Observations on the Relation Between Insulin Coma Dosage and Prognosis in Schizophrenia

Abstract

The evidence for somatological differences between various types of schizophrenia and its different stages of severity or chronicity is still scanty and often contradictory. The present investigation mainly concerns itself with endocrinological factors. Kraepelin, already, suggested disturbances in the endocrine system. The incidence of schizophrenia in different age-groups, especially its steep rise at puberty, reaching its peak at 20 in men and 25 in women and the rapid decline of its occurrence after these ages (Haas, 1938), has for a long time pointed to the sex steroids as an important factor in the pathology of this disorder. Hemphill et al. (1944, 1945, 1948) found an atrophy of the testes in many cases of schizophrenia, and considered the severity of the testicular change to be proportional to the severity of the psychosis. They suggest that the testicular lesions are not the cause of schizophrenia, but probably effects of the “pathogenic process” and related to hypothalamic or pituitary function. In confirmation of these findings Hoskins and Pincus (1949) observed the output of androgen in schizophrenics to be significantly lower than in normal men. Sears (1937) made similar observations in females, and found that the blood-œstrin level of female schizophrenics was much lower than in normal women. Possibilities for primary endocrinological factors suggest themselves; the “pathogenic process” can, however, still be primarily a psychological “stress” in this new constellation or a combination of both, or the effect of another central disturbance. Some of our somatological findings can, therefore, tentatively be interpreted as related to or identical with the primary stress or others only as secondary correlates or results, though the present state of our knowledge does not yet allow a final decision as to what is primary and what only secondary. Recent evidence, on the relationship of sex hormones and insulin (Houssay, 1951) suggests that oestrogens have a “sensitizing” and androgens a “desensitizing” effect. An investigation into the insulin sensitivity in clinically different schizophrenic groups and the two sexes expressed in the amount of insulin needed to produce a hypoglycaemic coma should, therefore, throw some light on other endocrinological mechanisms.