Psychosomatic Medicine 14:363-376 (1952)
© 1952 American Psychosomatic Society

An Autonomic Nervous System Test of Prognostic Significance in Relation to Electroshock Treatment

¹ Departments of Medicine and Psychiatry, The Johns Hopkins University, School of Medicine, Baltimore, Maryland; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
² Departments of Medicine and Psychiatry, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
³ Departments of Medicine and Psychiatry, The Johns Hopkins University, School of Medicine, Baltimore, Maryland; Department of Medicine, University of Iowa, School of Medicine, Iowa City, Iowa

The careful observation and psychological testing of 15 patients (10 of whom were asthmatics) treated with twenty-three courses of cortisone or ACTH has yielded one clearcut result and several definite impressions which help clarify the many observations concerning the effect of these hormones upon the emotional and mental states of patients.

The evidence seems adequately definite from the tests administered that neither ACTH nor cortisone as given in this study causes. transient degradation of mental functioning such as is seen with drugs capable of producing toxic psychoses. It remains possible that more prolonged administration on still heavier dosage may produce changes that affect cerebration. It is considered that any affective or behavioral changes that occurred were not due to toxic degradations of mentation.

There seems to be no evidence that an anesthetic effect of the corticosteroids such as had been noted by Selye can play a role. The patients tend, if changes in psychic function occur, to be more wakeful arid alert.

Emotional change, primarily consisting of mild euphoria, was observed in 12 patients, perhaps reaching transitory elation during three courses of therapy. However, the response was always in keeping with the amelioration or cessation of physical symptoms and was never observed during courses which did not produce definite physical improvement. It is possible that treatment that was effective usually produced more marked shifts in the physiological equilibrium than did unsuccessful courses of treatment.

Cortisone was clearly not as euphorigenic as ACTH, nor was it as effective therapeutically. Four patients who were treated with both hormones showed little if any euphoria while on cortisone therapy, but all 4 responded dramatically to ACTH and became euphoric.

Scrutiny of the protocols also revealed that several definite changes in mood occurred along with real or subjective physical improvement in response to placebos.

The findings suggest that the euphoria is due, at least in part, to dramatic physical improvement in chronically ill patients. Nevertheless, in some instances therapy stimulated appetite, diminished fatigue, and promoted a sense of physical well-being. In this sense, the hormones, particularly ACTH, as used in this series of patients may be considered euphorigenic. Such effects were also not seen in absence of amelioration of physical symptoms.

Electroencephalographic changes occurred in all patients examined by this procedure. However, with the exception of the patient who developed an organic psychosis, little or no correlation was found between the changes in the EEG and changes in mood or behavior.

The effect of the hormones in patients with illnesses that have caused brain damage may be different, as suggested by Thorn et d. The only clear-cut elation occurred in a patient with severe cortical brain damage from periarteritis nodosa; albeit along with an unusually dramatic improvement. The one definite psychosis during therapy was clearly related to the occurrence of brain damage in a girl with disseminated lupus. Such organic psychoses occur in the course of disseminated lupus independently of cortisone therapy, but review of the literature suggests that cerebral damage in patients with lupus may be precipitated by such therapy.

Two additional psychoses (one not included in this series of patients) were observed and were not related to the therapy; one occurring before treatment could be started and one long after it was terminated. The occurrence of these psychoses is cited to indicate that psychoses in medically ill patients cannot be uncritically attributed to the therapy.

A number of the patients in the series were highly unstable and poorly integrated individuals according to anamnesis, observation and Rorschach studies. It is of interest that they experienced no untoward emotional reaction as a result of ACTH or Cortisone therapy.

This article has been cited by other articles:

				B. I. LEWIS, D. W. SINTON, and J. R. KNOTT CENTRAL NERVOUS SYSTEM INVOLVEMENT IN DISORDERS OF COLLAGEN Arch Intern Med, March 1, 1954; 93(3): 315 - 327. [Abstract] [PDF]