Biomedical subjects

M De Ruyter

Publications and source records attributed to M De Ruyter.

12 recordsLinked to original sources

PubMed1989

Use of the dexamethasone suppression test in an inpatient setting: a replication and new findings.

The dexamethasone suppression test (DST) was administered to 131 depressed and 109 nondepressed psychiatric inpatients. The depressed patients were categorized according to DSM-III as minor depression, major depression without melancholia, and major depression with melancholia and/or with psychotic features. The nondepressed patients were stratified over several DSM-III subcategories. DST nonsuppression was nonspecific for major depression: the mean post-dexamethasone cortisol value and the number of nonsuppressors were not significantly different between the major depressives and the nondepressed psychiatric controls. Within the depressive sample the DST was a significant (p less than 0.01) discriminator between major and minor depression. Postdexamethasone plasma greater than or equal to 3.5 micrograms/dl at 0800h was the most sensitive (39%) and specific (94%) criterion; cortisol values at 1600h and 2300h showed no significant discriminating power for major vs. minor depression. The diagnostic utility of the DST thus appears to be limited to confirming the diagnosis of major depression, once the clinical diagnosis of depression is made. There was no significant influence of age or gender on postdexamethasone cortisol values.

Affective Disorders, Psychotic↗

PubMed1988

Self rated depression in relation to DSM-III classification: a statistical isolinear multiple components analysis.

The Zung Self-Rating Depression Scale (SDS) was presented to 99 depressed inpatients. The patients were categorized according to DSM-III as suffering from minor depression, major depression without melancholia and major depression with melancholia and/or with psychotic features. Differences in self-reported symptoms between these categories were studied with multivariate statistical techniques including linear discriminant analysis (LDA) and statistical isolinear multiple components analysis (SIMCA). Patients with minor depression rate themselves significantly less depressed than those with major depression. Patients with major depression without melancholia are less depressed than those with melancholia and/or psychotic features. The three DSM-III depressive categories can be regarded as belonging to a clinical continuum in which they form relevant levels with quantitative differences in self-reported symptoms. These differences are not only defined by gradual shiftings in the overall severity of illness, but also by quantitative differences in the severity of some target symptoms, i.e. agitation, retardation, diurnal variation, loss of libido, fatiguability, insomnia, anorexia, sadness and anhedonia.

Adjustment Disorders↗

PubMed1987

Prediction of subtype and severity of depression by means of dexamethasone suppression test, L-tryptophan: competing amino acid ratio, and MHPG flow.

The score on the Hamilton Depression Rating Scale (HDRS), the L-tryptophan:competing amino acid (valine + leucine) (L-TRP:CAA) ratio, and the 3-methoxy-4-hydroxyphenylglycol (MHPG) flow in 24-hr urine were recorded in 83 depressed patients undergoing a Dexamethasone Suppression Test (DST). The subjects were diagnostically subdivided according to DSM-III into minor depression (296.82, 300.40, 309.00), major depression without melancholia (296.X2), with melancholia (296.X3), or with psychotic features (296.X4). Minor depression, major depression with melancholia, and major depression with psychotic features can be regarded as distinct biological entities. Major depression without melancholia is a heterogeneous group with reference to the biological markers. By combining these biological data with age in a discriminant function analysis, 81.9% of all depressed patients can be correctly classified into minor or major depression groups. The combined biological markers can also be used to predict the severity of the depression; 42.5% of the variance in the HDRS score is accounted for by multiple regression on the biological figures. Multivariate statistical techniques considerably improve prediction for both subtype and severity of depression.

Adjustment Disorders↗

PubMed1987

Relationship between the dexamethasone suppression test and the L-tryptophan/competing amino acids ratio in depression.

Levels of L-tryptophan (L-TRP), of the competing amino acids (CAA) valine and leucine, and of postdexamethasone cortisol taken at 8 a.m., 4 p.m., and 11 p.m. were determined in serum samples from 140 depressive patients. The relationships between postdexamethasone cortisol values, the CAA, and the L-TRP/CAA ratio were assessed using Pearson and Spearman correlation coefficients and multiple regression. There was a significant correlation between postdexamethasone cortisol and both L-TRP and the L-TRP/CAA ratio. The highest correlation coefficients were obtained for the 8 a.m. cortisol values. Nonsuppressors, in comparison with suppressors, showed a significantly lower L-TRP value and L-TRP/CAA ratio.

Adult↗

PubMed1987

The cortisol suppression index and the dexamethasone suppression test in major depression.

