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PubMedDate not supplied

Post-partum psychoses and the dexamethasone suppression test.

The hypothesis that post-partum psychoses are predominantly mixed affective disorders was tested by administering the dexamethasone suppression test (DST) to seven puerperal psychotics, six puerperal depressives and comparison groups of non-puerperal psychotic and depressed women. The hypothesis received support from the finding that two-third of the puerperal patients had positive DSTs versus one-third of similar non-puerperal patients. An 80% rate of positive DSTs in 19 normal women 5 days post-partum, however, suggested this was an invalid interpretation of this finding, particularly as the majority of these tests returned to normal when repeated several weeks later.

Brief Psychiatric Rating Scale↗
PubMed1988

The dexamethasone suppression test in bulimia nervosa.

In a study of the dexamethasone suppression test (DST) in patients with bulimia nervosa, a non-suppression rate of about 50% was found. The only clinical correlates of DST non-suppression were a previous history of weight loss and/or of anorexia nervosa. These results suggest that DST non-suppression in these subjects may be a trait rather than a state marker of anorexia nervosa.

Adult↗
PubMed1987

Depression and dexamethasone suppression testing in children and adolescents.

The authors compare the incidence of dexamethasone nonsuppression in a large group of child and adolescent inpatients (N = 94) diagnosed by two criteria (DSM-III and Weinberg criteria). The incidence of dexamethasone suppression test nonsuppression in patients diagnosed with DSM-III major depressive disorder (n = 33) was 55%, compared to 11% in those with no affective disorder (n = 35). This was compared to the incidence of dexamethasone suppression test nonsuppression utilizing Weinberg criteria. In addition, symptoms that to varying degrees discriminated suppressors from nonsuppressors were examined. These included change in school performance and, to a lesser degree, somatic complaints and weight and appetite changes. Differences in the diagnostic criteria are discussed.

Adolescent↗
PubMedDate not supplied

Response to the dexamethasone suppression test in schizoaffective disorder, depressed type.

Response to the dexamethasone suppression test (DST) was tested in 20 patients fulfilling the Research Diagnostic Criteria (RDC) for schizoaffective disorder, depressed type, and in 52 patients meeting RDC for major depressive disorder. Non-suppression was observed in 25% of the schizodepressives and in 40.4% of the depressives. No significant difference between suppressor and non-suppressor schizodepressives was found with respect to demographic, historical and clinical variables. These results do not support the usefulness of the DST for the identification of a homogeneous subtype of schizoaffective disorders.

Adult↗
PubMed1984

Study of the diagnostic value of the dexamethasone suppression test in endogenous depression.

The diagnostic value of the dexamethasone suppression test (DST) in "endogenous" depression was evaluated in 209 psychiatric inpatients. A high incidence of abnormal DST results was observed in "endogenous" depressives (52%), schizo-affective (69%) and borderline patients (38%). However, 25% of the patients with other psychiatric disease also failed to suppress on the DST. Diagnostic criteria, previous history of alcoholism, psychiatric drug treatment, age and sex did not significantly affect DST performance. The present data do not indicate that the DST represents a highly specific marker of "endogenous" depression.

Borderline Personality Disorder↗
PubMedDate not supplied

Self-reported diurnal mood changes, early morning awakening and the dexamethasone suppression test in endogenous depression.

Several authors have suggested that Dexamethasone Suppression Test (DST) non-suppression is related to circadian alternations of hypothalamic-pituitary-adrenal function. Two clinical manifestations of altered circadian rhythms in depressed patients are early morning awakening and diurnal variation in mood. To observe whether these clinical symptom patterns were associated with an increased frequency of abnormal DSTs, we examined post-DST plasma cortisol concentrations and matched clinical ratings of early morning awakening and diurnal variation in mood in 49 patients with major depressive disorder, endogenous subtype. We found no significant association between these clinical and laboratory variables.

Adult↗
PubMed1986

Assessment of severity of suicide attempts. A trial with the dexamethasone suppression test and 2 rating scales.

