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Using the Protirelin Test to Distinguish Mania From Schizophrenia

Using the Protirelin Test to Distinguish Mania From Schizophrenia Abstract • To explore the possible utility of the protirelin test in differentiating manic and schizophrenic patients, we gave a test dose of protirelin to 30 consecutive euthyroid inpatients who met Research Diagnostic Criteria for mania, 30 who met criteria for schizophrenia, undifferentiated subtype, and 20 normal volunteer controls. The mean maximal thyroid-stimulating hormone (TSH) response (▵TSH) to protirelin in the manic patients was lower than in the schizophrenic patients and in the controls. This mean difference was not attributable to differences in age, sex, baseline thyroid functioning, cortisol levels, or medication, but there was a considerable overlap of values in the patient groups. However, with a ▵TSH less than or equal to 7.0 IμU/ml to identify manic patients in the overall group, the sensitivity of the protirelin test was 60% and the specificity was 84% References 1. Winokur G, Clayton PJ, Reich T: Manic-Depressive Illness . St Louis, CV Mosby Co, 1969. 2. Rosenthal D, Kety SS (eds): The Transmission of Schizophrenia . New York, Pergamon Press, 1968. 3. Spitzer RL, Endicott J, Robin E: Research Diagnostic Criteria:Rationale and reliability . Arch Gen Psychiatry 1978;35:773-782.Crossref 4. American Psychiatric Association, Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980. 5. Taylor MA, Gaztanaga P, Abrams R: Manic-depressive illness and acute schizophrenia: A clinical, family history and treatment-response study . Am J Psychiatry 1974;131:678-682. 6. Pope HG Jr, Lipinski JF Jr: Diagnosis in schizophrenia and manicdepressive illness: A reassessment of the specificity of 'schizophrenic' symptoms in the light of current research . Arch Gen Psychiatry 1978;35:811-828.Crossref 7. Schou M, Juel-Nielsen N, Stromgren E, et al: The treatment of manic psychosis by administration of lithium salts . J Neurol Neurosurg Psychiatry 1954;17:250-260.Crossref 8. Davis JM: Overview: Maintenance therapy in psychiatry: II. Affective disorders . Am J Psychiatry 1976;133:1-13. 9. Goodwin FK: Drug treatment of affective disorders: General principles , in Jarvik ME (ed): Psychopharmacology in the Practice of Medicine . New York, Appleton-Century-Crofts, 1977, pp 241-253. 10. Casey JF, Bennett IF, Lindley CJ, et al: Drug therapy in schizophrenia: A controlled study of the relative effectiveness of chlorpromazine, promazine, and placebo . Arch Gen Psychiatry 1960;2:210-220.Crossref 11. Davis JM: Overview: Maintenance therapy in psychiatry: I. Schizophrenia . Am J Psychiatry 1975;132:1237-1245. 12. Carlson GA, Goodwin FK: The stages of mania: A longitudinal analysis of the manic episode . Arch Gen Psychiatry 1973;28:221-228.Crossref 13. Sachar EJ: Evidence for neuroendocrine abnormalities in the major mental illnesses , in Freedman DX (ed): Biology of the Major Psychoses . New York, Raven Press, 1975, pp 347-358. 14. Ettigi PG, Brown GM: Psychoneuroendocrinology of affectivedisorders: An overview . Am J Psychiatry 1977;134:493-501. 15. Carroll BJ, Feinberg M, Greden JF, et al: A specific laboratory test for the diagnosis of melancholia: Standardization, validation, and clinical utility . Arch Gen Psychiatry 1981;38:15-22.Crossref 16. Hershman JM, Pittman JA Jr: Control of thyrotropin secretion in man . N Engl J Med 1971;285:997-1006.Crossref 17. Haigler ED Jr, Pittman JA Jr, Hershman JM: Direct evaluation of pituitary thyrotropin reserve utilizing synthetic thyrotropin-releasinghormone . J Clin Endocrinol Metab 1971;33:573-581.Crossref 18. Lamberg BA, Gordin A: Abnormalities of thyrotropin secretion and clinical implications of the thyrotropin releasing hormone stimulation test . Ann Clin Res 1978;10:171-183. 