Persistent Psychosis from Toluene Exposure; More Likely Coincidence than Cause: A Review of our Experience and the Literature

Inhalant abuse of toluene is frequently accompanied by visual and auditory hallucinations that cease at varying intervals following withdrawal. One study of institutionalized abusers describes persistent hallucinations despite abstinence, with evolution into a “schizophreniform” psychosis. It is suggested that occupational exposure to toluene can have a similar outcome. Taken in concert with the credible neurological literature, our considerable experience with more than 30 cases of toluene abuse, 15 of toluene solvent mixture neurotoxicity, and of many with considerable workplace exposure indicates the combination of persistent psychosis and toluene inhalation does rarely occur. However, it is the chance coincidence of two relatively common conditions, toluene encephalopathy and underlying schizophrenia.