Dexamethasone suppression test status and severity of depression.
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Adult↗
Biomedical subjects
J F Greden
Publications and source records attributed to J F Greden.
Monitoring of antidepressant response to ECT with polysomnographic recordings and the dexamethasone suppression test.
Ten patients treated with electroconvulsive therapy (ECT) only were followed with serial sleep polysomnographic recordings and dexamethasone suppression tests (DSTs). Both biological correlates of depression showed improvement with ECT. The use of serial sleep measures and serial DSTs in monitoring the clinical response to ECT is discussed.
Adult↗
Plasma postdexamethasone cortisol levels in schizoaffective disorder.
The degree of hypothalamic-pituitary-adrenal (HPA) axis dysregulation in depressed patients with schizoaffective disorder was compared to that seen in patients with major depressive disorder with and without delusional features. The frequency of nonsuppression to dexamethasone was similar for all three diagnostic groups. Maximum postdexamethasone plasma cortisol was greater for delusional depressives, but did not differ between patients with major depressive and schizoaffective disorders. Modest correlations were found between postdexamethasone plasma cortisol levels, severity of illness, age, and recent weight loss, for patients with both major depressive disorder and delusional depression. For schizoaffective patients, associations between postdexamethasone plasma cortisol levels and various measures of severity of illness, but not age and recent weight loss, were found. Although HPA axis dysregulation occurs more frequently in all three of the studied diagnostic groups than in normal individuals, factors contributing to this dysregulation may be qualitatively different for schizoaffective patients.
Adult↗
Chronic caffeine consumption and the dexamethasone suppression test in depression.
Acute caffeine administration increases cortisol and converts the dexamethasone suppression test (DST) to nonsuppression in normal humans; data concerning chronic administration as well as effects in depressed patients are minimal. To determine whether caffeine intake influenced DST results in depression, we retrospectively studied the relationship between regular daily caffeine consumption and pretreatment DST status in major depressives. Daily intake was not correlated with either post-DST cortisol levels or symptom ratings. These data suggest that chronic caffeine use is unlikely to be a major factor in dysregulation of the hypothalamic-pituitary-adrenal axis in depression, perhaps because of the development of tolerance.
Adult↗
CSF biochemical correlates of mixed affective states.
To evaluate the question of whether "mixed" bipolar disorder is a distinct entity, we compared selected cerebrospinal fluid (CSF) biochemical parameters from patients with bipolar disorder, mixed, to those with mania and major depression. Fourteen patients in each category (DSM-III) were studied with regard to CSF HVA, 5HIAA, sodium, potassium, calcium, and magnesium levels under carefully controlled conditions. CSF HVA, 5HIAA, and sodium were found to be significantly higher in manics than in major depressives. Discriminant analysis of the biochemical variables of the mixed affective group identified two biochemically distinct and clinically different subgroups of seven patients each, one resembling the manic group and the other the major depressive group. These findings suggest that mixed affective states do not exist as a separate entity, but are composed of two subgroups obtained from the manic and major depressive categories.
Adult↗
Anxiogenic effects of caffeine on panic and depressed patients.
Caffeine increases anxiety in people with anxiety disorders. To determine whether caffeine exerts a similar effect in depression, the authors compared retrospective reports of caffeine intake and symptoms produced by caffeine ingestion in patients with panic disorder, patients with major depression, and control subjects. Panic patients consumed less caffeine and reported more symptoms than depressed or control subjects. Although depressed patients did not differ from control subjects in caffeine intake or most symptoms, more depressed patients reported that caffeine induced anxiety. These data support prior reports that panic patients have increased sensitivity to caffeine; some depressed patients may also have increased sensitivity.
Adult↗
Effects of psychotropic medications on hypothalamic-pituitary-adrenal regulation.
The psychotropic medications reviewed in this paper have widespread clinical applicability in psychiatry and other branches of medicine. These drugs clearly can alter peripheral regulation of hypothalamic-pituitary-adrenal axis hormones. In general, psychotropic medications when administered acutely have a tendency to increase the output of both adrenal and pituitary hormones associated with the axis; the benzodiazepines appear to be the exception and indeed may decrease axis activity. Psychotropic agents may also alter the results of the dexamethasone suppression test as currently used in psychiatry, since they alter the neurotransmitters that regulate corticotropin-releasing hormone secretion and also because they may change the severity of the underlying pathophysiology. Withdrawal of these drugs after long-term administration may cause an elevation of these hormones, potentially increasing the false-positive rate of the dexamethasone suppression test and other neuroendocrine tests.
Antidepressive Agents↗
Effects of psychotropic medications on hypothalamic-pituitary-adrenal regulation.
The psychotropic medications reviewed in this paper have widespread clinical applicability in psychiatry and other branches of medicine. These drugs clearly can alter peripheral regulation of hypothalamic-pituitary-adrenal axis hormones. In general, psychotropic medications when administered acutely have a tendency to increase the output of both adrenal and pituitary hormones associated with the axis; the benzodiazepines appear to be the exception and indeed may decrease axis activity. Psychotropic agents may also alter the results of the dexamethasone suppression test as currently used in psychiatry, since they alter the neurotransmitters that regulate corticotropin-releasing hormone secretion and also because they may change the severity of the underlying pathophysiology. Withdrawal of these drugs after long-term administration may cause an elevation of these hormones, potentially increasing the false-positive rate of the dexamethasone suppression test and other neuroendocrine tests.
Adrenocorticotropic Hormone↗
A high-performance liquid-chromatographic method for routine simultaneous determination of nicotine and cotinine in plasma.
