exposure to occupational solvents. Methods-This cross sectional study evaluated retired male workers, 62-74 years of age, including 89 people with previous long term occupational exposure to solvents (67 retired painters and 22 retired aerospace manufacturing workers), and 126 retired carpenters with relatively minimal previous exposure to solvents. Subjects completed a standardised neuropsychological evaluation and psychiatric interview, structured interviews for histories of occupational exposure and alcohol consumption, and questionnaires assessing neurological and depressive symptoms. Results-By comparison with the carpenters, the painters on average reported greater cumulative alcohol consumption and had lower scores on the WAIS-R vocabulary subtest, usually presumed to reflect premorbid intellectual functioning. These findings, however, were not suYcient to account for the other study findings. Controlling for age, education, vocabulary score, and alcohol use, the painters had lower mean scores on test measures of motor, memory, and reasoning ability; and a subgroup of aerospace workers with moderate to high cumulative exposure to solvents (n=8) had lower mean scores on measures of visuomotor speed, and motor, attention, memory, and reasoning ability. Subjects were more likely to have an increased number of relatively abnormal test scores (three or more outlier scores on 17 test measures) among both the painter group (odds ratio (OR), 3.1; 95% confidence interval (95% CI) 1.5 to 6.2) and the subgroup of aerospace workers with higher cumulative exposure (OR 5.6; 95% CI 1.0 to 38). The painters, but not the aerospace workers, reported significantly more neurological and depressive symptoms. Conclusions-The findings are consistent with residual central nervous system dysfunction from long term exposure to organic solvents, persisting years after the end of exposure. (Occup Environ Med 1999;56:93-105)

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