Psychosomatic Medicine 12:377-385 (1950)
© 1950 American Psychosomatic Society

Psychophysiologic Relationship of Asthma and Urticaria to Mental Illness

¹ Department of Psychiatry, Harvard Medical School and the Boston Psychopathic Hospital

Six patients with mental illnesses and a history of asthma, and 1 patient who developed urticaria during a psychosis were given a test of the autonomic nervous system which we have reported extensively elsewhere. This test revolves about the effect on systolic blood pressure of standardized doses of intravenous epinephrine and intramuscular mecholyl during a stated test period. The blood pressure patterns obtained were classifiable into seven groups. The subjective psychologic responses of the patients were also recorded.

One patient was tested before, during, and after psychosis, 3 patients were studied during and after psychoses and 3 only during their mental illnesses.

All the patients were free of asthma while mentally ill. In the 3 cases in which the psychoses cleared there was a return of the asthma. Paralleling these changes in the patient's psychologic states there were also changes in autonomic reactions to the drugs.

When the patients were not psychotic and having asthma, there was evidence of increased parasympathetic reactivity. This was seen in the marked drop in blood pressure associated with the long severe precipitated asthmatic attack following mecholyl.

When the patients were mentally ill and not having asthma, they showed altered sympathetic nervous system function. Thus the parasympathetic effects of mecholyl were much less marked and much more quickly overcome. This was evidenced in the slight drop in blood pressure and the precipitation of a mild brief asthmatic attack.

The altered sympathetic nervous system function during mental illness was of three types. This is offered as an explanation of the freedom of patients from asthma at that time. Once the psychosis was over, the evidence of altered sympathetic activity was no longer obtained and the attacks of asthma returned.

In one psychotic patient the diagnosis of "cholinergic urticaria" was established. Mecholyl, anxiety, heat, and cold all precipitated urticaria. When this patient recovered from his psychosis, but showed clinical evidence of an anxiety neurosis, neither anxiety nor any of the chemical or physical agents mentioned above precipitated the allergic state.

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