We describe a rapid, sensitive method for the routine simultaneous determination of nicotine and cotinine in 1 mL of plasma. Extraction in 10-mL screw-capped Teflon tubes with methylene chloride after deproteinization with trichloroacetic acid eliminated emulsion formation. The extract, after evaporation and reconstitution in 30 microL of mobile phase, is injected into a reversed-phase C-18 ion-pair column of an isocratic high-performance liquid-chromatographic unit. Absorbance is monitored at 256 nm. The mobile phase is a citrate-phosphate (30 mmol each per liter) buffer mixture containing 50 mL of acetonitrile and 1 mmol of sodium heptanesulfonate per liter. 2-Phenylimidazole is the internal standard. The detection limit is 1 microgram/L for nicotine and 3 micrograms/L for cotinine. The standard curve is linear from 0 to 700 micrograms/L for both compounds. The average CV for nicotine in the concentration range 0-100 micrograms/L is 6.5%, and that for cotinine in the concentration range 50-700 micrograms/L is 4%.
Chromatography, High Pressure Liquid↗
Treatment of negative schizophrenic symptoms with trihexyphenidyl.
In an effort to investigate reports of possible benefits of trihexyphenidyl on residual schizophrenic symptoms, the drug was administered to five chronic schizophrenic patients with predominantly negative symptoms. These patients were simultaneously receiving various antipsychotic agents without extrapyramidal side effects. There was a marked improvement in four of the five patients, mainly in the areas of affective flattening, anhedonia-asociality, and avolition-apathy. Three of these four patients also reported a reduction in excessive dreaming and nightmares experienced prior to the introduction of trihexyphenidyl. Common pathogenetic mechanisms for negative schizophrenic symptoms and excessive dreaming are discussed. In view of these findings, an investigation of the therapeutic benefits of anticholinergic agents in the treatment of negative schizophrenic symptoms, and the use of decreased dreaming as a possible marker of response, is warranted.
Female↗
Postdexamethasone plasma cortisol and beta-endorphin levels in depression: relationship to severity of illness.
The hypothalamic-pituitary-adrenal (HPA) axis is dysregulated in many patients with depression, probably at all levels of the axis. To determine if HPA dysregulation is associated with severity of depression, we studied a group of 66 patients with major depressive disorder. Each patient underwent a pretreatment Dexamethasone Suppression Test, with plasma postdexamethasone cortisol determination at 8:00 AM, 4:00 PM, and 11:00 PM. All three postdexamethasone cortisol levels were significantly correlated with the Hamilton Rating Scale for Depression (HRSD) scores. We also examined the "profile" measures of mean, maximum, and minimum of the three cortisol values; again, all three were significantly correlated with HRSD scores. To evaluate associations between clinical severity and HPA dysregulation at the pituitary level, we studied a second group of 44 patients with major depressive disorder. Each had postdexamethasone cortisol determinations at 4:00 PM and 11:00 PM as well as pre- and postdexamethasone beta-endorphin determinations at 4:00 PM. The cortisol data from this group followed the same pattern as in the first sample, and there was a significant relationship between HRSD score and degree of beta-endorphin nonsuppression as well. These results suggest that severity of depression is one of the determinants of dysregulation at both adrenal and pituitary levels of the HPA axis, accounting for 10%-20% of the observed variance.
Adult↗
Serial dexamethasone suppression tests in simultaneous panic and depressive disorders.
Recent work suggests that the simultaneous occurrence of major depressive disorder (MDD) and panic disorder (PD) may be of relevance for clinical findings, therapeutic outcome, and prognosis. It is of interest to know whether or not this relevance extends to biological findings. We addressed this question through comparison of serial Dexamethasone Suppression Test (DST) results in patients who had either MDD alone or simultaneous MDD and PD. We were unable to describe differences between the groups.
Adult↗
The dexamethasone suppression test in inpatients with panic disorder or agoraphobia with panic attacks.
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Adult↗
Multiple depressive episodes and plasma postdexamethasone cortisol levels.
The hypothalamic-pituitary-adrenal (HPA) axis is dysregulated in many patients with major depressive disorder (MDD). To determine whether or not a past history of depressive episodes is associated with this dysregulation, we studied the relationships among number of past depressive episodes, number of previous hospitalizations for depression, and number of years since first depressive episode and biological markers of depression (postdexamethasone plasma cortisol levels and dexamethasone suppressor/nonsuppressor status). No significant relationships were detected.
Adult↗
Lymphocyte numbers in endogenous depression.
The blood counts of 80 patients with depression were examined (50 unipolar, 30 bipolar). Many had reduced numbers of circulating lymphocytes. This abnormality was more common in the unipolar group (52%) than in the bipolar group (27%). When those patients with an abnormal dexamethasone suppression test response in both groups were compared, the relative and absolute lymphocyte counts were significantly lower in unipolars. Although cortisol hypersecretion may reduce lymphocyte numbers it is not yet clear whether the findings can be satisfactorily explained in this way.
Adult↗
Living with a depressed person.
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Adaptation, Psychological↗
Antidepressant withdrawal syndromes: phenomenology and pathophysiology.
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Adult↗
Schneiderian first rank symptoms: reconfirmation of high specificity for schizophrenia.
The prevalence of Schneiderian first-rank symptoms (FRS) in 294 consecutive admissions to a research unit was evaluated with reference to their diagnostic distribution (SADS/RDC). Thirty-five of 58 patients with schizophrenia had FRS, as compared to nine of 190 patients with major depressive disorder. All patients with two or more FRS received a diagnosis of schizophrenia. In the absence of organic or toxic etiology, the specificity of FRS for schizophrenia was 95% and their predictive value was 90%. These findings indicate that FRS should be regarded as strongly suggestive of schizophrenia in the absence of an organic syndrome.
Antipsychotic Agents↗