Psychiatric Observations in Patients Treated with Cortisone and ACTH

Abstract

The role of the individual personality was noted in various emotional reactions induced by cortisone and ACTH therapy in 8 medical patients. Case reports presented included the following reactions: ambivalence, depression, psychosis, euphoria and over compliance. Emotional disturbances played a role in the development of the diseases treated. Emotional reactions to hormone therapy were based on the over-stimulating action of cortisone and ACTH, and equally on the abrupt removal of symptoms, which upset the psychological and psychosomatic adjustment established. Study of the personality factors indicated limited emotional control, so that defenses became more rigid, or broke down under the stress of over stimulation or fustration. Critical situational stress contributed to the outbreak of the organic symptoms. Turning aggression inwards was a basic mechanism in the formation of mental and physical symptoms. A neurotic equilibrium was thus established in which the symptom was incorporated. Cortisone and ACTH were experienced as a threat to this equilibrium because of their abrupt action. Patients responded to this threat by various defensive reactions which seemed to be determined by their personality patterns. On tracing back the pre-disease personality, it was found that the reactions to hormone therapy coincided with former behavior patterns or appeared to be exacerbated versions of them.