An Investigation of the Adrenocortical Response of Mental Patients to E.C.T. and Insulin Hypoglycaemia

Abstract

Somatic disturbances in schizophrenia include metabolic, circulatory and endocrine changes frequently associated with disorders of the pituitary gland and adrenal cortex. Depression of the metabolic rate is often severe (Hoskins, 1932), the systolic blood-pressure is sometimes as low as 80 mm. Hg (Hoskins, 1934; Rheingold, 1939; Shattock, 1950), and the pulse pressure only a few millimetres. Peripheral vascular deficiency and atrophy of the tissues (Bleuler, 1920; Mapother, 1924; Minski, 1937; Shattock, 1950), asthenia and various cutaneous changes are common; amenorrhoea is almost the rule.It is remarkable that these disturbances are reversible, and that they are relieved or greatly alleviated during mental remission. Physical health is restored during a spontaneous remission, and a gradual improvement can be observed during a course of insulin comas. Sometimes a dramatic recovery follows electroconvulsion when this initiates a mental remission; somatic improvement is then rapid and the vascular deficiency may be relieved within a few hours (Shattock, 1950). Unfortunately these remissions are often brief, and as relapses become more frequent after repeated treatment, physical and mental deterioration may be noticeable a few days after the initial improvement. The point of interest is a concordance of physical and mental changes, and not the therapeutic value of E.C.T. used as an adjunct to insulin treatment or as a means of moderating extreme restlessness in chronic patients.