Accelerating Medicines Partnership® Schizophrenia (AMP® SCZ): Rationale and Study Design of the Largest Global Prospective Cohort Study of Clinical High Risk for Psychosis

This article describes the rationale, aims, and methodology of the Accelerating Medicines Partnership® Schizophrenia (AMP® SCZ). This is the largest international collaboration to date that will develop algorithms to predict trajectories and outcomes of individuals at clinical high risk (CHR) for psychosis and to advance the development and use of novel pharmacological interventions for CHR individuals. We present a description of the participating research networks and the data processing analysis and coordination center, their processes for data harmonization across 43 sites from 13 participating countries (recruitment across North America, Australia, Europe, Asia, and South America), data flow and quality assessment processes, data analyses, and the transfer of data to the National Institute of Mental Health (NIMH) Data Archive (NDA) for use by the research community. In an expected sample of approximately 2000 CHR individuals and 640 matched healthy controls, AMP SCZ will collect clinical, environmental, and cognitive data along with multimodal biomarkers, including neuroimaging, electrophysiology, fluid biospecimens, speech and facial expression samples, novel measures derived from digital health technologies including smartphone-based daily surveys, and passive sensing as well as actigraphy. The study will investigate a range of clinical outcomes over a 2-year period, including transition to psychosis, remission or persistence of CHR status, attenuated positive symptoms, persistent negative symptoms, mood and anxiety symptoms, and psychosocial functioning. The global reach of AMP SCZ and its harmonized innovative methods promise to catalyze the development of new treatments to address critical unmet clinical and public health needs in CHR individuals.

Development of the PSYCHS: Positive SYmptoms and Diagnostic Criteria for the CAARMS Harmonized with the SIPS

AIM

To harmonize two ascertainment and severity rating instruments commonly used for the clinical high risk syndrome for psychosis (CHR-P): the Structured Interview for Psychosis-risk Syndromes (SIPS) and the Comprehensive Assessment of At-Risk Mental States (CAARMS).

METHODS

The initial workshop is described in the companion report from Addington et al. After the workshop, lead experts for each instrument continued harmonizing attenuated positive symptoms and criteria for psychosis and CHR-P through an intensive series of joint videoconferences.

RESULTS

Full harmonization was achieved for attenuated positive symptom ratings and psychosis criteria, and modest harmonization for CHR-P criteria. The semi-structured interview, named Positive SYmptoms and Diagnostic Criteria for the CAARMS Harmonized with the SIPS (PSYCHS), generates CHR-P criteria and severity scores for both CAARMS and SIPS.

CONCLUSIONS

Using the PSYCHS for CHR-P ascertainment, conversion determination, and attenuated positive symptom severity rating will help in comparing findings across studies and in meta-analyses.

#DID: The Role of Social Media in the Presentation of Dissociative Symptoms in Adolescents

The recent social media-led and -centered movement encouraging mental health awareness, disclosure, and discussion, primarily among adolescents,1 can have significant benefits, including reducing mental health stigma, providing peer and social support, and disseminating information. Conversely, mental health disclosure online provides a catalyst for spreading misinformation and cyberbullying. It may also present opportunities for monetary and other forms of secondary gain; for example, some TikTok dissociative identity disorder (DID) influencers have vast numbers of followers and include donation links to their Venmo and PayPal accounts. At the time of this writing, TikTok hashtags "#did," "#didsystem," and "#dissociativeidentitydisorder" have amassed hundreds of thousands of views.

