Psychoendocrine Aspects of Acute Schizophrenic Reactions

Four young male soldiers suffering from first-episode acute schizophrenic reactions were studied psychiatrically and endocrinologically over a period of months while they received milieu therapy for their illnesses. Independent of endocrine findings, the clinical course of each patient was classified into phases, in which special emphasis was given to periods designated “Acute Psychotic Turmoil,” “Psychotic Equilibrium”, “Anaclitic Depression,” and “Recovery.” Psychiatric phases characterized by a high degree of anxiety or depression were found to be associated with marked elevations in urinary 17-hydroxycorticosteroid excretion--as high as 2–3 times normal. Conversely, output of corticosteroids dropped toward normal levels during “Psychotic Equilibrium” and “Recovery” periods, both these phases being characterized by relative emotional calm. These shifts in 17-hydroxycorticosteroid excretion (Turmoil > Psychotic Equilibrium Recovery < Turmoil) were predicted, and were statistically highly significant. Epinephrine excretion tended to follow a similar pattern, with elevations as high as 8 times normal occurring during “Turmoil” phases. It is suggested that corticosteroids and epinephrine excretion may not be influenced by the type of psychological defenses employed by the patient in protecting himself from anxiety and depression, but rather by the effectiveness of the defenses, whether they be psychotic or neurotic. The potential uses of psychoendocrine techniques in clinical psychiatry are discussed.