Psychoendocrinology of Ego Disintegration

Sachar, Edward J.; Kanter, Stanley S.; Buie, Daniel; Engle, Ralph L.; Mehlman, Robert D.

doi:10.1176/ajp.126.8.1067

Cited by 90 publications

(36 citation statements)

References 22 publications

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“…Previous studies have found raised cortisol and ACTH levels in patients with first-episode schizophrenia (Ryan et al, 2003(Ryan et al, , 2004aSachar et al, 1970), together with increased intra-abdominal fat (Ryan et al, 2004a) and impaired glucose tolerance (Ryan et al, 2003), thus suggesting that these endocrine abnormalities could have important metabolic consequences (Dinan, 2004). Studies of patients in the acute relapse phase of a psychotic disorder (with florid symptoms, newly hospitalized or unmedicated) have also found elevated cortisol levels that correlate with the severity of psychotic and arousal symptoms (Lammers et al, 1995;Tandon et al, 1991;Walder et al, 2000), nonsuppression of cortisol secretion by dexamethasone in the dexamethasone suppression test and in the dexamethasone/CRH test (Coryell and Tsuang, 1992;Herz et al, 1985;Lammers et al, 1995), and elevated levels of CRH in the cerebrospinal fluid (Banki et al, 1987).…”

Section: Discussionmentioning

confidence: 97%

“…Both old (Sachar et al, 1970) and recent studies (Ryan et al, 2003(Ryan et al, , 2004a have demonstrated hyperactivity of the main hormonal stress system, the hypothalamic-pituitary-adrenal (HPA) axis, in subjects experiencing their first psychotic episode. In turn, HPA axis hyperactivityFin major depressionFhas been linked to an increased volume of the pituitary gland (Axelson et al, 1992;Krishnan et al, 1991;MacMaster and Kusumakar, 2004).…”

Section: Introductionmentioning

confidence: 99%

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Increased Pituitary Volume in Antipsychotic-Free and Antipsychotic-Treated Patients of the Æsop First-Onset Psychosis Study

Pariante

Dazzan

Danese

et al. 2005

Neuropsychopharmacol

142

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Subjects at their first psychotic episode show an enlarged volume of the pituitary gland, but whether this is due to hypothalamicpituitary-adrenal (HPA) axis hyperactivity, or to stimulation of the prolactin-secreting cells by antipsychotic treatment, is unclear. We measured pituitary volume, using 1.5-mm, coronal, 1.5 T, high-resolution MRI images, in 78 patients at the first psychotic episode and 78 age-and gender-matched healthy controls. In all, 18 patients were antipsychotic-free (12 of these were antipsychotic-naïve), 26 were receiving atypical antipsychotics, and 33 were receiving typical antipsychotics. As hypothesized, patients had a larger pituitary volume than controls ( þ 22%, po0.001). When divided by antipsychotic treatment, and compared to controls, the pituitary volume was 15% larger in antipsychotic-free patients (p ¼ 0.028), 17% larger in patients receiving atypicals (p ¼ 0.01), and 30% larger in patients receiving typicals (po0.001). Patients receiving typicals not only had the largest pituitary volume compared to controls but also showed a trend for a larger pituitary volume compared to the other patients grouped together ( þ 11%, p ¼ 0.08). When divided by diagnosis, and compared to controls, the pituitary volume was 24% larger in patients with schizophrenia/schizophreniform disorder (n ¼ 40, po0.001), 19% larger in depressed patients (n ¼ 13, p ¼ 0.022), 16% larger in bipolar patients (n ¼ 16, p ¼ 0.037), and 12% larger in those with other psychoses (n ¼ 9, p ¼ 0.2). In conclusion, the first-episode of a psychotic disorder is associated with a larger pituitary independently of the presence of antipsychotic treatment, and this could be due to activation of the HPA axis. Typical antipsychotics exert an additional enlarging effect on pituitary volume, likely to be related to activation of prolactin-secreting cells. This activation of the hormonal stress response could participate to the important metabolic abnormalities observed in patients with psychosis.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Increased Pituitary Volume in Antipsychotic-Free and Antipsychotic-Treated Patients of the Æsop First-Onset Psychosis Study

Pariante

Dazzan

Danese

et al. 2005

Neuropsychopharmacol

142

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“…Toutefois, si la personne qui a développé une résolution psychotique voit son nouvel équilibre rompu par l'effondrement de ses mécanismes de défense et la perte de son omnipotence, elle peut, à l'aide d'une psychothérapie intensive (sans utilisation de médicaments), s'acheminer vers le réé-quilibre en prenant la voie de la dépression anaclitique (Sachar et al, 1963(Sachar et al, , 1970 …”

