Hormonal influence upon “puerperal psychosis” and neurotic conditions

Summary

• 1. The history of a patient who developed schizophrenia after the birth of her first child is discussed; exacerbation of the psychotic symptoms occurred during the postovulative phase of menstruation; and there was sudden decrease of symptoms on the first day of menstruation or on the day when menstruation was to be expected without actually taking place.

• 2. Both the hormonal change after childbirth, degeneration of placenta (sudden decrease of progesterone level), and exacerbation of psychotic symptoms during the postovulative phase (at a time when progesterone would normally be increased) suggest a disturbed endocrine, probably progesterone, balance.

• 3. Insulin treatment induced a marked decrease of the psychotic symptoms and sensitized the autonomic centers, possibly involved in the schizophrenic process, for the following progesterone treatment.

• 4. Progesterone completed the induced mental recovery; but, when it was discontinued, menstrual irregularity reappeared.

• 5. Premenstrual “neurotic” tension accompanied by organic symptoms in other patients disappeared after administration of progesterone.

• 6. Experimental determination of the “endocrine balance” is considered of great value for the therapeutic approach in schizophrenia.