Panic Disorder Can Be Caused by Neurotoxicity[1]
Raymond Singer, Ph.D.
36 Alondra Road
Santa Fe, New Mexico, USA
Introduction: Subject was exposed for some minutes to 1,1,1,2-Tetrafluoroethane, a gaseous fluorocarbon refrigerant, with possible prior exposure to the same substance without noticeable symptoms.  The International Chemical Safety Card for 1,1,1,2-Tetrafluoroethane reports that acute symptoms of inhalation include dizziness, drowsiness, and dullness, and “a harmful concentration of this gas in the air will be reached very quickly on loss of containment… The substance may cause effects on the central nervous system and the cardiovascular system, resulting in cardiac disorders… inhaling high concentration of vapor… may cause light-headedness, shortness of breath, heart irregularities, unconsciousness or death” and that the vapor “reduces the oxygen available for breathing.”


Exposure: A 1000 pound cylinder was leaking in a basement, which set off an alarm that the subject, a maintenance supervisor, investigated. Upon descent into the basement area, she became severely dizzy, with difficulty breathing and weakness. Signs of intoxication were witnessed by a co-worker.


Two months later, she began having attacks of heart palpitations, dizziness, shortness of breath, and tingling and numbness of head and arms, and she was taken to the emergency room. Two months later, she was diagnosed with panic disorder, short-term memory loss, fatigue, and irritability, confirmed by the same doctor for more than 1 year. Two years after exposure, a brain MRI revealed small sites of abnormal peri-ventricular white matter signal, compatible with micro-vascular or hypoxic ischemic changes.


Results: Prior to the exposure, the subject had not taken any sick leave for 8 years. Supervisor records showed excellent work. Prior IQ was 131 (98th percentile), with similarly elevated prior aptitude testing scores. Upon examination 2½ years post-exposure, symptoms consistent with permanent neurotoxicity were found with the Neurotoxicity Screening Survey; as well as the following results:


Test Percentile
WAIS-III: Processing Speed 58
Expanded Paired Associate Test (recent) 5
Expanded Paired Associate Test (delayed) 11
Selective Reminding Test 13
Stroop Color-Word Test 54

Additional cognitive deficits were identified.  She was positive for anxiety and depression on Beck’s Inventories. No psychosis on Whitaker Inventory of Schizophrenic Thought. Malingering testing was negative using multiple tests of this variable.


Personality testing revealed a possibly emerging personality disorder. However, prior to her illness, there was no evidence of a personality disorder. For example, her brother who accompanied the subject to the exam was interviewed without forewarning concerning these matters, and he confirmed a drastic deterioration in the subject’s personality post-exposure. Examination of the medical record found no alternate explanation of her cognitive and emotional illness.


Conclusion: Neurotoxicity can be expressed as cognitive dysfunction, emotional disorder, panic attacks, personality disorders, or a combination of the above. All results must be interpreted within the subject’s history. Neurotoxicity may be a significant cause of psychiatric disorders among people with exposure to neurotoxic substances, resulting in various diagnoses, such as panic disorder.


            [1]Singer, R (2002). Panic disorder can be caused by neurotoxicity. Presented at the 22nd Annual Meeting of the National Academy of Neuropsychology, Miami, Florida, October 12, 2002. http://www.neurotox.com/ ; ray.singer@gmail.com

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Subject was exposed for some minutes to 1,1,1,2-Tetrafluoroethane, a gaseous fluorocarbon refrigerant, with possible prior exposure to the same substance without noticeable symptoms.