Section: La Dépression Anaclitiqueunclassified

“…Il atteindra le rééquilibre en passant par une étape de réintégration partielle accompagnée seulement d'une psychothérapie intensive. Selon Sachar et al (1963Sachar et al ( , 1970 Il faudra finalement compter dix jours pour que Michel puisse se reconstituer et quitter l'hôpital. Il peut alors se fier à des mécanismes d'adaptation pré-morbides et nier et réprimer ses préoccupations psychotiques.…”

Section: La Réintégration Partielleunclassified

Processus de la psychose chez les jeunes adultes

Lecomte¹

2006

smq

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L'expérience accumulée au cours des années auprès des psychotiques risque de se perdre dans la confusion si on ne prend pas soin d'y introduire des questions repères et d'y répondre au moins partiellement. Dans ce texte, nous nous poserons les questions suivantes en tentant de communiquer à travers elles notre expérience et les éléments de réponse que nous y avons puisées : 1. Quelle est la dynamique de la rencontre avec le psychotique en phase aiguë? Quelle réponse doit-on choisir parmi les trois qui sont possibles : l'enkystement, l'intégration ou l'accompagnement? 2. Quelles sont les étapes du processus d'équilibration chez un jeune schizophrène? 3. Existe-t-il un modèle d'accompagnement efficace? Nous terminerons cet article par quelques interrogations qui pourraient servir de pistes pour d'éventuelles recherches.The experience accumulated over the years with psychotic indi-viduals risks being lost in confusion if care is not taken to introduce certain reference questions and to respond to them, at least partially. In this text, we will ask ourselves the following questions while attempting to communicate, through them, our experience and the elements of response that we have discovered there : 1. What is the dynamic of the encounter with the psychotic in the acute phase? What response should we choose among the three which are possible : sealing-over, integration or accompaniment? 2. What are the stages in the process of equilibration in the young schizophrenic? 3. Does an effective model of accompaniment exist? We will end this article with several questions which might serve as directions for eventual research efforts

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“…Sachar et al (86,87) found increased urinary and plasma 17-OHCS, urinary epine phrine and norepinephrine in schizophrenic patients while they were either in 'psychotic turmoil' or 'anaclitic depression', as com pared with the lower levels of these sub stances during the phases of 'organized psychotic integration' and recovery. This observation is supported by Matsumoto et al (72) who found shifting urinary 17-OHCS in relation to changes in symptoms in these longitudinal studies of schizophrenic patients.…”

Section: Stress and Schizophreniamentioning

confidence: 99%

Possible Interaction of Environmental and Biological Factors in the Etiology of Schizophrenia: Review and Integration

Strahilevitz¹

1974

Canadian Psychiatric Association Journal

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Possible interactions of genetic and environmental factors in the etiology of schizophrenia are discussed. Studies on the significance of genetic-constitutional and environmental factors in determining specificity of behavioural and biochemical responses to stressors in humans and experimental animals are reviewed. Studies of stress in schizophrenia are also revieweed and their possible relationships discussed. Hypotheses related to the interaction of environmental factors and genetic constitutional factors in the production of acute schizophrenic psychosis in genetically predisposed people are presented. Research studies supporting such hypotheses are reviewed and discussed. It is proposed that environmental pressures, by inducing a physiological state of stress or other biochemical physiological alterations, may be etiologically related to the development of acute schizophrenic psychosis by: • Producing chemical substances that act as inducers of enzymes, in particular transmefhylating enzymes and those involved in the production of proteins, which may be related to the etiology of schizophrenia; • Activating autoimmune processes which may be related to the etiology of schizophrenia; • Changing levels of brain amines; •Altering the permeability of the blood-brain barrier.

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Psychoendocrinology of Ego Disintegration

Cited by 90 publications

References 22 publications

Increased Pituitary Volume in Antipsychotic-Free and Antipsychotic-Treated Patients of the Æsop First-Onset Psychosis Study

Increased Pituitary Volume in Antipsychotic-Free and Antipsychotic-Treated Patients of the Æsop First-Onset Psychosis Study

Processus de la psychose chez les jeunes adultes

Possible Interaction of Environmental and Biological Factors in the Etiology of Schizophrenia: Review and Integration

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