19. Martin JP, Reichlin S, Brown GM: Clinical Neuroendocrinology . Philadelphia, FA Davis Co, 1977, pp 201-228. 20. Prange AJ Jr, Wilson IC, Lara PP, et al: Effects of thyrotropin releasing hormone in depression . Lancet 1972;2:999-1002.Crossref 21. Gold MS, Pottash ALC, Davies RK, et al: Distinguishing unipolar and bipolar depression by thyrotropin release test . Lancet 1979;2:411-413.Crossref 22. Gold MS, Pottash ALC, Ryan N, et al: TRH induced TSH response in unipolar, bipolar, and secondary depressions: Possible utility in clinical assessment and differential diagnosis . Psychoneuroendocrinology 1980;5:147-155.Crossref 23. Gold MS, Pottash ALC, Extein I, et al: The TRH test in the diagnosis of major and minor depression . Psychoneuroendocrinology 1981;6:159-169.Crossref 24. Extein I, Pottash ALC, Gold MS: TRH test in depression . N Engl J Med 1980;302:923-924. 25. Extein I, Pottash ALC, Gold MS: The thyrotropin-releasing hormone test in the diagnosis of unipolar depression . Psychiatr Res 1981;5:311-316.Crossref 26. Gold PW, Goodwin FK, Wehr T, et al: Pituitary thyrotropin response to thyrotropin releasing hormone in affective illness: Relationship to spinal fluid amine metabolites . Am J Psychiatry 1977;134:1028-1031. 27. Amsterdam JD, Winokur A, Mendels J, et al: Distinguishing depression subtypes by thyrotropin response to TRH testing . Lancet 1980;2:914-915. 28. Bjorum N, Kirkegaard C: Thyrotropin-releasing hormone test in unipolar and bipolar depression . Lancet 1979;2:694-695.Crossref 29. Extein I, Pottash ALC, Gold MS, et al: Differentiating mania from schizophrenia by the TRH test . Am J Psychiatry 1980;137:981-982. 30. Extein I, Pottash ALC, Gold MS: Decreased TSH response to TRH in mania compared to schizophrenia . Soc Neurosci Abstr 1980;6:759. 31. Wallach J: Interpretation of Diagnostic Tests . Boston, Little Brown & Co, 1974, p 26. 32. Hall R, Amos J, Ormston B: Radioimmunoassay of human serum thyrotropin . Br Med J 1971;1:582-585.Crossref 33. Donahue J, Sgontas D: Improved radioimmunoassay of plasma cortisol . Clin Chem 1975;21:770-773. 34. Snyder PJ, Utiger RD: Response to thyrotropin releasing hormone (TRH) in normal man . J Clin Endocrinol Metab 1972;34:380-384.Crossref 35. Galen RS, Gambino SR: Beyond Normality: The Predictive Value and Efficiency of Medical Diagnosis . New York, John Wiley & Sons Inc, 1975. 36. Duick DS, Wahner HW: Thyroid axis in patients with Cushing's syndrome . Arch Intern Med 1979;139:767-772.Crossref 37. Loosen PT, Prange AJ Jr: Thyrotropin releasing hormone (TRH): A useful tool for psychoendocrine investigation . Psychoneuroendocrinology 1980;5:63-80.Crossref 38. Kirkegaard C, Bjorum N, Conn D, et al: Studies of the influence of biogenic amines and psychoactive drugs on the prognostic value of the TRH stimulation test in endogenous depression . Psychoneuroendocrinology 1977;3:131-136.Crossref 39. Robins E, Guze SB: Establishment of diagnostic validity in psychiatric illness: Its application to schizophrenia . Am J Psychiatry 1970;126:983-987. 40. Goodwin FK, Extein I: The biological basis of affective disorders , in Cancro R, Shapiro L, Kesselman M (eds): Progress in the Functional Psychoses . Jamaica, NY, Spectrum Publications, 1979, pp 129-152. 41. Grimm Y, Reichlin S: Thyrotropin releasing hormone (TRH): Neurotransmitter regulation of secretion by mouse hypothalamic tissue in vitro . Endocrinology 1973;93:626-631.Crossref 42. Reichlin S, Jackson I, Seyler LE: Regulation of the secretion of TRH and LHRH , in Seeman P, Brown GM (eds): Frontiers in Neurology and Neuroscience Research . Toronto, University of Toronto Press, 1974, pp 48-59. 