In this study, the dexamethasone suppression test (DST) and 2 rating scales, the 'Echelle d'Evaluation de Risque Suicidaire' and the Pierce modified form of the Suicide Intent Scale, were administered to a group of 37 subjects admitted to the general hospital of Padua for suicide attempts. The purpose of our study was to verify if these tools could be considered useful in assessing the severity of the attempts. 10 subjects were DST-positive, but the test evidenced very low sensitivity and predictive value. The 2 rating scales demonstrated a good degree of concordance in identifying the adjustment disorder group as being at a lower risk for a serious attempt.

Adult↗
PubMed1990

Plasma dexamethasone concentrations and the dexamethasone suppression test.

Altered bioavailability or altered pharmacokinetics of dexamethasone (dex) may contribute to a positive Dexamethasone Suppression Test (DST) in psychiatric patients. We measured plasma dex and plasma cortisol concentrations in 32 patients with primary major depressive disorder (MDD), 14 patients with other psychiatric disorders, and 16 normal controls. Cortisol was measured by the competitive protein binding (CPB) assay and dex by RIA (IgG Corp.). Additionally, cortisol was measured by a fluorescent polarization immunoassay (FPIA) available on the Abbott TDx analyzer in an attempt to validate this method for use in the DST. The agreement between FPIA and CPB cortisol results was excellent. Depressed nonsuppressors, by definition, had significantly higher mean plasma cortisol concentrations than depressed suppressors, psychiatric controls, and normal volunteers at 8:00 AM, 3:00 PM, and 10:00 PM postdex. When DST nonsuppressors and suppressors were compared regardless of diagnostic group, plasma dex concentrations were significantly lower (p less than 0.01) in the DST nonsuppressors. There was a significant negative correlation between plasma cortisol levels and plasma dex levels across all subjects at 8:00 AM (r = -0.365, n = 44, p less than 0.05). When the subjects were sorted by diagnostic category, there was a strong, but not statistically significant, trend toward lower plasma dex concentrations in the melancholic nonsuppressors versus the melancholic suppressors and between the psychiatric control non-suppressors and the corresponding suppressor group. These relationships disappeared when we restricted our analyses to an empirically derived middle range of plasma dex concentrations within which the DST results were considered to be valid. We conclude that bioavailability or pharmacokinetics of dex may significantly contribute to DST results. Further investigation is needed to determine whether or not the quantification of dex and its metabolites and their determination at which specific timepoints during the DST will enhance the predictive or interpretive value of the DST in psychiatric patients.

Adult↗
PubMed1981

Changes in serial dexamethasone suppression tests among unipolar depressive receiving electroconvulsive treatment.

An abnormal dexamethasone suppression test (DST) identifies endogenous depressive with 95% confidence. The DST normalizes with successful treatment. Serial DSTs throughout treatment could provide useful information on (i) whether they biologically monitor clinical response, (ii) when DST normalization does occur, and (iii) whether early normalization predicts clinical outcome. We studied six inpatients who had abnormal DSTs on admission and serial DSTs during and after a course of ECT. All were diagnosed as unipolar major depressive disorder, endogenous (RDC). Clinical improvement was monitored with weekly Hamilton Rating Scales. Five of six abnormal DST patients converted to a normal test and showed significant clinical improvement. On patient failed to normalize and also had a poor outcome. All DST normalizations occurred by the fourth to sixth ECT. Additional ECTs resulted in further reduction in DST plasma cortisol values. All normalizers experienced progressive clinical improvement, and the DST successfully monitored these changes. DST conversion occurred early in treatment. Early DST normalization may have predictive value for good treatment response.

Depressive Disorder↗
PubMed1983

The dexamethasone suppression test in demented outpatients with and without depression.

The dexamethasone suppression test (DST) was given to 33 elderly, male outpatients, previously diagnosed by DSM-III criteria as having dementia. Fifteen of these patients also had signs and symptoms of depression and, except for the presence of organic mental syndrome, would have met DSM-III criteria for major depressive episode. Of these 15 depressed, demented patients, 40% had abnormal DST results. None of the 18 patients who had dementia alone had abnormal DSTs. Our data suggest that in elderly, demented outpatients, an abnormal DST may be associated with concomitant depression.

Aged↗
PubMed1983

The dexamethasone suppression test in the clinical setting.

