Growth hormone, prolactin and cortisol responses and growth patterns in hyperkinetic children treated with dextro-amphetamine. Preliminary findings

Psychotropic medication effects on cortisol: Implications for research and mechanisms of drug action

Stress and the hypothalamic-pituitary-adrenal (HPA) axis have been implicated in the etiology of a range psychiatric disorders; abnormalities in cortisol secretion are well documented in mood, anxiety, and psychotic disorders. There is, however, evidence that psychotropic medications affect HPA function, and are often a confound in research on the relation of cortisol secretion with psychiatric symptoms and syndromes. Psychotropic effects are particularly problematic in longitudinal research on individuals at clinical high risk (CHR) for serious mental illness, because they have the potential to obscure neurobiological mechanisms involved in crossing the threshold from CHR states to clinical disorders. This paper reviews the research literature on the relation of cortisol secretion with the three major classes of psychotropic medication that are most often prescribed; antipsychotics, antidepressants, and stimulants. The studies included in this review are those that measured both baseline and post-treatment cortisol. Taken together, most studies of antidepressants find that they are associated with a reduction in both basal and post-dexamethasone-CRH (DEX/CRH) cortisol, although some report no change. Similarly, antipsychotics, both typical and atypical, are found to reduce basal and DEX/CRH cortisol levels in most studies. Psychostimulant medications, in contrast, are associated with an increase in basal cortisol levels or no change. Effects of psychotropics on the cortisol awakening response (CAR) are less consistent. Implications of these effects for clinical research, especially studies of CHR populations, are discussed. Limitations of the research, due to variations in sample demographic and methodologic factors, are noted, and directions for future research are proposed.

Roy Porter Student Essay Prize WinnerPsychiatry Limited: Hyperactivity and the Evolution of American Psychiatry, 1957–1980. SOCIAL HISTORY OF MEDICINE 2008;21:541-559. [PMCID: PMC2639095 DOI: 10.1093/shm/hkn060]

Hyperactivity is the most commonly diagnosed childhood psychiatric disorder in north America. Most physicians believe that the disorder is a neurological dysfunction which is best treated with stimulants, such as ritalin. Accounts of the history of hyperactivity written by physicians, psychologists and even historians suggest that the disorder was always conceived as such. This paper argues that, on the contrary, the notion that hyperactivity was a neurological condition only emerged after vigorous debate during the 1960s between three competing fields within American psychiatry: specifically psychoanalysis, social psychiatry and biological psychiatry. Biological psychiatry won the debate, not because its approach to hyperactivity was more scientifically valid, but rather because its explanations and methods fit the prevailing social context more readily than that of its rivals. American psychiatry's refusal to draw pluralistic conclusions about hyperactivity undermined the development of a deeper understanding of the disorder. The history of hyperactivity provides an ideal lens through which to view the evolution of psychiatry from a field dominated by Freudian psychoanalysis to one rooted in the neurosciences.

Varieties of attention-deficit/hyperactivity disorder-related intra-individual variability

Intra-individual variability in behavior and functioning is ubiquitous among children with attention-deficit/hyperactivity disorder (ADHD), but it has not been systematically examined or integrated within causal models. This article seeks to provide a conceptual, methodologic, and analytic framework as a foundation for future research. We first identify five key research questions and methodologic issues. For illustration, we examine the periodic structure of Eriksen Flanker task reaction time (RT) data obtained from 24 boys with ADHD and 18 age-matched comparison boys. Reaction time variability in ADHD differed quantitatively from control subjects, particularly at a modal frequency around .05 Hz (cycle length approximately 20 sec). These oscillations in RT were unaffected by double-blind placebo and were suppressed by double-blind methylphenidate. Together with converging lines of basic and clinical evidence, these secondary data analyses support the speculative hypothesis that the increased power of multisecond oscillations in ADHD RT data, and by inference, in attentional performance, represents a catecholaminergic deficit in the ability to appropriately modulate such oscillations in neuronal activity. These results highlight the importance of retaining time-series data and quantitatively examining intra-subject measures of variability as a putative endophenotype for ADHD.

The persistence of stimulant effects in chronically treated children: further evidence of an inverse relationship between drug effects and placebo levels of response

Seventeen hyperactive children who had been treated for 1-5 years with methylphenidate were studied in a double-blind placebo-controlled crossover study. Specific measures of stimulant response were found to be inversely related to the subject's level of response in the placebo condition. This inverse relationship was previously found to characterize the clinical effects of hyperactive children in an acute-treatment paradigm. It is equally valid in a chronic-treatment study. "State-contingency" is not, therefore, simply a function of the "novelty" of initial drug treatment.

Some thoughts on the social ecology of present day psychopharmacology

The present paper discusses some of the questions frequently encountered in the diagnosis and treatment of hyperactive children. The author attempts to order these questions within an ecological frame of reference, using Popper and Eccles' recent book The Self and its Brain as an evolutionary model. Problems of diagnosis and treatment relating to hyperactivity are given for each evolutionary level and data from the author's own work are cited in support of this model.