Treatment of Inadequate Personality in Juveniles by Dehydroisoandrosterone
Authors: D. E. Sands, G. H. A. Chamberlain
Journal: BMJ (1952)

Results of TreatmentRoughly speaking, the results of treatment can be con- sidered under two main headings, subjective and objective, although there is bound to be some overlapping.Subjective.-Most patients stated that they felt less fear- ful and apprehensive and that the outside world appeared to be brighter and more real; there was an increase in self- confidence, combined with a slight euphoria; they felt more energetic and active.Objective.-Behaviour-patternsbecame less withdrawn, and the patients seemed to be less apathetic and scared, and better adjusted to their environment.Their general attitude became manifestly more sthenic and virile.Those patients who had shown an undifferentiated or homosexual orientation began to develop heterosexual interests, although there were no observable changes from the anatomical point of view.Two patients became more accessible so far as analytical psychotherapy and rehabilitation were concerned.Cases 2 and 8 became more deluded and paranoid, and so aggressive that treatment had to be discontinued.Conclusions It is clear that dehydroisoandrosterone can alter mental states even in the case of schizophrenic illness of long standing.The chief effect of the drug would seem to be to increase self-confidence and to induce a slight euphoria.In the case of two patients, in whom delusion-formation was a prominent symptom, increased aggressiveness and nervous tension occurred in the course of treatment.Further work will be needed to show whether these changes are in any way related aetiologically to the reestablishment of the normal spectrum of 17-ketosteroid excretion, either by substitution therapy as in Cases 2 to 5 or by suppression of an abnormality, as might explain the result in Case 1.It is perhaps noteworthy that all the patients mentioned in this paper were consti- tutionally immature, and more or less conformed to Kretschmer's description of pubertal retardation.In some cases the symptomatology resembled that of prolonged unresolved pubertal crises-again in Kretschmer's sense-rather than a true process-schizophrenia.These preliminary results suggest the possibility that the beta fraction of the 17-ketosteroids represents the metabolites of substances which may be concerned with the development of " self-confidence " in adolescence or early adult life, in a way somewhat similar to the adrenal stimulation of A.C.T.H. in raising resistance to general stress (Selye, 1950).In the case of a drug with such positive results it is necessary to be very cautious in the matter of dosage and to vary the dose from patient to patient in accord- ance with constant psychiatric observation.Special prudence is demanded when aggression is present in the symptom-picture.The results of treatment in this small group suggested that dehydroisoandrosterone might be of value in the case of constitutionally inadequate and anxious juveniles, especially those with a tendency to schizoid psychopathy.Further investigations on these lines at St. Ebba's HoQ- pital are reported by Sands and Chamberlain (1952).