Paranoid Psychosis Successfully Treated by Adrenalectomy

The Somatic Manifestations of Schizophrenia

There is still no agreement on the aetiology of schizophrenia, or general acceptance of its definition as a “functional psychosis.” There is agreement only on the complexity of the problem presented by an illness which involves every aspect of the personality, and is precipitated by a multiplicity of internal and external causes. This complexity suggests that an approach from many angles, clinical, genetic, sociological, statistical, or even a more remote biological or physiological approach may yield some information of value.

Psychopathological aspects of neuroendocrine diseases: possible parallels with the psychoendocrine aspects of normal aging

Psychological impairments can occur during the course of major endocrine diseases. These impairments range from mild affective-cognitive-behavioral disturbances to frank psychoses. The former are rather specific for each hormonal disorder and disappear with the hormonal correction. The latter, instead, seem to be quite nonspecific and include depression, mania, schizophrenia-like and organic brain syndromes which appear at random in each endocrinopathy, not always regressing with hormonal recovery, and apparently correlating more with the severity than with the nosographic classification of the metabolic disturbances. It is suggested that age-related physiological changes of hormonal and psychological patterns mimic those occurring in neuroendocrine diseases and that, possibly, common brain biochemical changes may underlie the two phenomena.

Schizophrenia and Cushing's syndrome cured by adrenalectomy

A case of Cushing's syndrome in a woman aged 50 years is described, with psychosis of schizophrenic type. The psychosis and endocrine disorder were subsequently cured by adrenalectomy. Twenty-five years previously the patient had a typical schizophrenic psychosis treated in mental hospital with a deep insulin therapy and ECT. The possibility is raised that deep insulin therapy could have induced the Cushing's syndrome through its non-specific stressor effect on the pituitary-adrenal axis.

KORSAKOFF'S SYNDROME ASSOCIATED WITH ADRENAL VIRILISM

Korsakoff's syndrome of obscure etiology was observed in a 34-year-old single woman with an 11-year history of hirsutism and mood swings, and previous hospitalizations for mania three years ago and depression 11 years ago.Recently the virilism had intensified with increased muscularity and coarsening of facial features. The 24-hour urinary 17-ketosteroids ranged between 14.4 mg. and 21.5 mg. and were suppressed by dexamethasone. The 17-hydroxycorticosteroid excretion was normal. These and other findings suggested a diagnosis of adrenal virilism due to adrenocortical hyperplasia. In the absence of other discernible causes it appeared that the adrenal pathology was responsible for the Korsakoff's syndrome. Both conditions responded well to glucocorticoid therapy although low doses were necessary to avoid mania.It is speculated that the encephalopathy was due to an associated adrenal insufficiency. Although hypoadrenalism is accepted as a complication of only the infant form of adrenal virilism, it is noteworthy that this patient had pathological pigmentation of her skin.

The endocrine concomitants of schizophrenia

In attacking the problem of the relationship of endocrine function to the schizophrenias and other mental diseases, we have avoided the elementary conception that certain hormones are responsible for special psychological traits and have reached the following conclusions. First, the quality of the mental disturbance depends mainly on a genetically conditioned personality pattern, various individuals reacting in different ways to the precipitating causes. Second, the hormones come into the whole picture only in so far as the hormone equilibrium of the body determines how far the individual can adjust himself to the increased demands arising out of the occurrence of various precipitating causes (Reiss, 1955). It is therefore understandable that very many, or even the majority of people suffering from severe endocrine disturbance, need not necessarily show any psychopathological changes, since their personality pattern is not so conditioned and no increased demands for adjustment are made by the occurrence of precipitating causes. On the other hand, it is equally understandable that certain disturbances in hormone production and equilibrium, even when clinically obscure, can be decisive for mental breakdown in individuals with the appropriate personality pattern, at the occurrence of precipitating causes.

A note on urinary copper-reducing steroid excretion in patients with psychiatric disorders

Altered adrenocortical activity has been reported in patients suffering from primarily psychiatric disorders by Hemphill and Reiss (1947), Reiss, Hemphill, Gordon and Cook (1949a and b) and others. The chance finding of a high urinary copper-reducing steroid (CRS) excretion in a man suffering from recurrent depressive illnesses who was suspected of having Addison's Disease, prompted us to investigate the excretion of these steroids in a group of un-selected psychiatric patients. We report here the results of 23 estimations on 21 patients.

Some cultural group abreactive techniques and their relation to modern treatments

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