43. Reichlin S: Regulation of the hypophysiotropic secretions of the brain . Arch Intern Med 1975;135:1350-1361.Crossref 44. Besser GS, Burrow GN, Spaulding SW, et al: Dopamine infusion acutely inhibits the TSH and prolactin response to TRH . J Clin Endocrinol Metab 1975;41:985-988.Crossref 45. Chen HJ, Meites J: Effects of biogenic amines and TRH on release of prolactin and TSH in the rat . Endocrinology 1975;96:10-14.Crossref 46. Bunney WE Jr: Psychopharmacology of the switch process in affective illness , in Lipton MA, DiMascio A, Killam KR (eds): Psychopharmacology: A Generation of Progress . New York, Raven Press, 1978, pp 1249-1259. 47. Schildkraut JJ: Current status of the catecholamine hypothesis of affective disorders , in Lipton MA, DiMascio A, Killam RF (eds): Psychopharmacology: A Generation of Progress . New York, Raven Press, 1978, pp 1223-1224. 48. Gold MS, Byck R: Endorphins, lithium, and naloxone: Their relationship to pathological and drug-induced manic-euphoric states , in Petersen RC (ed): The International Challenge of Drug Abuse , monogr 19. Rockville, Md, National Institute on Drug Abuse, 1978, pp 192-209. 49. Burt DR, Synder SH: Thyrotropin releasing hormone (TRH): Apparent receptor binding in rat brain membranes . Brain Res 1975;92:309-328.Crossref 50. Renaud LP, Martin JP: Thyrotropin releasing hormone (TRH): Depressant action on central neuronal activity . Brain Res 1975;86:150-154.Crossref 51. Plotnikoff NP, Prange AJ Jr, Bréese GR, et al: Thyrotropin releasing hormone: Enhancement of DOPA activity in thyroidectomized rats . Life Sci 1974;14:1271-1278.Crossref 52. Hokfelt T, Fuxe K, Johansson O, et al: Thyrotropin releasing hormone containing nerve terminals in certain brain stem nuclei and the spinal cord . Neurosci Lett 1975;1:133-139.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Using the Protirelin Test to Distinguish Mania From Schizophrenia

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References (55)

Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1982.04290010053010
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Abstract

Abstract • To explore the possible utility of the protirelin test in differentiating manic and schizophrenic patients, we gave a test dose of protirelin to 30 consecutive euthyroid inpatients who met Research Diagnostic Criteria for mania, 30 who met criteria for schizophrenia, undifferentiated subtype, and 20 normal volunteer controls. The mean maximal thyroid-stimulating hormone (TSH) response (▵TSH) to protirelin in the manic patients was lower than in the schizophrenic patients and in the controls. This mean difference was not attributable to differences in age, sex, baseline thyroid functioning, cortisol levels, or medication, but there was a considerable overlap of values in the patient groups. However, with a ▵TSH less than or equal to 7.0 IμU/ml to identify manic patients in the overall group, the sensitivity of the protirelin test was 60% and the specificity was 84% References 1. Winokur G, Clayton PJ, Reich T: Manic-Depressive Illness . St Louis, CV Mosby Co, 1969. 2. Rosenthal D, Kety SS (eds): The Transmission of Schizophrenia . New York, Pergamon Press, 1968. 3. Spitzer RL, Endicott J, Robin E: Research Diagnostic Criteria:Rationale and reliability . Arch Gen Psychiatry 1978;35:773-782.Crossref 4. American Psychiatric Association, Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980. 5. Taylor MA, Gaztanaga P, Abrams R: Manic-depressive illness and acute schizophrenia: A clinical, family history and treatment-response study . Am J Psychiatry 1974;131:678-682. 