Skills program for awareness, connectedness, and empowerment: A conceptual framework of a skills group for individuals with a psychosis-risk syndrome

Intervention strategies for those diagnosed with psychotic disorders such as schizophrenia can be effective in reducing symptoms and improving quality of life. While strides have been made in developing prevention and intervention strategies earlier on in the disease progression, among those at clinical high-risk (CHR) for psychosis, challenges with heterogeneity can limit symptom and diagnosis specific treatment. Here, we discuss a newly developed therapy skills group called the Skills Program for Awareness, Connectedness, and Empowerment (SPACE) that integrates different types of behavioral skills - standard and radically open dialectical behavioral therapy as well as cognitive behavioral therapy - for CHR youth between the ages of 13-18 years. With the diathesis-stress framework serving as a foundation, the intervention is divided into three stages. These stages target specific signs and symptoms contributing to the progression of CHR symptoms. Stage 1 targets stress (with the goal of developing awareness and reducing distress), stage 2 targets self-disturbances (with a goal of increasing self-connectedness), and stage 3 targets social connectedness (with a goal of improving social domains of functioning). The focus of this article is to introduce the theoretical framework underlying the pilot skills group and discuss ongoing progress.

Clinical Trial Registration

NCT05398120; https://clinicaltrials.gov/ct2/show/NCT05398120.

Premorbid adjustment in childhood is associated with later emotion management in first-episode schizophrenia

Poor premorbid adjustment and social functioning deficits are recognized as cardinal features of schizophrenia. Whether premorbid maladjustment is associated with interpersonal functioning problems that manifest during the first episode of psychosis is less well-established. No previous work has investigated the relationship between premorbid adjustment and a key component of social cognition (emotion management) during the early phase of schizophrenia. A sample of 119 individuals (40 experiencing a first episode of schizophrenia, FE-SZ, 22 experiencing a first episode of another psychotic disorder, FE-OP, and 57 healthy controls, HC) participated in an assessment of premorbid adjustment and emotion management, measured using the Cannon-Spoor Premorbid Adjustment Scale (PAS) and the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) Managing Emotions (ME) scale. The relationship between premorbid adjustment (from age 5 to onset of psychotic symptoms) and ME was examined, as well as the specific relationship between childhood premorbid adjustment (ages 5-11) and ME. Results indicated that both FE-SZ and FE-OP participants exhibited significantly worse premorbid adjustment (all p's < 0.01) across development and lower ME scores when compared to HC participants. Among FE-SZ participants only, premorbid maladjustment in childhood was correlated with deficits in emotion management. This study is the first to suggest that poor premorbid social and academic functioning in childhood is related to later deficits in emotion management in those experiencing a first episode of schizophrenia. These results point to a possible relationship between early developmental deficits in premorbid social and school functioning and social cognitive deficits during the early (first episode) phase of schizophrenia.

Counterpoint. Early intervention for psychosis risk syndromes: Minimizing risk and maximizing benefit

BACKGROUND

Malhi et al. in this issue critique the clinical high risk (CHR) syndrome for psychosis.

METHOD

Response to points of critique.

RESULTS

We agree that inconsistency in CHR nomenclature should be minimized. We respectfully disagree on other points. In our view: a) individuals with CHR and their families need help, using existing interventions, even though we do not yet fully understand disease mechanisms; b) substantial progress has been made in identification of biomarkers; c) symptoms used to identify CHR are specific to psychotic illnesses; d) CHR diagnosis is not "extremely difficult"; e) the pattern of progression, although heterogenous, is discernible; f) "psychosis-like symptoms" are common but are not used to identify CHR; and g) on the point described as 'the real risk,' CHR diagnosis does not frequently cause harmful stigma.

DISCUSSION

Malhi et al.'s arguments do not fairly characterize progress in the CHR field nor efforts to minimize stigma. That said, much work remains in areas of consistent nomenclature, mechanisms of disease, dissecting heterogeneity, and biomarkers. With regard to what the authors term the "real risk" of stigma associated with a CHR "label," however, our view is that avoiding words like "risk" and "psychosis" reinforces the stigma that both they and we mean to oppose. Moreover, patients and their families benefit from being given a term that describes what is happening to them.

Emotion recognition and social skills in child and adolescent offspring of parents with schizophrenia

INTRODUCTION

Emotion recognition, a social cognition domain, is impaired in people with schizophrenia and contributes to social dysfunction. Whether impaired emotion recognition emerges as a manifestation of illness or predates symptoms is unclear. Findings from studies of emotion recognition impairments in first-degree relatives of people with schizophrenia are mixed and, to our knowledge, no studies have investigated the link between emotion recognition and social functioning in that population.

