Effects of Cortisone on Psychological Test Performance

Abstract

Since 1946 when cortisone was first used to treat physical illness at the Mayo Clinic, interest has been growing in the possible psychological effects of this drug. Investigators (3) have thought that at least some cases of mental illness are associated with an imbalance in body biochemistry. Although no one has yet been able to work out a theory which will predict the occurrence and course of a mental illness on this basis, Selye's (6) recent formulation of the general adaptation syndrome appears to offer some suggestions about the way in which pituitary and adrenocortical functioning could relate to the conditions under which mental illnesses often occur. Practical problems of a psychological nature have arisen where cortisone has been used in the treatment of physical illnesses. Elation, euphoria, irritability, depression, psychotic episodes, transitory disturbances in intellectual functioning, and other changes have been reported. Lidz, Carter, Lewis, and Surratt (4) have recently summarized the medical literature reporting changes in psychological functioning following administration of ACTH and cortisone and conclude that it is difficult to find much consistency in these reports. A number of questions in this broad area need to be clarified and answered: (a) Are the changes observed specifically associated with the treatment or might not some of these changes occur spontaneously in any group of sick people under close observation? Although some studies have sought to establish controls by observations made during periods when Ss were not receiving medication, little attention has been paid to the use of a control group as such to establish what changes will occur as a function of the passage of time, the conditions of observation, and retesting. (b) Are the changes observed the result of some direct action of change in hormonal balance within the body, or are they related to the individual's responses to his changed physical status, e.g., relief from pain or increased feelings of well being? Lidz, et a1 (4) specifically raise the question whether these hormones produce toxic effects which lead to transitory decrement in intellectual performances. They found in a clinical study of 15 patients, using the Kohs Block Test, that there was no decrement in performance during medication. Delay, Pichot, Perse, and Aubry (1) administered a series of psychological tests to arthritic patients before and after 10 days of treament with ACTH, cortisone, or both. They report that although patients felt their intellectual functioning was more efficient, their scores on the Cattell Non-Verbal Intelligence Test showed a sig