The authors administered the dexamethasone suppression test (DST) to 47 inpatients on a clinical, nonresearch psychiatric unit who had been diagnosed according to DSM-III. Of the 30 patients with major depression, 23 (77%) exhibited nonsuppression (serum cortisol concentrations greater than 5 micrograms/dl); only 1 of the 17 patients with other diagnoses and depressive symptoms exhibited nonsuppression. There was no difference in the rate of nonsuppression between the patients with subgroups of major depression, but those with major depression and psychosis had significantly higher postdexamethasone cortisol levels than those with major depression with and without melancholia and those with diagnoses other than major depression.

Adolescent↗
PubMed1984

Dexamethasone suppression test in recently detoxified alcoholics: clinical implications.

An overnight dexamethasone suppression test (DST) was performed on 66 nondepressed primary alcoholics, a mean of 20.79 +/- 11.5 days after last alcohol intake. The Beck Depression Inventory (BDI) was given concurrently. Only 6% of the subjects were nonsuppressors. There was no correlation between cortisol levels at 17 and 24 hours postdexamethasone and the age of the subjects or duration of abstinence. There was a low level correlation between cortisol values at 24 hours and the BDI scores. Review of published data indicates that the DST may be abnormal in alcoholics in the first 2 weeks of abstinence, probably a result of abnormal liver function and withdrawal phenomena. DST response of alcoholics resembles that of normal controls after more than 2 weeks of abstinence. Alcoholics with clinical features of depression and an abnormal DST after 2 weeks of abstinence may be candidates for antidepressant therapy or electroconvulsive therapy.

Adult↗
PubMed1986

The dexamethasone suppression test and response to somatic treatment: a review.

The dexamethasone suppression test (DST) has been primarily investigated as an aid in diagnosing endogenous depression; yet, its major clinical use has been as a predictor of treatment response. It is commonly held that 1) an abnormal DST predicts response to somatic (and not psychologic) therapies, 2) an abnormal DST predicts response to noradrenergic antidepressants, and 3) a normal DST predicts response to serotonergic agents. The DST predicted response to somatic therapies in only 6 of 16 published studies. No single methodologic factor, such as population variables, DST technique, or study design, can explain the marked discrepancy in study results. Only two of seven studies examining the DST and response to neurotransmitter-specific antidepressant groups found a positive relationship. The evidence that the DST predicts response to noradrenergic agents is weak. The DST does not predict acute response to somatic treatment in general or response to specific antidepressants. The selection of the appropriate treatment for depressed patients is still best made using clinical criteria.

Antidepressive Agents↗
PubMed1985

Direct radioimmunoassay of cortisol in saliva and its application to the dexamethasone suppression test in affective disorders.

In order to perform the dexamethasone suppression test (DST) with saliva as an alternative to serum, we assayed directly the cortisol concentrations in 25 microliters saliva samples, using a commercial radioimmunoassay kit for serum cortisol with minor modifications. Cortisol in saliva showed a diurnal rhythm parallel to that of cortisol in serum samples collected simultaneously. Saliva cortisol levels increased significantly after ACTH injection, but with a 60 min delay in reaching their peak compared to peak serum cortisol levels. The increase in saliva cortisol was five-fold, while that in serum was two-fold. Saliva cortisol levels continued to increase in some subjects while serum total cortisol levels already had begun to decline. In those subjects, the correlation of saliva with serum cortisol was greater when a quadratic curve was fitted than when calculated for a linear correlation. Considerable variation was observed for within-subject correlations, ranging from + 0.48 to + 0.999. The DST with saliva sample collection was performed on 43 inpatients with affective disorders. Sensitivity, specificity and diagnostic confidence of the DST for major depressive episode with melancholia were 33%, 91%, and 78%, respectively, at the criterion value of 0.3 microgram/100 ml for saliva cortisol, which are similar to those most often reported for the DST with serum cortisol determination. These results indicate that saliva cortisol levels do not always parallel serum cortisol levels and thus are not an unequivocal substitute. The findings for the DST in psychiatric patients, however, support the practical clinical usefulness of saliva cortisol measurements.

Adrenocorticotropic Hormone↗
PubMed1981

Dexamethasone suppression test in the management of hyperandrogenized patients.

