Murray A. Morphy

Psychosomatic View of Endocrine Disorders

This review is concerned with the clinical and research implications of psychosomatic research in endocrinology. A possible role of life events in the pathogenesis of endocrine disease, the psychological distress associated with acute illness, and the issue of quality of life in clinical endocrinology are surveyed. In particular, the psychosomatic aspects of Cushings syndrome, Addisons disease, hyperthyroidism, hypothyroidism, hyperprolactinemia, acromegaly, growth hormone deficiency, and hirsutism are considered.

Stress and growth factors in psychiatric residency training

Previous studies of emotional stress in psychiatric residency training have been impressionistic, focused on suicide or severe emotional disorder, or derived from small samples. There have been no reports of what large groups of “average” residents consider stressful, and no reports of the relationship of stress factors to personal and professional growth. The authors, working with a Task Force of the American Association of Directors of Psychiatric Residency Training, developed a questionnaire that was distributed to all residents who completed their training in 1975.Summarized in this paper are many of the more significant results obtained from this very detailed survey. The 148 variables examined include considerable demographic data. This is analyzed and correlated with the impact on stressfulness and impact on personal and professional growth rated for many specific aspects of residency training. Concrete data and recommendations that might prove useful to all psychiatry programs are provided. It is hoped that this may stimulate similar research in other areas of postgraduate medical education.

The metyrapone test in affective disorders and schizophrenia

The metyrapone test was applied to patients suffering from major depressive illness with melancholia, from mania, and from schizophrenia. Hypoactivity of the HPA axis as assessed by the test appears to occur infrequently in affective disorders and schizophrenia. High normal or exaggerated responses to metyrapone, as observed in Cushings disease, appear to be correlated to DST non-suppression in melancholia.

Nocturnal prolactin and cortisol secretion and recovery from melancholia

Spontaneous prolactin and cortisol patterns were determined at 20 min intervals over 3 hr during the night in eight patients with melancholia, both during illness and after treatment with amitriptyline. Mean plasma prolactin levels were greater after recovery in the seven patients who responded to treatment. Mean cortisol secretion decreased upon recovery from melancholia, and such changes in two patients paralleled normalization of dexamethasone suppression test responses. The influence of assumptions of lack of interaction on the statistical significance of the analysis of variance with repeated measures for prolactin and cortisol values was evaluated.

The dexamethasone suppression and metyrapone tests in depression

The dexamethasone suppression test (DST) and the metyrapone test (MT), a useful and reliable procedure for assessing the integrity of the hypothalamic-pituitary-adrenal (HPA) axis, were performed in 28 patients suffering from major depressive illness with melancholia. The relationship between the DST and MT appeared to be complex. Patients who failed to suppress cortisol secretion after dexamethasone administration had higher postmetyrapone cortexolone levels and cortexolone/cortisol ratios than suppressors. However, there was a wide range of metyrapone responses in patients exhibiting abnormal DST results. This suggests that failure of adequate suppression after 1 mg of dexamethasone in depressed patients does not necessarily reflect homogeneity in the HPA axis disturbances of such patients.

The Metyrapone Test in Schizophrenic Patients and Healthy Subjects

The metyrapone test, a useful and reliable procedure for assessing hypothalamic-pituitary-adrenocortical (HPA) axis function, was applied to schizophrenic patients and healthy controls. 4 out of 18 patients had subnormal responses to metyrapone whereas there were no such cases in the 22 control subjects. 1 schizophrenic patient and 3 control subjects had high normal responses to metyrapone. The relationship with the dexamethasone suppression test was found to be complex. These preliminary results suggest that the HPA axis activity patterns in psychiatric illness may be more complicated than previously reported.

Case report of prolactin and bipolar illness: a longitudinal study.

A longitudinal and naturalistic study of nine bipolar patients attending a lithium clinic during a six-month period was undertaken. Prolactin plasma levels and psychiatric symptoms were evaluated bi-weekly. Wide interindividual and intraindividual fluctuations were observed both in prolactin levels and psychiatric symptoms. The relationship between prolactin and affective episodes was found to be complex. In a few instances, sharp prolactin changes preceded behavioral modifications. Bipolar disorders, even if treated, appeared to be unstable conditions, from both the phenomenological and neuroendocrinological viewpoints.

Beta-endorphin responses to metyrapone and dexamethasone in depressed patients

Controversy continues over the characteristics of beta-endorphin secretion in depression. Beta-endorphin plasma levels were measured in 30 drug-free male patients with a DSM-III-R major depressive disorder and 21 healthy controls. Depressed patients displayed significantly lower beta-endorphin plasma levels in baseline conditions, after the single dose metyrapone test, and after the dexamethasone suppression test. The activation of hypothalamic-pituitary-adrenal (HPA) axis in depression might be due, at least in part, to low levels of beta-endorphin. These results suggest that HPA axis dysregulation in depression may involve peptides other than ACTH.

Emotional problems in psychiatric residency training: Recommendations for their reduction

Working from an initial study, which attempted to quantify the number of serious mental disorders among psychiatric residents, the authors focused on the relationship of these problems to the exigencies of the training experience. Under the auspices of the American Association of Directors of Psychiatric Residency Trainings Task Force on Emotional Problems of Residents, a questionnaire was distributed to all residents who completed training in 1975. Respondents in this national survey had an opportunity to rate the stressfulness and the impact on personal and professional growth for many specific aspects of residency training. These ratings, plus the considerable demographic data obtained, suggest high stress levels for many aspects of residency training, but also illustrate the growth promoting effects of most of these experiences. Much of this important data was included in an article recently published in this journal. As a follow-up to this initial report, this article provides a further review of the data and offers guidelines for improving the emotional status of our colleagues in training.

The metyrapone test in affective disorders and schizophrenia II: Changes upon treatment☆

The metyrapone test was applied to groups of patients suffering from major depressive illness with melancholia, mania or schizophrenia, before and after treatment. There were interesting individual correlations between post-metyrapone cortexolone values, cortexolone/cortisol ratios and clinical improvement in depressives. Two patients who had exhibited abnormal metyrapone responses displayed a normalization of post-metyrapone cortexolone values upon clinical improvement, whereas the opposite trend was observed in a patient who did not improve and in another who became manic. These preliminary results may indicate that abnormal metyrapone responses in depression are state dependent.