The pre- and postdexamethasone cortisol levels are determined at 8 a.m. in 106 depressive patients. The patients are classified according to DSM-III in two categories: minor depression (300.40, 296.82, 309.00) and major depression (296.X2, 296.X3, 296.X4). The cortisol suppression index (CSI) e.g. the ratio of pre- and postdexamethasone cortisol levels is calculated. The clinical relevance of the CSI for major depression is compared to the dexamethasone suppression test (DST). The CSI is significantly (p = 0.018) lowered in patients with major depression as compared to those with minor depression. The CSI depends (r = -0.929) on changes of the postdexamethasone cortisol levels. The DST is more useful as an external validating criterion for major depression than is the CSI. The determination of the CSI is not an asset in the diagnosis of major depression.

Adult↗

PubMedDate not supplied

The dexamethasone suppression test, the Hamilton Depression Rating Scale and the DSM-III depression categories.

The Hamilton Depression Rating Scale (HDRS) score and plasma cortisol values were measured in 100 depressed patients at 8 a.m., 4 p.m. and 11 p.m. after oral administration of 1 mg dexamethasone the previous night. The patients were categorized according to DSM-III as suffering from either minor depression (including dysthymic disorder, 300.40; adjustment disorder with depressed mood, 309.00; atypical depression, 296.82) or major depression (without melancholia, 296.X2; with melancholia, 296.X3; with psychotic features, 296.X4). Plasma cortisol levels of greater than or equal to 3.5 micrograms/dl at 8 a.m. were found to be the most sensitive (56.9%) and specific (94.3%) discriminator between minor and major depression. Plasma cortisol levels at 4 p.m. and 11 p.m. or the combination of several cortisol values also differentiated between minor and major depression; however, the results were not so conclusive. According to the ratings on the Hamilton Depression Scale the patients with major depression were more severely depressed (P less than 0.001) than patients suffering from minor depression. Cortisol values at 8 a.m., 4 p.m., 11 p.m. and the highest levels were significantly (P less than 0.001) correlated with the HDRS score. A maximum of 20.2% of the score variance could be explained by the correlation with the highest cortisol value observed. Severity of illness does not exclusively account for the biological differences between minor and major depression.

Adjustment Disorders↗

PubMedDate not supplied

The importance of creatinine flow, age and 24 h urinary output in the interpretation of the MHPG flow.

The 3-methoxy-4-hydroxyphenylglycol (MHPG) flow, the creatinine flow in 24 h urine and the plasma creatinine level were determined in 42 psychiatric control patients. The creatinine clearance was calculated. The relationship between MHPG flow in 24 h urine and creatinine clearance, creatinine flow, 24 h urinary output, age, sex and weight of the patient were studied by means of single and multiple regression methods. The MHPG flow was significantly correlated with creatinine clearance (r = 0.597), creatinine flow (r = 0.646) and sex of the patient (rpb = 0.434). The variance of the MHPG flow can be explained by the regression with creatinine flow, age and urinary output for a maximum 51.5%. These variables have to be taken into account for the interpretation of data concerning the MHPG flow in subsequent experimental designs. The results of the measurements of the MHPG flow can best be expressed as the residual values obtained after partialling out the predictable component calculated by multiple regression with creatinine flow, age and 24 h urine output.

Adult↗

PubMedDate not supplied

Repeated dexamethasone suppression test in depressed patients.

In 17 depressed patients with initially abnormal results on the dexamethasone suppression test (DST), serial plasma samples for the determination of cortisol concentrations were taken every 10 days, following overnight dexamethasone administration at 11 p.m. Severity ratings were repeated on the days of blood sampling. There was a gradual normalization of the DST and progressive clinical improvement during selective antidepressant therapy. The DST was closely related (r = 0.573, P less than 0.005) to the patients' clinical mood level during the depressive episode. At the point where normalization of the DST occurred, the patients were still moderately severely ill. DST conversion occurred early in the treatment, i.e. after 23.9 (+/- 15.1) days, and preceded symptomatic improvement by 24.5 (+/- 18.1) days. Normalization of the DST was a predictor (r = 0.691, P less than 0.005) of the time of clinical improvement, but not of clinical recovery. The test was a biological discriminator between severe and less severe depressions. The time of symptomatic improvement (r = 0.505, P less than 0.05), but not of biological remission, depended on age; severe depressions lasted longer in the elderly patients.

Depressive Disorder↗

PubMedDate not supplied

The cortisol responses to 5-hydroxytryptophan, orally, in depressive inpatients.