6. Pope HG Jr, Lipinski JF Jr: Diagnosis in schizophrenia and manicdepressive illness: A reassessment of the specificity of 'schizophrenic' symptoms in the light of current research . Arch Gen Psychiatry 1978;35:811-828.Crossref 7. Schou M, Juel-Nielsen N, Stromgren E, et al: The treatment of manic psychosis by administration of lithium salts . J Neurol Neurosurg Psychiatry 1954;17:250-260.Crossref 8. Davis JM: Overview: Maintenance therapy in psychiatry: II. Affective disorders . Am J Psychiatry 1976;133:1-13. 9. Goodwin FK: Drug treatment of affective disorders: General principles , in Jarvik ME (ed): Psychopharmacology in the Practice of Medicine . New York, Appleton-Century-Crofts, 1977, pp 241-253. 10. Casey JF, Bennett IF, Lindley CJ, et al: Drug therapy in schizophrenia: A controlled study of the relative effectiveness of chlorpromazine, promazine, and placebo . Arch Gen Psychiatry 1960;2:210-220.Crossref 11. Davis JM: Overview: Maintenance therapy in psychiatry: I. Schizophrenia . Am J Psychiatry 1975;132:1237-1245. 12. Carlson GA, Goodwin FK: The stages of mania: A longitudinal analysis of the manic episode . Arch Gen Psychiatry 1973;28:221-228.Crossref 13. Sachar EJ: Evidence for neuroendocrine abnormalities in the major mental illnesses , in Freedman DX (ed): Biology of the Major Psychoses . New York, Raven Press, 1975, pp 347-358. 14. Ettigi PG, Brown GM: Psychoneuroendocrinology of affectivedisorders: An overview . Am J Psychiatry 1977;134:493-501. 15. Carroll BJ, Feinberg M, Greden JF, et al: A specific laboratory test for the diagnosis of melancholia: Standardization, validation, and clinical utility . Arch Gen Psychiatry 1981;38:15-22.Crossref 16. Hershman JM, Pittman JA Jr: Control of thyrotropin secretion in man . N Engl J Med 1971;285:997-1006.Crossref 17. Haigler ED Jr, Pittman JA Jr, Hershman JM: Direct evaluation of pituitary thyrotropin reserve utilizing synthetic thyrotropin-releasinghormone . J Clin Endocrinol Metab 1971;33:573-581.Crossref 18. Lamberg BA, Gordin A: Abnormalities of thyrotropin secretion and clinical implications of the thyrotropin releasing hormone stimulation test . Ann Clin Res 1978;10:171-183. 19. Martin JP, Reichlin S, Brown GM: Clinical Neuroendocrinology . Philadelphia, FA Davis Co, 1977, pp 201-228. 20. Prange AJ Jr, Wilson IC, Lara PP, et al: Effects of thyrotropin releasing hormone in depression . Lancet 1972;2:999-1002.Crossref 21. Gold MS, Pottash ALC, Davies RK, et al: Distinguishing unipolar and bipolar depression by thyrotropin release test . Lancet 1979;2:411-413.Crossref 22. Gold MS, Pottash ALC, Ryan N, et al: TRH induced TSH response in unipolar, bipolar, and secondary depressions: Possible utility in clinical assessment and differential diagnosis . Psychoneuroendocrinology 1980;5:147-155.Crossref 23. Gold MS, Pottash ALC, Extein I, et al: The TRH test in the diagnosis of major and minor depression . Psychoneuroendocrinology 1981;6:159-169.Crossref 24. Extein I, Pottash ALC, Gold MS: TRH test in depression . N Engl J Med 1980;302:923-924. 25. Extein I, Pottash ALC, Gold MS: The thyrotropin-releasing hormone test in the diagnosis of unipolar depression . Psychiatr Res 1981;5:311-316.Crossref 26. Gold PW, Goodwin FK, Wehr T, et al: Pituitary thyrotropin response to thyrotropin releasing hormone in affective illness: Relationship to spinal fluid amine metabolites . Am J Psychiatry 1977;134:1028-1031. 27. Amsterdam JD, Winokur A, Mendels J, et al: Distinguishing depression subtypes by thyrotropin response to TRH testing . Lancet 1980;2:914-915. 28. Bjorum N, Kirkegaard C: Thyrotropin-releasing hormone test in unipolar and bipolar depression . Lancet 1979;2:694-695.Crossref 29. Extein I, Pottash ALC, Gold MS, et al: Differentiating mania from schizophrenia by the TRH test . Am J Psychiatry 1980;137:981-982. 30. Extein I, Pottash ALC, Gold MS: Decreased TSH response to TRH in mania compared to schizophrenia . Soc Neurosci Abstr 1980;6:759. 