Autolíticos attempts: answer of the hormone of growth to GRF (1-29) NH₂.

S. Porras, J. Girbés, C. Vidal and Serrano S..
General hospital of Elda (Alicante, ESPAÑA-UE).

INTRODUCTION:

6,80 %(78) of the interconsultations (1146) between 1988 and 1996 were motivated by autolíticos attempts that needed hospitalization in plant or the unit intensive cares. In these years we have studied the hipofisaria reserve to different stimuli in multiple psychiatric diagnoses including a the autolíticos attempts. We have been communicating the findings of an hypoanswer of the growth hormone (GH) after the stimulation with GRF or GHRH (liberating factor of the growth hormone), agreeing with other authors, in the diagnoses of depression, upheaval of anguish, compulsive obsessive upheaval and alcoholism. Although in the three first diagnoses the findings in general go please in the existence of a levelling of the GH answer, in the alcoholism the findings are more different reason why, resorting to the own data base, we have found significant differences when comparing the test resultses between the first week of abstinence and after the first week (in press). In order to understand to us in the exhibition of the results found in the autolíticos attempts we called diagnoses of phantom + to the following ones: alcoholism in first week of abstinence, upheaval of anguish, obsessive upheaval and depression. Consequently we called phantom to the rest of the diagnoses. Potentially any person can make an attempt autolítico and the diagnoses are multiple (Table 1), nevertheless the hypoanswer of the growth hormone seems to correlate itself with the diagnoses before mentioned and in this line we continued investigating.

A step in this line of investigation was our contribution in 1995 more, in the National Congress of Seville, of the possibility that the hypoanswer of the GH in the resistant TOC to the clorimipramina could be a characteristic marker since stays stable with the passage of time, whereas in the TOC with better clinical answer agreeing with a greater answer of GH than the previous one to the treatment, it could be a state marker since it reverts or it stays unstable. Then, we think that this concept is extrapolateable to the depression and the upheavals of anguish and will be communicating in the future our findings in this field. Following this reasoning the hypothesis that could be raised the psychiatric upheavals with a clinical expression, that would oscillate quantitatively of weighs it to burdens it, would be modulated by psycho-social factors on trasfondo genetic with a penetrancia graduated as less to more. When the genic penetrancia was greater the clinic would be more serious and the less modifiable biological substratum when we used therapeutic the present ones, which would even condition the one that the biological markers vice versa went of characteristic and to smaller genic penetrancia smaller clinical expression and greater possibilities of debatable findings and discordant of the biological markers that could at least be operative like markers of state in the upheavals that we mentioned here and with that more experience we have.

Without forgetting the psicopatología, the vital scales of conductual evaluation, events and the influence of the psycho-social thing in the biological thing and either in the doors of century XXI we would dare to suggest the necessity to consensuar the inclusion as greater criteria for the diagnosis of "some psychiatric" the presence of one, two or the more marking upheavals biological ones, like for example, the answer of GH to GRF, the answer of ACTH to CRF, the diminution of the plaquetaria M.A.O. or the receivers of imipramina in these, etc.

To accept as it guides the biological markers would have important therapeutic and evolutionary implications in the reagudizaciones, relapses, recurrences or as it is wanted them to call based on the moment at which the psicopatología reappears. When the marker outside characteristic the treatment would be "for always" since it comes making clinical psychiatry with experience ; when the biological marker outside state would be necessary to return to consensuar the therapeutic plan between the clinical ones and with the patients. The investigating work in the last supposed will have to consist of trying to determine if the biological marker changes before of sense, to the unisonous one or after the reappearance of the psicopatología and the ideal it would be to find marking predicting of answer or what is the same, to be able to begin to treat before reagudice the psicopatología.

Until we have not mentioned the neurotransmitters now, do not fear that we will not do it, single interests to us to continue studying GH answer the most physiological stimulus of the market, the GRF, in some psychiatric upheavals, without trying to find answers absolute, the rest are lucubrations.

MATERIAL And METHOD:

Of the 78 interconsultations hospitalized by autolíticos attempts they allowed in being studied 35 (44.87%) patient ones: 22 were on first attempt and 13 of two or more attempts (Table 2). The group control was of 53 cases, without significant differences as far as age and sex. The hipofisaria hormone reserve studied of growth (GH) after the intravenous stimulation of 150 µg of estimulador factor of this hormone (GHRH). By means of radioinmunoensayo (I.R.M.A.) the values of GH to the -15, 0, 15, 30, 60 and 120 were obtained minutes (tables and graphs are omitted in the -15 and 120 minutes to have values similar to the 0 minutes). The statistical analysis was made with the test of Mann Whitney, Wilcoxon, Friedman and c².

