Dexamethasone Suppression Test in Depression and other Psychiatric Illness

The metabolic disturbances of monoamine in the hypothalamic-pituitary-adrenal axis (HPA axis) was examined in patients with chronic schizophrenia showing nonsuppression of the dexamethasone suppression test (DST). Subjects were 16 male chronic schizophrenics consisting of 8 DST suppressors and 8 nonsuppressors. All the patients were orally given the 5HT precursor, L-5-hydroxytryptophan (L-5HTP, 3 mg/kg) and the α₂-adrenergic agonist, clonidine (3 μg/kg), and the concentrations of plasma prolactin, cortisol, human growth hormone, and blood 5HT were measured chronologically. As a result, all of the DST nonsuppressors showed no increased response of prolactin after L-5HTP loading. Moreover, in the DST nonsuppressors, the secretion response of cortisol after L-5HTP loading was delayed compared with that of the suppressors. However, no different response between the DST suppressors and the nonsuppressors was observed after a loading dose of clonidine. These results suggest that there might be a metabolic disturbance of 5HT in the HPA axis of chronic schizophrenics showing DST nonsuppression.

Section: Discussionmentioning

confidence: 99%

Dexamethasone Suppression Test in Schizophrenia: Its Relation to Monoamine Metabolism in Hypothalamic-Pituitary-Adrenal Axis

Kaneko¹,

Murata²,

Hoshino³

et al. 1990

“…Failure to suppress plasma cortisol with the 1-mg dexamethasone suppression test (DST) has repeatedly been reported in major depressed patients [Carroll, 1980[Carroll, , 1982Brown and Shuey, 1980;Coppen et al, 1983;Feinberg and Carroll, 1984;Maes et al, 1986aMaes et al, , 1989a, Several studies showed that the DST may help con firm the diagnosis of major depression and distinguish that disorder from normal controls [Carroll et al, 1981] or from minor dépressives [Maes et al, 1986a[Maes et al, , 1989a. The postdexamethasone cortisol values at 8 a.m., 4 p.m. and 11 p.m. in parallel (anyone of the values showing nonsuppression) [Brown and Shuey, 1980;Carroll et al, 1981;Syvalahti, 1985] or the cortisol values at 4 p.m. only [Giles and Rush, 1982;Klein et al, 1984] at a threshold value 5= 5 pg/dl were recommended for this value of the DST for melancholia was not affected by the purpose.…”

Section: Introductionmentioning

confidence: 99%

Results of the 8 a.m. Dexamethasone Suppression Test Constitute a Suitable Tool for Confirming the Diagnosis of Melancholia

Maes

Vandewoude²,

Schotte

et al. 1989

This prospective study was conducted in order (1) to examine which postdexamethasone cortisol value -i.e., 8 a.m., 4 p.m. or peak cortisol – is most suitable as a laboratory test to help confirm the diagnosis of melancholia and (2) to investigate the influence of the dexamethasone levels in the results of the dexamethasone suppression test (DST). To this end we administered the DST to 48 controls and 115 depressed inpatients categorized according to DSM-III. The 8 a.m. and 4 p.m. dexamethasone levels were determined in 100 subjects. We found that an 8 a.m. postdexamethasone cortisol value ≧3.5 µg/dl was of the most significant diagnostic value in order to separate melancholia from normal controls and/or minor depressives. The 8 a.m. and 4 p.m. dexamethasone values did not differ between healthy controls, minor and severely depressed patients. Although cortisol nonsuppressors exhibited significantly lower dexamethasone values, the predictive value of the DST for melancholia was not affected by the large variation in the bioavailability of dexamethasone.

“…Moroji [5] reported that the diurnal variation of plasma 17-hydroxycorticosteroid (17-OHCS) is irregular and in dependent of emotion in chronic schizophrenics. Recent ly, Coppcn [6] found that the majority of nonsuppressors in DST among chronic schizophrenics had prominent negative symptoms such as affective flattening, poverty of speech and loss of drive. Coppen [7] also supported the association between DST nonsuppression and type II schizophrenia proposed by Crow [8], Crow [8] speculated that the negative symptoms observed in type II schizo phrenics may be due to structural abnormalities in the brain.…”

mentioning

confidence: 99%

Hypothalamic-Pituitary-Adrenal Axis Function in Chronic Schizophrenia: Association with Clinical Features

Kaneko¹,

Yokoyama²,

Hoshino³

et al. 1992

The function of the hypothalamic-pituitary-adrenal axis (HPA-axis) and its association with clinical features in chronic schizophrenia were investigated. Twenty of 33 chronic schizophrenics exhibited an abnormal diurnal variation of the saliva cortisol level. The patients with abnormal diurnal variation gave higher scores for some negative symptoms than those with normal diurnal variation. On the dexamethasone suppression test (DST) of saliva samples, 13 of 34 chronic schizophrenics were abnormal. The patients with DST nonsuppression were more frequently classified into disorganized type and exhibited low scores of anxiety compared with the patients with normal suppression. The 9 patients who showed abnormal diurnal variation and DST nonsuppression were more frequently classified into disorganized type and showed higher scores of negative symptoms than the 9 patients who did not show any abnormal cortisol data. These results suggest that there might be some disturbance in the function of the HPA-axis in a group of chronic schizophrenics and that these patients might have severe negative symptoms.