Cortisone in the Treatment of Schizophrenia

1952 ◽  
Vol 98 (412) ◽  
pp. 401-403 ◽  
Author(s):  
Linford Rees ◽  
G. M. King

Recent research has given rise to the hope that the secretory products of the adrenal cortex might be useful in the treatment of schizophrenia.Two main lines of research have stimulated renewed interest in the role of the adrenal cortex in the pathophysiology of schizophrenia. A number of investigations have produced evidence that the responsivity of the adrenal cortex of schizophrenic patients to stress is lower than that of normal controls (Freeman et al., 1944; Hoagland et al., 1946; Pincus and Elmadjian, 1946; Pincus et al., 1949).Another series of investigations has shown that adrenocortical activity is stimulated by insulin coma therapy, electronarcosis and electroconvulsive therapy (Hemphill and Reiss, 1942; Mikkelsen and Hutchins, 1948; Rees (1949a); Parson et al., 1949).Cranswick and Hall (1950) reported that desoxycortone acetate and ascorbic acid appeared to be therapeutically valuable in schizophrenia. Rees and King (1951) carried out a controlled investigation on the treatment of schizophrenia with desoxycortone acetate and ascorbic acid, and found no evidence that the method was of any therapeutic value. It was pointed out that the investigation did not preclude the possibility that other products of the adrenal cortex might be therapeutically useful in schizophrenia.The present paper describes a controlled investigation in the therapeutic value of cortisone administration in schizophrenia.We are indebted to Dr. Ernest Evans, Consultant Physician, East Glamorgan Hospital, for making available a supply of cortisone for the investigation.

1952 ◽  
Vol 98 (412) ◽  
pp. 411-420 ◽  
Author(s):  
John W. Lovett Doust ◽  
Robert A. Schneider

This investigation deals with the measurement, by a peripheral method of discontinuous spectroscopic oximetry, of the arterial blood oxygen saturation levels in a group of schizophrenic patients undergoing insulin coma therapy.The association between tissue anoxia and insulin hypoglycaemia was first established by Campbell and Dudley in 1924. Dameshek and Meyerson (1935), using the arterio-venous oxygen difference method with the internal jugular vein as the source of venous blood, showed that the injection of insulin in coma doses was accompanied by an anoxaemia in the schizophrenic patients they studied. This work was confirmed by Himwich, Bowmanet al.(1939), and in another paper Himwich (1951, p. 277) and his co-workers found that the correlation of progressively developing clinical symptoms with the decrease of cerebral oxygen uptake was a closer one than the correlation with the more acute fall in the blood-sugar curve. An important symptomatic aspect of insulin hypoglycaemia includes the progressive changes in the levels of consciousness accompanying the approach towards coma. Wilder (1943) has outlined some of these changes, and Frostig (1940) and Himwich (1951, pp. 258-265) have delineated these awareness thresholds and discussed their relationship to the Hughlings Jackson theory of the phyletic organization of the central nervous system. Thus, during thefirst hourfollowing insulin injection, somnolence and lassitude appear to be associated with suppression of cortical and cerebellar activity; in thesecond hourfurther clouding of consciousness, sometimes with excitement, perceptual disturbances, periods of confusion, exacerbations of previously existing hallucinations and latent psychotic syndromes are seen; in thethird hourmotor restlessness and loss of consciousness suggest the release of basal ganglia and hypothalamus; in thefourth hourdeepening stupor and depression of exteroceptive sensitivity indicate a probable release of the midbrain and suppression of pyramidal function; in thefifth hourthe deep pre-mortal coma presages medullary release. Similarly, it is with awareness changes that many workers prefer to diagnose the “real coma” level in a patient under treatment. Thus Sakel (1937) held that coma was to be diagnosed when no further personal contact with the patient was possible, and Kalinowsky and Hoch (1946) agree that the real coma level is reached when it is completely impossible to awaken the patient.