RESULTS:

When comparing the different groups were not differences between unique and multiple attempts (table 2, graphical 1). There were no clear differences between global controls and autolíticos attempts (table 3, graphical 2). There is an hypoanswer of GH, minor tip maximum and area under the curve in the autolíticos attempts of phantom + (14 cases): depressive, obsessive, upheaval of anguish and alcoholism in first week of abstinence, when comparing them with the group control (53 cases) and with the rest of diagnoses (phantom) (21 cases, tables 4, 5 and 6, graphical 3, 4 and 5).

DISCUSSION:

The growth hormone is secretada of pulsating form throughout the twenty-four hours and the pulses are diminishing with the age until disappearing in the adults. In spite of the saying they are the thousand works published on this hormone and the greater critic to the test resultses of stimulation they are based on the existence of a refractory period after each pulse, which implies a null answer if it is stimulated at that one moment. These two postulates have not prevented that based on the answer of GH to diverse stimuli that would imply to diverse neurotransmitters, have given rise to theories which they would extrapolate what it would happen at level hipotálamo-hipófisis to other límbicas structures implied in psychiatric pathologies and endocrinas.

Basing to us on ours limited experience with the test of stimulation of GH with GRF (1-29)NH2 in different pathologies us some theoretical considerations have been happened, without a doubt nothing novel, but that not being very disparatas, at least comentables and yes debatable. That the alcohol has poisonous effects in the SNC and that is reversible it does not seem to offer objections; that different receivers are affected does not have discussion, that is affected the GH answer after GRF and that this one objetivación is diluted as we moved away of the first day of abstinence we will publish it next and that it does not happen equal with TSH and PRL after TRH (less sensible the TSH than the invariable GH and the PRL) or with FSH and LH after LHRH. By this one reason we differentiated in this one work alcoholism in first week or after abstinence.

Of this one constructo theoretical of which an exogenous substance as the alcohol alters the endogenous thing we happened to the theory of the psychic disease as genetically conditional endogenous alteration and porqué psycho-social it would not behave as the alcohol and in both a reversible effect would be obtained modifying first and avoiding the second. Following the compulsive speech, while the alcohol produce reversible but superposable alterations to which it happens in the depression, upheavals obsessive and the upheavals of anguish, in the three last the biological manifestation that objetivamos will revert spontaneously or with the psicofármacos which we have?Las at the moment considerations done in the introduction and the fact that the natural history of the syndromes evolves with agudizaciones and more or less silentes periods and thus continues being in spite of the psicofármacos and of the psycotherapies of different directions, which makes us suppose that throughout the life of an individual the sindrómica manifestation and the biological one will walk of the hand and in the pathologies most endogenous of one more a more evident form. In the most serious pictures and with the data that we are gathering, although still very it is ventured to send this one idea, nor the psicofármacos that the more modify the GH answer (Lithium, tricyclic, I.M.A.O.), are able to increase the answer. Which can always be alleged that they are too old to obtain answer, to we will answer that depressive a severe one with attempt of hanging of more than eighty years after three weeks of tto. with lithium and ISRS responds like jovenzuelo. Anyway after to have studied some hundreds of answers of GH to GRF we continued considering that our casuistry continues very being limited.

CONCLUSIONS:

It would be possible to be spoken of a group of psychiatric diagnoses, in which the probability of finding an answer flattened of the growth hormone is very high.

The levelling of the answer of GH after GHRH could be a good biological marker and to confirm nonsingle the clinical diagnoses of the phantom +, but that would be helpful in the therapeutic plan.

BIBLIOGRAPHY:

1-No I have found bibliography referring to the answer of GH to GRF (1-29) NH2 in the autolíticos attempts.
2-in the Medline with abbreviations GH and GHRH appears hundreds of articles.

Table 1. Distribution of the diagnoses in the groups phantom + and -.

Table 2. Without significant differences in age, sex and in all the times of the test

Table 3. Without significant differences in age, sex and in all the times of the test

Tabla 5. Con diferencias significativas en edad y en todos los tiempos de la prueba.

Tabla 6. Sin diferencias significativas en edad, sexo y en todos los tiempos de la prueba

Gráfico 3. Los pacientes con espectro + tuvieron una respuesta plana de la GH comparada con los controles.

Gráfico 4. Los pacientes con espectro + tuvieron una respuesta plana en comparación con los pacientes con espectro -.

Gráfico 5. El área bajo la curva de GH fue menor en los pacientes con espectro + que en los de espectro – (p<0.05)

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