METHODS

This study examined facial affect recognition and social skills in 16 offspring of parents with schizophrenia (familial high-risk/FHR) compared to 34 age- and sex-matched healthy controls (HC), ages 7-19.

RESULTS

As hypothesised, FHR children exhibited impaired overall accuracy, accuracy in identifying fearful faces, and overall recognition speed relative to controls. Age-adjusted facial affect recognition accuracy scores predicted parent's overall rating of their child's social skills for both groups.

CONCLUSIONS

This study supports the presence of facial affect recognition deficits in FHR children. Importantly, as the first known study to suggest the presence of these deficits in young, asymptomatic FHR children, it extends findings to a developmental stage predating symptoms. Further, findings point to a relationship between early emotion recognition and social skills. Improved characterisation of deficits in FHR children could inform early intervention.

A comparison of psychometric and convergent validity for social anhedonia and social closeness

Social anhedonia is an important construct that describes individual differences in preferences for interacting in and experiencing pleasure from social interactions and has been a central construct in the schizotypy literature. The description of social anhedonia is very similar to that of social closeness from the personality literature. However, no published studies have directly compared associations between social anhedonia and social closeness with an array of other measures of anhedonia, personality, and depression. The present study examined the internal psychometrics of primary measures of social anhedonia and social closeness; the bivariate association between social anhedonia and social closeness; and the associations between these target constructs and measures of individual differences in a large sample of undergraduate students (mean age = 20.53 years; 76.3% were women). We found that (a) social anhedonia and social closeness were strongly correlated; (b) the unidimensional measurement model for social closeness was stronger than that for social anhedonia; (c) the pattern of associations for social closeness and social anhedonia with measures of physical anhedonia, personality, and depressive symptoms were substantively identical; and (d) a collection of items from both measures assessed information across a wider range of social anhedonia than either instrument alone. Thus, given the similar patterns of validity against multiple criteria social anhedonia and social closeness appear to be representing very similar constructs. The Social Closeness scale provides complementary information to the social anhedonia dimension. Our results provide recommendations for instrument selection when normative or elevated levels of social anhedonia are intended to be assessed. (PsycINFO Database Record

Trajectories of premorbid childhood and adolescent functioning in schizophrenia-spectrum psychoses: A first-episode study

Evidence of social and behavioral problems preceding the onset of schizophrenia-spectrum psychoses is consistent with a neurodevelopmental model of these disorders. Here we predict that individuals with a first episode of schizophrenia-spectrum psychoses will evidence one of three patterns of premorbid adjustment: an early deficit, a deteriorating pattern, or adequate or good social adjustment. Participants were 164 (38% female; 31% black) individuals ages 15-50 with a first episode of schizophrenia-spectrum psychoses. Premorbid adjustment was assessed using the Cannon-Spoor Premorbid Adjustment Scale. We compared the fit of a series of growth mixture models to examine premorbid adjustment trajectories, and found the following 3-class model provided the best fit with: a "stable-poor" adjustment class (54%), a "stable-good" adjustment class (39%), and a "deteriorating" adjustment class (7%). Relative to the "stable-good" class, the "stable-poor" class experienced worse negative symptoms at 1-year follow-up, particularly in the social amotivation domain. This represents the first known growth mixture modeling study to examine premorbid functioning patterns in first-episode schizophrenia-spectrum psychoses. Given that the stable-poor adjustment pattern was most prevalent, detection of social and academic maladjustment as early as childhood may help identify people at increased risk for schizophrenia-spectrum psychoses, potentially increasing feasibility of early interventions.

The nature and timing of social deficits in child and adolescent offspring of parents with schizophrenia: preliminary evidence for precursors of negative symptoms?

Children with social dysfunction and a first-degree relative with schizophrenia are at elevated risk for schizophrenia; however, the nature of this dysfunction is unclear. It was hypothesized that familial high-risk (HR) children and adolescents (n=17) would have social skill deficits relative to healthy controls (HC; n=35). HR participants had a bimodal distribution of social skill scores (47% excellent; 53% poor). HR participants had worse social skills, assertion and empathy scores, suggesting possible developmental precursors to the social amotivation domain of negative symptoms. Characterizing HR children's social deficits could assist identification of those at risk for schizophrenia.

