Hypothalamic-hypophysial-adrenal function in acute and chronic schizophrenic patients and the role of the frontal lobe cortex to the adrenal system

Cortisol and corticosterone were measured on 27 excited acute schizophrenic patients, 17 deteriorated chronic schizophrenic patients, and 16 general paresis patients. Cortisol and corticosterone were concurrently measured by the Van der Vies fluorimetric procedure. ACTH (water soluble regular ACTH) at 25 I.U. was injected once intramuscularly. Blood and cerebrospinal fluid (CSF) samples were collected one week prior to and 120 minutes after the ACTH injection. The results were as follows: 1. The mean total blood concentrations of cortisol and corticosterone were higher in the general paresis group than in either schizophrenic group. Almost no difference was present between the acute schizophrenic group and the chronic schizophrenic group. Blood concentrations of corticosterone were higher in the chronic schizophrenic group and general paresis group than in the acute schizophrenic group. The ratio of blood cortisol to corticosterone was high in the acute schizophrenic group while the chronic schizophrenic group and general paresis group showed low ratios. 2. Blood cortisol levels of the acute schizophrenic group and the general paresis group were markedly increased after ACTH administration, but the chronic schizophrenic group did not show such a marked increase. 3. The blood corticosterone level of the chronic schizophrenic group decreased after ACTH administration. This finding suggests that ACTH administration might induce some unknown responses on the metabolic pathway from progesterone to cortisol or from progesterone to corticosterone. 4. The ratios of blood cortisol to corticosterone induced by ACTH injection were reversed between the acute schizophrenic group and the chronic schizophrenic group, due presumable to the inefficient increase of cortisol in the chronic schizophrenic group. 5. Blood and CSF corticoid levels were high in the general paresis group. This may be due to atrophy of the frontal lobe cortex and impairment of the blood-brain barrier. 6. The ratios of plasma cortisol to CSF cortisol before and after ACTH administration were almost the same. However, the ratios of plasma corticosterone to CSF corticosterone before and after ACTH administration differed.7. Blood and CSF corticoid levels of the chronic schizophrenic group before and after ACTH injection indicated that this group had a distinctive response pattern compared to the acute schizophrenic group. 8. A characteristic feature of the chronic schizophrenic group was a decreased response to ACTH injection and a high level of plasma corticosterone. 9. Atrophy of the frontal lobe cortex seemed not to interfere with the acute stress response.