31. Wallach J: Interpretation of Diagnostic Tests . Boston, Little Brown & Co, 1974, p 26. 32. Hall R, Amos J, Ormston B: Radioimmunoassay of human serum thyrotropin . Br Med J 1971;1:582-585.Crossref 33. Donahue J, Sgontas D: Improved radioimmunoassay of plasma cortisol . Clin Chem 1975;21:770-773. 34. Snyder PJ, Utiger RD: Response to thyrotropin releasing hormone (TRH) in normal man . J Clin Endocrinol Metab 1972;34:380-384.Crossref 35. Galen RS, Gambino SR: Beyond Normality: The Predictive Value and Efficiency of Medical Diagnosis . New York, John Wiley & Sons Inc, 1975. 36. Duick DS, Wahner HW: Thyroid axis in patients with Cushing's syndrome . Arch Intern Med 1979;139:767-772.Crossref 37. Loosen PT, Prange AJ Jr: Thyrotropin releasing hormone (TRH): A useful tool for psychoendocrine investigation . Psychoneuroendocrinology 1980;5:63-80.Crossref 38. Kirkegaard C, Bjorum N, Conn D, et al: Studies of the influence of biogenic amines and psychoactive drugs on the prognostic value of the TRH stimulation test in endogenous depression . Psychoneuroendocrinology 1977;3:131-136.Crossref 39. Robins E, Guze SB: Establishment of diagnostic validity in psychiatric illness: Its application to schizophrenia . Am J Psychiatry 1970;126:983-987. 40. Goodwin FK, Extein I: The biological basis of affective disorders , in Cancro R, Shapiro L, Kesselman M (eds): Progress in the Functional Psychoses . Jamaica, NY, Spectrum Publications, 1979, pp 129-152. 41. Grimm Y, Reichlin S: Thyrotropin releasing hormone (TRH): Neurotransmitter regulation of secretion by mouse hypothalamic tissue in vitro . Endocrinology 1973;93:626-631.Crossref 42. Reichlin S, Jackson I, Seyler LE: Regulation of the secretion of TRH and LHRH , in Seeman P, Brown GM (eds): Frontiers in Neurology and Neuroscience Research . Toronto, University of Toronto Press, 1974, pp 48-59. 43. Reichlin S: Regulation of the hypophysiotropic secretions of the brain . Arch Intern Med 1975;135:1350-1361.Crossref 44. Besser GS, Burrow GN, Spaulding SW, et al: Dopamine infusion acutely inhibits the TSH and prolactin response to TRH . J Clin Endocrinol Metab 1975;41:985-988.Crossref 45. Chen HJ, Meites J: Effects of biogenic amines and TRH on release of prolactin and TSH in the rat . Endocrinology 1975;96:10-14.Crossref 46. Bunney WE Jr: Psychopharmacology of the switch process in affective illness , in Lipton MA, DiMascio A, Killam KR (eds): Psychopharmacology: A Generation of Progress . New York, Raven Press, 1978, pp 1249-1259. 47. Schildkraut JJ: Current status of the catecholamine hypothesis of affective disorders , in Lipton MA, DiMascio A, Killam RF (eds): Psychopharmacology: A Generation of Progress . New York, Raven Press, 1978, pp 1223-1224. 48. Gold MS, Byck R: Endorphins, lithium, and naloxone: Their relationship to pathological and drug-induced manic-euphoric states , in Petersen RC (ed): The International Challenge of Drug Abuse , monogr 19. Rockville, Md, National Institute on Drug Abuse, 1978, pp 192-209. 49. Burt DR, Synder SH: Thyrotropin releasing hormone (TRH): Apparent receptor binding in rat brain membranes . Brain Res 1975;92:309-328.Crossref 50. Renaud LP, Martin JP: Thyrotropin releasing hormone (TRH): Depressant action on central neuronal activity . Brain Res 1975;86:150-154.Crossref 51. Plotnikoff NP, Prange AJ Jr, Bréese GR, et al: Thyrotropin releasing hormone: Enhancement of DOPA activity in thyroidectomized rats . Life Sci 1974;14:1271-1278.Crossref 52. Hokfelt T, Fuxe K, Johansson O, et al: Thyrotropin releasing hormone containing nerve terminals in certain brain stem nuclei and the spinal cord . Neurosci Lett 1975;1:133-139.Crossref

Journal

Archives of General Psychiatry – American Medical Association

Published: Jan 1, 1982

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