The authors evaluated 86 hyperandrogenized women with measurements of serum cortisol, dehydroepiandrosterone sulfate, testosterone, and dihydrotestosterone in pooled sera before and after a dexamethasone suppression test. According to strict criteria, 70 (81%) of 86 women demonstrated a major glucocorticoid-suppressible component to their hyperandrogenism. Endocrine therapy was dictated by the results of the dexamethasone suppression test. To assess the predictive value of this test, we evaluated the clinical responses of the subgroup of 55 women who received appropriate endocrine suppression therapy for 6 to 15 months. Of this subgroup, 38 were identified as having adrenal hyperandrogenism; 3 had ovarian hyperandrogenism; and 14 had mixed hyperandrogenism. Of the 55 patients, 49 received dexamethasone alone; 3 received dexamethasone plus Ovral (an oral contraceptive containing the synthetic progestogen norgestrel 0.5 mg and ethinyl estradiol 0.05 mg); and 3, all with ovarian hyperandrogenism, received depomedroxyprogesterone acetate (Depo-Provera). Clinical response was assessed in terms of improvement or no improvement in menstrual status, acne, and hirsutism. Of 29 patients with adrenal or mixed hyperandrogenism associated with abnormal menses, the menstrual status of 17 (59%) improved after dexamethasone therapy. Acne improved in 39 (100%) of 39 subjects. Hirsutism showed moderate to marked improvement in 40 (73%) of 55 women after 6 to 15 months of endocrine suppression therapy. These results indicate the endocrine suppression therapy, particularly with repeated low-dose dexamethasone, prescribed on the basis of a dexamethasone suppression test, is an effective means of managing hyperandrogenism.

Adolescent↗
PubMed1988

The dexamethasone suppression test in relation to symptomatology: preliminary findings controlling for serum dexamethasone concentrations.

A diagnostically heterogeneous sample of psychiatric inpatients (n = 52) was administered the 1 mg dexamethasone suppression test (DST) shortly after hospital admission. Each was also assessed using the Hamilton Rating Scale for Depression (HRSD) and selected items of the Present State Examination (PSE) representing psychomotor retardation and anxiety. A potent determinant of postdexamethasone serum cortisol concentrations was found to be the level of serum dexamethasone concentration achieved following the oral dose. No relationship was found between postdexamethasone cortisol concentration and the scores on either the HRSD or an anxiety scale derived from selected PSE items. However, symptoms of psychomotor retardation were significantly related to postdexamethasone serum cortisol concentration, particularly when the serum dexamethasone concentrations were taken into account. It may be that DST nonsuppression in psychiatric patients is in part a reflection of the presence of psychomotor retardation, a phenomenon that cuts across diagnostic categories.

Adolescent↗
PubMed1997

Evaluation of the dexamethasone suppression test for the diagnosis of glucocorticoid-remediable aldosteronism.

Glucocorticoid-remediable aldosteronism (GRA) is a rare form of inherited hypertension caused by a characteristic gene duplication. With the advent of definitive genetic testing for GRA, the performance of the traditional screening test for GRA, the dexamethasone suppression test (DST), can be evaluated. We compared the DST to direct genetic testing in 24 patients referred for genetic screening for GRA (12 GRA positive and 12 GRA negative) based on clinical and biochemical findings, DST, and family history. Plasma aldosterone was measured before and after oral dexamethasone administration to determine the extent to which aldosterone was suppressed by glucocorticoids in each patient group. The results of the DST in these subjects were also compared to those in 19 historical patients with primary aldosteronism [4 bilateral hyperplasia and 15 aldosterone-producing adenoma (APA)] reported previously. The DST differentiated GRA-positive from GRA-negative patients with 92% sensitivity and 100% specificity. Cutoffs based on the post-DST plasma aldosterone level (< 4 ng/dL) or percent suppression compared to baseline (> 80%) were equally effective in correctly diagnosing GRA (only one GRA-positive patient would have been incorrectly diagnosed). However, DST in 15 APA patients revealed that 33% had greater than 80% suppression of aldosterone, and 1 had aldosterone levels below 4 ng/dL. We conclued that a post-DST aldosterone level below 4 ng/dL will correctly diagnose GRA patients with high sensitivity and specificity. Suppression compared to baseline can be misleading, as evidenced by the results in APA patients and referred subjects who genetically screened negative.

Adrenocorticotropic Hormone↗