Worries about being judged versus being harmed: disentangling the association of social anxiety and paranoia with schizotypy

Paranoia is a dimension of clinical and subclinical experiences in which others are believed to have harmful intentions. Mild paranoid concerns are relatively common in the general population, and more clinically severe paranoia shares features with social anxiety and is a key characteristic of schizotypy. Given that subclinical manifestations of schizotypy and paranoia may predict the occurrence of more severe symptoms, disentangling the associations of these related constructs may advance our understanding of their etiology; however no known studies to date have comprehensively evaluated how paranoia relates to social anxiety and schizotypy. The current research sought to examine the association of paranoia, assessed across a broad continuum of severity, with 1) the positive and negative schizotypy dimensions and 2) social anxiety. Specifically, the study tested a series of six competing, a priori models using confirmatory factor analysis in a sample of 862 young adults. As hypothesized, the data supported a four-factor model including positive schizotypy, negative schizotypy, social anxiety, and paranoia factors, suggesting that these are distinct constructs with differing patterns of interrelationships. Paranoia had a strong association with positive schizotypy, a moderate association with social anxiety, and a minimal association with negative schizotypy. The results are consistent with paranoia being part of a multidimensional model of schizotypy and schizophrenia. Prior studies treating schizotypy and schizophrenia as homogenous constructs often produce equivocal or non-replicable results because these dimensions are associated with distinct etiologies, presentations, and treatment responses; thus, the present conceptualization of paranoia within a multidimensional schizotypy framework should advance our understanding of these constructs.

Generalization of aggressive behavior in adolescent delinquent boys

The generalization of conditioned aggressive and nonaggressive responses in a group of six adolescent delinquent boys was investigated. Responses were reinforced in card games where a token reinforcement system with money as a back-up rinforcer was used. Conditioning of responses was rapid. Generalization, measured in terms of frequency of physical contact, was tested in a group game for which no reinforcement was given. Generalization occurred during aggressive contingencies. During nonaggressive contingencies, responses did not return completely to the baseline level.

The yeast hsp70 homologue Ssa is required for translation and interacts with Sis1 and Pab1 on translating ribosomes

The 70-kDa heat shock proteins are molecular chaperones that participate in a variety of cellular functions. This chaperone function is stimulated by interaction with hsp40 proteins. The Saccharomyces cerevisiae gene encoding the essential hsp40 homologue, SIS1, appears to function in translation initiation. Mutations in ribosomal protein L39 (rpl39) complement loss-of-function mutations in SIS1 as well as PAB1 (poly(A)-binding protein), suggesting a functional interaction between these proteins. However, while a direct interaction between Sis1 and Pab1 is not detectable, both of these proteins physically interact with the essential Ssa (and not Ssb) family of hsp70 proteins. This interaction is mediated by the variable C-terminal domain of Ssa. Subcellular fractionations demonstrate that the binding of Ssa to ribosomes is dependent upon its C terminus and that its interaction with Sis1 and Pab1 occurs preferentially on translating ribosomes. Consistent with a function in translation, depletion of Ssa protein produces a general translational defect that appears similar to loss of Sis1 and Pab1 function. This translational effect of Ssa appears mediated, at least in part, by its affect on the interaction of Pab1 with the translation initiation factor, eIF4G, which is dramatically reduced in the absence of functional Ssa protein.

The cyclin box and C-terminus of cyclins A and E specify CDK activation and substrate specificity

The cyclins and their catalytic partners, the Cyclin Dependent Kinases (CDKs), are essential for progression through the cell cycle. Cyclin/kinase complexes containing cyclins A or E are active primarily in late G1 to S phase and both have been shown to phosphorylate histone H1 and the retinoblastoma gene product (pRb) in vitro. Despite these similarities, cyclins A and E display differences in CDK activation and substrate specificity. We find that in vitro, cyclin E/CDK2 and cyclin A/CDK2 phosphorylate histone H1 similarly but only cyclin A/CDK2 phosphorylates lamin B. While both cyclin A and cyclin E bind CDK1 efficiently, only cyclin A activates CDK1 kinase activity. Using chimeric proteins between cyclins A and E we find that both the cyclin box and C-terminus of cyclins A and E are required for CDK binding, activation and targeting of substrate specificity.