1950 ◽  
Vol 96 (402) ◽  
pp. 285-292 ◽  
Author(s):  
Desmond McGrath

This paper is concerned with two schizophrenic patients showing unusual complications of Sakel's insulin coma therapy. The first had a series of attacks of spontaneous hypoglycaemia apparently uninfluenced by the temporary withholding of insulin; the other developed diabetes mellitus a short time after finishing his treatment.


1951 ◽  
Vol 97 (407) ◽  
pp. 376-380 ◽  
Author(s):  
Linford Rees ◽  
G. M. King
Keyword(s):  

During recent years there has been a revival of interest in the possible role of the adrenal cortex in the pathophysiology of schizophrenia.


2021 ◽  
pp. 0957154X2110625
Author(s):  
Robert Freudenthal ◽  
Joanna Moncrieff

This paper examines the evidence behind the use and decline of insulin coma therapy as a treatment for schizophrenia and how this was viewed by the psychiatric profession. The paper demonstrates that, from the time of its introduction, there was considerable debate regarding the evidence for insulin treatment, and scepticism about its purported benefits. The randomized trials conducted in the 1950s were the result, rather than the origins, of this debate. Although insulin treatment was subsequently abandoned, it was still regarded as a historic moment in the modernization of psychiatry. Then, as now, evidence does not speak for itself, and insulin continued to be incorporated into the story of psychiatric progress even after it was shown to be ineffective.


Endocrinology ◽  
1985 ◽  
Vol 117 (3) ◽  
pp. 1264-1271 ◽  
Author(s):  
PETER J. HORNSBY ◽  
SANDRA E. HARRIS ◽  
KATHY A. ALDERN

1956 ◽  
Vol 14 (2) ◽  
pp. 181-187 ◽  
Author(s):  
R. G. BARTLETT ◽  
M. A. MILLER

SUMMARY The role of the adrenal cortex in restraint-induced hypothermia and in adaptation to the stress of restraint was investigated. There was an increase in ascorbic acid and a less marked increase in the cholesterol content of the adrenals accompanying 1 week's exposure to the stress of light restraint to produce adaptation, as well as a decrease in the adrenal ascorbic acid and cholesterol levels accompanying restraintinduced hypothermia, but changes in adrenocortical activity were probably not of sufficient magnitude to account for either the increased thermostability after the adaptive procedure or the thermolability of the animals exposed to the short-term stress. It was also demonstrated that after a 7-day exposure to light restraint (to produce adaptation), adrenalectomized animals, maintained with isotonic salt solution or DCA, could not maintain a normal body temperature when restrained in the cold. Cortisone, whether administered alone or with DCA, permitted these adrenalectomized, adapted animals to maintain essentially normal body temperatures when exposed to restraint in the cold, indicating that adaptation had occurred.


1951 ◽  
Vol 97 (406) ◽  
pp. 132-135 ◽  
Author(s):  
W. Mayer-Gross

From Dr. Sakel's address there emerge two questions regarding the indications for insulin treatment in the psychoses which are worth discussing on this occasion:(1) General indications for the treatment: Should every case of schizophrenia undergo insulin therapy, i.e., be admitted to a hospital as soon as the illness has been diagnosed ?(2) Special indications and procedure: What is the role of convulsions in insulin therapy ? What proof is there of the presumed antagonism between coma and convulsion ? Are there any facts supporting the idea that insulin fixes the results of convulsion therapy ?


2003 ◽  
Vol 62 (1) ◽  
pp. 45-51 ◽  
Author(s):  
Marek Nieznanski

The aim of the study was to explore the basic features of self-schema in persons with schizophrenia. Thirty two schizophrenic patients and 32 normal controls were asked to select personality trait words from a check-list that described themselves, themselves as they were five years ago, and what most people are like. Compared with the control group, participants from the experimental group chose significantly more adjectives that were common to descriptions of self and others, and significantly less that were common to self and past-self descriptions. These results suggest that schizophrenic patients experience their personality as changing over time much more than do healthy subjects. Moreover, their self-representation seems to be less differentiated from others-representation and less clearly defined than in normal subjects.


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