Studies of Proteolytic Enzyme Systems in Patients with Emotional Disorders.

Abstract

Studies of protein metabolism have revealed well-defined deviations in the Concentrations of certain protein-splitting enzymes in the sera of patients with cancer( 1-3). This report concerns the existence of analogous enzymatic disturbances in the presence of emotional disorders. The enzymes in question are accompanied in the blood by excesses of their inhibitors. Measurements of the latter permit valid deductions referable to the particular enzyme systems. Chymotrypsin-inhibitor is one element of an enzyme system which correlates with the rate of protein destruction. For example, abnormal concentrations have been noted in the presence of cancer, infections, physical trauma and wasting diseases. The relief from anxiety afforded by prefrontal lobotomy (4) for the alleviation of intractable pain of cancer, is often followed by significant reductions in abnormally increased concentration of chymotrypsin-inhibitor. Electric convulsivetherapy provides comparable results.Therefore it becomes important to know the * Reviewed in the Veterans Administration and published with the approval of the chief medical director. The statements and conclusions published by the authors are the result of their own study and do not necessarily reflect the opinions or policy of the Veterans Administration.effect of emotional status alone upon the titer of chymotrypsin-inhibitor. Under certain circumstances its concentration in the serum correlates with the intensity of emotional reaction. In a series of 102 patients, the degree of anxiety experienced by each was estimated clinically (Fig. 1.) A graded scale of 5 divisions was employed: absence of anxiety and panic represented the extreme categories; slight, moderate and severe anxiety were defined in :the intermediate groups. Only schizophrenic psychotics, conversion hysterics and patients with acute anxiety states were included. A direct correlation between the degree of anxiety and elevations of chymotrypsin-inhibitor concentrations was found to exist in the last group alone. Patients with conversion hysteria exhibited no such relationships, and furthermore seldom demonstrated more than slight elevations in titer. On the other hand, schizophrenic psychotics showed highly variable enzymatic changes, some of which were directly related to the level of anxiety, while the majority were not. But, in this group high titers were obtained. I t then became imperative to investigate the possibility that the changes in protein metabolism might be associated with variations in adrenal function. The demonstration that the urinary excretion of the proteolytic enzyme, uropepsin, is an appropriate measure of adrenal activity, the titer directly paralleling adrenal function (5) , provided a satis-5. Spiro, H. M., Reifenstein, R. W., and Gmy, S . J.,