G1 cyclins control the retinoblastoma gene product growth regulation activity via upstream mechanisms

Inactivation of the retinoblastoma gene product (pRb) occurs concomitant with the appearance of its hyperphosphorylated form in mid to late G1. Multiple cyclin/CDK complexes are implicated in the cell cycle phosphorylation of pRb. Using in vivo expression systems, we show that cyclins A, E, D1, D2, and D3 each function to phosphorylate and inactivate pRb. In vivo, G1 cyclin/kinase complexes enhance the phosphorylation of pRb, and these effects of cyclin/kinases on pRb can be overcome by the addition of p21, a wide spectrum inhibitor of G1 kinases. Kinases associated with cyclins A, E, and D1 phosporylate pRb indistinguishably in vivo, according to proteolytic maps. Although cyclin D1 has been reported to bind to pRb directly, requiring the pRb-binding motif LXCXE, a mutant D1 lacking the pRb-binding motif remains able to phosphorylate pRb in vivo and in vitro and is also able to reverse the growth-inhibitory properties of pRb in intact cells. Finally, coexpression of G1 cyclins and kinases represses pRb-mediated growth inhibition in Saos-2 cells. The multiplicity of mechanisms for pRb phosphorylation and inactivation suggests that several pathways exist for the regulation of pRb by phosphorylation.

Time-course and steroid specificity of aromatase induction in rat hypothalamus-preoptic area

We studied the time-course and steroid specificity for aromatase induction in the hypothalamus-preoptic area (HPOA) of the adult male rat. Aromatase activity (AA) was measured in tissue homogenates by using a radiometric assay that quantifies the stereospecific production of 3H2O from [1 beta-3H] androstenedione. We found that by 48 h after administration of testosterone, HPOA AA was significantly (p less than 0.01) greater than control values in castrated rats. In contrast, AA was significantly (p less than 0.01) reduced 12 h after castration, and reached its lowest levels by 4 days after castration. Several other steroids, administered in 3-cm Silastic capsules for 7 days, were tested for their capacity to induce hypothalamic AA. In addition to testosterone, only 5 alpha-dihydrotestosterone and 5 alpha-androstane-3 alpha, 17 beta-diol were effective. Neither the stereoisomers of these compounds nor several other steroids, including estradiol, progesterone, and corticosterone, were active. This profile of activity indicates that the induction of HPOA AA is androgen-specific and, together with the demonstrated time-course of induction, lends further support to the hypothesis that androgens regulate AA through a receptor mechanism and the synthesis of new protein.

Regulation of androgen metabolism and luteinizing hormone-releasing hormone content in discrete hypothalamic and limbic areas of male rhesus macaques

