Neuropsychiatric Implications of Chronic Lead Exposure

There is growing awareness of chronic exposures to lead, with recent evidence indicating that there is an increased risk of a range of health effects that include cardiovascular, kidney, cognitive, and premature mortality, at blood levels lower than what was previously considered elevated. This report describes the case of a 42-year-old active duty officer with a history of anxiety, cognitive impairment, and paroxysmal hypertensive episodes associated with elevated body burdens of lead as measured in bone, while having low or unremarkable blood level measurements. Challenges related to work-up, treatments, and outcomes are discussed. An elevated body burden of lead may contribute to increased irritability, fatigue, and anxiety, mimicking posttraumatic stress disorder and other primary psychiatric conditions. This presentation highlights the need for an increased index of suspicion of lead poisoning in both medical and psychiatric care, particularly in military populations.