PSYCHOLOGICAL RESPONSE TO CORTICOTROPIN, CORTISONE, AND RELATED STEROID SUBSTANCES

1we have summarized the psychological responses which attend the administration of corticotropin (ACTH), cortisone, and other related steroids. It has been indicated that these responses are but one aspect of the widespread change induced by these agents\p=m-\that the total adaptation of the human organism is altered by a multiplicity of factors. These relate to the direct and indirect effects on both the internal and external environments. The rapidity as well as the degree of change produced constitutes a stress which in turn mobilizes resources characteristic of the patient. Hence, the clinical form which the response takes is determined in large part by the habitual organization of the patient's personality; most particularly by the preferred way in which he has responded to stress in the past. The descriptive aspects of the range of responses noted have been grouped into four clinical grades. Grade 1 is comprised of deviations in mood, usually in the direction of elevation. There are commensurate changes in the patterns of thinking and behavior which reflect these mood alterations. Grade 2 differs from the grade 1 response only in a quantitative sense. Grade 2 responses are detected more readily merely because they are more pronounced. It is for this reason that euphoria has been reported to be typical.2 The grade 3 response subsumes what are typically the psychoneurotic adaptations to this stress. These adaptations, therefore, comprise a gamut of clinical forms clinically indistinguishable from the usual psychoneurotic reaction types. The grade 4 response designates the psychotic reaction types which are encoun¬ tered occasionally. These also vary clinically in accord¬ ance with the organization of the patient's previous personality. The striking deviations in mood, thought processes, and behavior which distinguish psychotic reactions from all others, furnish substantial clues to a better under¬ standing of some of the underlying physiological and psychological dynamics responsible for these reactions. There have been suggestions 3 that some psychiatric disorders (including some of the psychotic reaction types) are related to the altered function or the direct and indirect effects of the anterior pituitary-adrenal cortical activity. If these hypotheses are valid, the nature of the events which result in the occurrence of a psy¬ chotic reaction following the administration of these hormones is of considerable significance. However, many of the hypotheses concerning the eti¬ ology of psychiatric disorders which have been advanced are partisan in the sense that they tend to ascribe the resulting clinical syndrome to more or less "specific" factors which arise either in the internal or the external environments. It would appear that such conclusions tend to oversimplify the determinants of the enormous complexity of human function. Halliday,4 in a discussion of some of the principles of psychiatric etiology, empha¬ sized the need to consider the resulting pattern of morbid reaction a consequence of a multiplicity or synergy of causes. Our observations tend to support his thesis. Recent speculations on the theory of control and com¬ munication underscore this hypothesis of interrelated causes.5 Essentially, the operative principle seems to be that the stability and integrity of the human organism is maintained by the harmonious integration of a series of interdependent buffer-like systems. In addition to spe¬ cific, more or less independent functions, under certain conditions each system is capable of provoking exten¬ sive changes in other systems. An operation analogous to that of a feed-back type of control is suggested as a possible explanation of the dynamic relationships which link otherwise autonomous parts—hence, the error in limiting attention to one element of such a complex with¬ out regard for its influences and the consequences of such influences on all the other components. As this operation applies to the psychiatric phenomena which attend the administration of these hormones, it