The conversion of androgens to active metabolites by neural tissue is believed to be an essential component in the cellular mechanism of androgen-induced neuroendocrine responses. In this study, we measured the in vitro aromatization and 5 alpha-reduction of androgens in incubations of microdissected brain regions from four intact and five castrated (6 weeks) adult male rhesus monkeys. Individual nuclei were microdissected from 600-microns frozen brain sections and homogenized in a potassium phosphate buffer. Aromatase activity was measured by a radiometric assay that uses the incorporation of tritium from [1 beta-3H]androstenedione into 3H2O as an index of estrogen formation. We estimated 5 alpha-reductase activity by isolating 5 alpha-dihydrotestosterone on two different chromatography systems and measuring the amount of this product formed from [1 alpha,2 alpha-3H]testosterone. We acidified a portion of each homogenate and determined LHRH content by RIA. Between brain nuclei, aromatase activity varied 1500-fold, whereas 5 alpha-reductase activity varied only 3-fold. Both enzyme activities were highest in amygdaloid, medial preoptic, and medial diencephalic nuclei and lowest in the caudate nucleus. Aromatase activities in the supraoptic nucleus, periventricular area, medial preoptic area-anterior hypothalamus, and lateral hypothalamus were significantly (P less than 0.05) lower in castrated males. Castration did not significantly affect 5 alpha-reductase activity, except for an increase in the basolateral amygdala. The highest concentrations of LHRH were in the infundibular nucleus-median eminence and were 30 times greater than amounts measured in preoptic and medial hypothalamic nuclei. The LHRH contents of the infundibular nucleus-median eminence, ventral medial nucleus, and lateral hypothalamus were significantly lower in castrated males (P less than 0.05). In addition, we observed a significant correlation between aromatase activity and LHRH content in the basal hypothalamus of intact males (r = 0.947; P less than 0.05; n = 8), but not in the preoptic-anterior hypothalamus (r = 0.068; P greater than 0.05; n = 10). No correlation was observed between 5 alpha-reductase activity and LHRH content in either area. These data indicate that castration selectively affects androgen metabolism and LHRH content in discrete regions of the brain of male monkeys and suggest that aromatase and 5 alpha-reductase are regulated differentially in the primate brain.

Distribution and regulation of aromatase activity in the rat hypothalamus and limbic system

Conversion of androgen to estrogen in the rat brain is catalyzed by aromatase enzymes. The maximum concentrations of these enzymes are found within the hypothalamus and amygdala, where they appear to play an important role in the process by which androgens affect both behavior and neuroendocrine function. In the present study, we measured the levels of aromatase activity (AA) in 20 nuclei and brain regions of the adult rat brain. Individual nuclei were microdissected from 600-micron frozen sections. Tissues from 3 animals were pooled, and AA was measured by an in vitro radiometric assay that quantifies the stereospecific production of 3H2O from [1 beta-3H]androstenedione as an index of estrogen formation. We report that AA is heterogeneously distributed within the rat brain. The greatest amounts of activity were found in the bed nucleus (n.) of the stria terminalis (700 protein fmol/h . mg) and in the medial (MA) and cortical amygdala (400-600 fmol/h . mg protein) of the male. There was an evident rostral-caudal and medial-lateral gradient in AA throughout the diencephalon. Activity was high in the periventricular preoptic n. and medial preoptic n.; intermediate in the suprachiasmatic preoptic n., anterior hypothalamus, periventricular anterior hypothalamus, and ventromedial n.; and low in the arcuate n.-median eminence, lateral preoptic n., supraoptic n., dorsomedial n., and lateral hypothalamus. Regions devoid of measurable AA included the medial and lateral septum, caudate-putamen, hippocampus, and parietal cortex. In the female, AA was greatest in the MA and cortical amygdala. We found that AA in the MA, stria terminalis n., suprachiasmatic preoptic n., periventricular preoptic in., medial preoptic n., anterior hypothalamus, and ventromedial n. was significantly greater (P less than 0.05) in males than in females. Orchidectomy reduced AA to levels seen in females, and administration of testosterone to castrated males restored AA in these areas. No significant sex differences were observed in any other hypothalamic or amygdaloid nuclei, although AA was increased by testosterone treatment in the periventricular anterior hypothalamus, arcuate n.-median eminence, and lateral hypothalamus. Our results provide a quantitative profile of AA in specific hypothalamic and limbic nuclei of the rat brain as well as information on the control of AA within these discrete regions.