Baseline cortisol levels at 8:00 a.m. and the cortisol responses at 90 and 120 min after oral administration of 200 mg 5-hydroxytryptophan (5-HTP) (L-isomer, non-enteric-coated) were assessed in 65 depressed inpatients. Patients were categorized according to DSM-III as major (296.22; 296.32; 296.23; 296.33; 296.24; 296.34) and minor (300.40; 309.00; 296.82) depressives. We observed a significant rise of plasma cortisol in patients with major depression at 90 (P = 0.0001) and 120 (P = 0.002) min, but not in patients with minor depression. Patients with major depression showed significantly higher cortisol responses than those with minor depression (P = 0.016). This significant rise of plasma cortisol after 5-HTP could be attributed to sex-linked differences: we observed significant (P = 0.0065) rises in cortisol responses in women with major depression compared to depressed men and women with minor depression. These differences could not be attributed to age, concomitant benzodiazepine use or pre/postmenopausal status. Baseline cortisol correlated negatively with the cortisol response to 5-HTP. The increased cortisol responses in women with major depression remained significant even after the effects of baseline cortisol were partialled out. This rise in cortisol response can be explained by an increased responsiveness of the hypothalamic-pituitary-adrenal axis to 5-HTP.

5-Hydroxytryptophan↗

PubMedDate not supplied

Sex-related differences in the relationships between self-rated depression and biological markers.

Gender-related differences in self-reported depression, in biological factors putatively related to depression and in the associations between severity of illness and biological factors were investigated. To this end the Zung Self-Rating Depression Scale (SDS), the ratio L-tryptophan/valine + leucine (L-TRP/CAA) and basal cortisol in serum at 8 a.m. were determined in 51 depressed inpatients undergoing a dexamethasone suppression test (DST). In the total study group no significant relationships were established between severity of illness and either of the biological markers. In women, SDS correlated significantly (P less than 0.01) negatively with the ratio L-TRP/CAA and positively with post-dexamethasone cortisol (P less than 0.01). In men these relationships tended to be inverted. The differences in the two sexes between these correlation coefficients were significant (P less than 0.01). These gender-related differences in the relationships between self-reported depression and the biological variables could be explained by differential psychoneuroendocrine and psychobiochemical responses. Future work on the severity of illnesses in terms of biological factors must take into account these differential responses between depressed males and females.

Adult↗

PubMedDate not supplied

Xanthurenic acid flow in 24-hour urine following L-tryptophan loading in depressive patients.

The xanthurenic acid (XA) flow in 24-hour urine following L-tryptophan loading was determined in a control group and in depressive patients divided into two DSM-III categories: minor depression (dysthymic disorder, atypical depression, adaptation disorder with depressive mood), and major depression. The XA flow is not significantly (p = 0.15) different in these categories of depression and in the control group. The number of patients with an abnormal XA flow (cut-off value greater than or equal to 106.8 mu mol/24 hours) is not significantly different among these groups (p = 0.40). The XA flow is therefore not relevant whether for depression or major depression. The XA flow in 24-hour urine following L-tryptophan loading decreases with age (p = 0.006) and increases with the 24-hour urinary output (p = 0.02). Women excrete significantly more XA (p = 0.02) than men. One must take age, 24-hour urinary output and sex into account for the interpretation of the XA data.

Adjustment Disorders↗

PubMedDate not supplied

The diagnostic performance of the L-tryptophan/competing amino acids ratio in major depression.

L-tryptophan (L-TRP), the competing amino acids (CAA) valine and leucine and the cortisol levels taken at 8 a.m. after administration of dexamethasone on the previous day, were determined in 160 patients suffering from depression. The ratio between the L-TRP values and the sum of the competing amino acids was calculated. The clinical relevance of the L-TRP/CAA ratio in the case of major depression (DSM-III) versus minor depression (dysthymic disorder, atypical depression and adaptation disorder with depressive mood) was studied in comparison with the DST. Patients suffering from major depression showed a significantly decreased (p = 0.0006) L-TRP/CAA ratio. The combination of a decreased L-TRP/CAA ratio (cut off point less than or equal to 0.130) or an abnormal DST (cut off point greater than or equal to 3.5 micrograms/dl) is the best criterion which allows 59.0% of the patients suffering from major depression to be identified correctly with a specificity of 90.9%; the above-mentioned criterion permits 70.0% of the patients to be classified correctly into their actual group.

Adjustment Disorders↗