The function of the hypothalamic-pituitary-adrenal axis (HPA-axis) and its association with clinical features in chronic schizophrenia were investigated. Twenty of 33 chronic schizophrenics exhibited an abnormal diurnal variation of the saliva cortisol level. The patients with abnormal diurnal variation gave higher scores for some negative symptoms than those with normal diurnal variation. On the dexamethasone suppression test (DST) of saliva samples, 13 of 34 chronic schizophrenics were abnormal. The patients with DST nonsuppression were more frequently classified into disorganized type and exhibited low scores of anxiety compared with the patients with normal suppression. The 9 patients who showed abnormal diurnal variation and DST nonsuppression were more frequently classified into disorganized type and showed higher scores of negative symptoms than the 9 patients who did not show any abnormal cortisol data. These results suggest that there might be some disturbance in the function of the HPA-axis in a group of chronic schizophrenics and that these patients might have severe negative symptoms.

In order to examine the function of hypothalamic‐pituitary‐adrenal axis (HPA‐axis) in autistic children, the diurnal rhythm of saliva Cortisol and the response of Cortisol to the DST was investigated using saliva samples. The plasma and saliva Cortisol levels showed a positive correlation in normal healthy adults. Moreover, the saliva Cortisol level exhibited a similar diurnal rhythm and DST response as did the plasma Cortisol level. The saliva Cortisol level in normal children showed a similar diurnal rhythm and DST response as that in normal healthy adults. Some children with infantile autism showed an abnormal diurnal rhythm or DST response for saliva Cortisol. Moreover, the latter abnormality was observed more frequently in poorly‐developed cases than in highly‐developed cases. These results suggest that the negative feedback mechanism of the HPA‐axis may be disturbed in autistic children, especially the poorly‐developed cases, owing to a disorder inthe regulation by serotonin metabolism.

Most heart transplant candidates are equipped with left ventricular assist devices (LVADs). LVAD therapy is associated with characteristic psychiatric and psychosocial problems. To investigate the mental states of heart transplant candidates, psychiatric diagnosis, psychological or behavioral problems, and the need for treatment were evaluated around the time of registration to the waiting list and during follow-up. Saitama Medical University Hospital has been designated a hospital for heart transplantation since October 2002. The subjects were 14 heart transplant candidates (9 male candidates and 5 female candidates, mean age 29 years) at the hospital from September 1997 to October 2005. These 14 candidates were equipped with LVADs. The waiting periods on LVAD support were from 119 days to 1028 days, and the average waiting period was 313 days. Six candidates among the 14 had more than one DSM-IV diagnosis. Seven candidates were diagnosed with adjustment disorder, which was the most frequent diagnosis. Three candidates had depressive disorder, one had psychotic disorder, and one had dissociative disorder. Three candidates had acute cognitive dysfunction (delirium) due to their general medical condition. All three had other disorders with mainly psychological elements. Nine candidates (64%) were diagnosed with disorders with mainly psychological elements. Antipsychotics were used for the candidates in psychotic states and with delirium, and there was a need for crisis intervention. Antidepressants and antianxiety drugs were used for the candidates with depressive disorder; they needed intensive observation. Four candidates (28%) needed some attention and some antianxiety drugs or hypnotics. Psychiatric interventions were not necessary in five candidates (36%).

A dexamethasone suppression test (DST) was carried out on autistic and other handicapped children to investigate the function of the hypothalamo‐pituitary adrenal axis (HPA‐axis). The subjects were 19 autistic children consisting of 11 relatively well‐developed and eight poorly‐developed children. The control groups were 26 normal volunteers, 19 patients with schizophrenia and 15 children with mental retardation (MR) or minimal brain dysfunction (MBD). The DST procedures followed the Carroll method. As a result, all of the normal volunteers and 19 schizophrenic patients showed normal response (suppressor). Nine of the 11 well‐developed autistic children exhibited suppressor, while all of the poorly‐developed children showed an abnormal response (non‐suppressor). Nine of the 10 children with MR and all of the five children with MBD were suppressor. These results suggest that there might be a dysfunction in the HPA‐axis of the poorly‐developed autistic children.

The metabolic disturbances of monoamine in the hypothalamic-pituitary-adrenal axis (HPA axis) was examined in patients with chronic schizophrenia showing nonsuppression of the dexamethasone suppression test (DST). Subjects were 16 male chronic schizophrenics consisting of 8 DST suppressors and 8 nonsuppressors. All the patients were orally given the 5HT precursor, L-5-hydroxytryptophan (L-5HTP, 3 mg/kg) and the α₂-adrenergic agonist, clonidine (3 μg/kg), and the concentrations of plasma prolactin, cortisol, human growth hormone, and blood 5HT were measured chronologically. As a result, all of the DST nonsuppressors showed no increased response of prolactin after L-5HTP loading. Moreover, in the DST nonsuppressors, the secretion response of cortisol after L-5HTP loading was delayed compared with that of the suppressors. However, no different response between the DST suppressors and the nonsuppressors was observed after a loading dose of clonidine. These results suggest that there might be a metabolic disturbance of 5HT in the HPA axis of chronic schizophrenics showing DST nonsuppression.