Experimental induction of estradiol positive feedback in intact male monkeys: absence of inhibition by physiologic concentrations of testosterone

Estradiol benzoate (E2B) induces an increase in serum luteinizing hormone (LH) in gonadectomized macaques of both sexes and in intact females but not males. To determine the interaction of testosterone (T) with E2B, we treated 6 intact male cynomolgus macaques as follows: 1) with E2B alone; 2) E2B after pretreatment with estradiol-17 beta (E2) for 2 wk; and 3) Treatment 2 plus exogenous T along with the E2. In Experiment 4, 6 female cynomolgus macaques were treated with large doses of T for 10 days prior to E2B. Serum levels of T and E2 were quantified by radioimmunoassay; LH by bioassay. In Experiment 1, LH decreased from 5.20 +/- 0.95 micrograms/ml (mean +/- SEM) to 0.47 +/- 0.04 micrograms/ml. In Experiment 2, E2 pretreatment depressed LH and T, and these animals responded to E2B with an increase in LH. Replacement of T (Experiment 3) did not inhibit positive feedback. Intact females treated with T responded to E2B with an increase in LH. These results suggest that a testicular product other than T is involved in the inhibition of the positive feedback response to E2B in intact male macaques, and that E2 pretreatment overcomes this effect.

Small doses of human chorionic gonadotropin prevent estradiol-induced luteolysis

The manner in which exogenous 17 beta-estradiol (E2) induces premature luteolysis in primates is unclear. In an effort to determine whether exogenous luteotropic hormone inhibits E2-induced luteolysis, E2 capsules were implanted subcutaneously in 11 cynomolgus macaques during the early luteal phase; six animals received injections of human chorionic gonadotropin (hCG; 7.5, 10, or 15 IU/day) for 10 days, and the remaining monkeys received saline. Blood was collected once daily for measurement of E2, progesterone, and bioactive luteinizing hormone (LH). Peak progesterone concentrations were between 0.7 and 5.0 ng/ml and declined prematurely in monkeys given E2 plus saline; the luteal phase was 11.5 +/- 0.6 days (mean +/- SE). With E2 plus hCG treatment, serum progesterone continued to increase after E2 capsule placement and reached peak levels of 4.0-13.0 ng/ml; the luteal phase was 15.3 +/- 0.5 days. Therefore, E2-induced luteolysis was overcome by concurrent administration of hCG. These results suggest that exogenous tropic hormone circumvents the inhibitory influence of E2 on luteal function, but the details of the interaction remain unknown.

Effects of progesterone on estrogen-induced gonadotropin release in male rhesus macaques

The effects of progesterone (P) on estrogen (E)-induced gonadotropin release were studied in 10 adult male rhesus macaques castrated more than 2 yr earlier. The intent was to determine whether physiological levels of P (approximately 400 pg/ml) found in the systemic circulation of intact males would block E-induced gonadotropin release and whether the responses of castrated males were similar to those of castrated females with and without pretreatment with 17 beta-estradiol (E2). Different doses of P were administered in Silastic capsules (0.3, 4.0, and 5.0 cm) implanted sc. A 0.3-cm implant maintained serum P levels at about 400 pg/ml (equivalent to physiological levels in intact males); 5.0-cm implants produced serum levels of about 4.0 ng/ml (similar to luteal phase levels in females). In male monkeys treated for approximately 3 weeks with E2, only the highest dose (approximately 4.0 ng/ml) of P blocked FSH induced by estradiol benzoate (E2B). LH was blocked in one third of the animals thus treated. The same P dose was ineffective in blocking E2-induced LH release in spayed females pretreated with E2, but did block FSH release. Gonadectomized males and females not treated beforehand with E2 released LH in response to an E2B challenge, but FSH was not elevated in the peripheral circulation under these experimental conditions. These results suggest that luteal phase levels of P block E2-induced FSH release in gonadectomized males and females. With the same treatment regimens, P blocks E2 action in some males, but all females responded to E2B by releasing LH. These data also suggest that estrogen priming is necessary for FSH, but not LH, release in adult rhesus macaques of both sexes. The prerequisite of E treatment for the induction of positive feedback appears to be associated with the level of gonadotropin suppression before E2B treatment.

The boys in the club

A historical perspective of men in dietetics. The pioneer spirit of Lenna Cooper is exemplified in the gradual emergence of the male dietitian. It was not an easy task for the early female dietitian to accept the concept of male membership. From the acceptance of the first known qualified male dietitian in 1921 and of the first male intern in 1934 to the final acceptance of male dietitians in the U.S. Army in the early 1950s, there is recorded female resistance. As the status of the profession grew, so did men's interest in it.