Nor-epinephrine-like and epinephrine-like substances in psychotic and psychoneurotic patients.

Abstract

1. Sixty-three patients with elevated blood pressures who were routine admissions to the Boston Psychopathic Hospital were given a standardized dose of mecholyl intramuscularly. On the basis of their blood pressure reactions to the drug during a stated observation period, the patients could be divided into 2 groups: (1) Type A were those in which following the injection of the mecholyl the blood pressure remained below the preinjection level throughout the observation period. (On the basis of previous experimentation (10, 12) this was interpreted as indicating excessive secretion of an epinephrine-like substance.) (2) Group B were those in which following the injection of mecholyl the blood pressure returned to the preinjection level within the observation period. (On the basis of previous experimentation (10, 12) this was interpreted as indicating excessive secretion of a nor-epinephrine-like substance.) When these 2 groups were compared in regard to 2 other variables, the maximum fall in blood pressure after mecholyl, and the area between the mecholyl reaction and the basal blood pressure, the difference between the types was found to be significant at better than the .01 level. 2. Thirty-nine of 42 cases showing evidence interpreted as indicating excessive secretion of an epinephrine-like substance improved with electric shock therapy. In contrast to this, only 3 of 21 cases showing evidence interpreted as indicating excessive secretion of a nor-epinephrine-like substance responded to electric shock. This was significant at better than the .01 level. 3. The great majority of the cases interpreted as showing excessive secretion of an epinephrine-like substance were diagnosed as manic-depressive or involutional psychosis; whereas the majority of the cases interpreted as showing excessive secretion of a nor-epinephrine-like substance were diagnosed schizophrenia. The response to electric shock followed the autonomic type rather than diagnostic category, as the majority of the schizophrenic patients who showed evidence interpreted as indicating excessive secretion of an epinephrine-like substance responded to electric shock therapy. 4. A discussion of the contrasting physiological effects of the 2 products of the adrenal medulla was made, and the suggestion was offered that the manic-depressive and involutional psychoses represent in man the counterpart of Cannon's fight-flight reaction in cats.