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Dexamethasone suppression test in chronic schizophrenia

Published online by Cambridge University Press:  28 April 2020

S.D. Soni ,
A. Mallik ,
V. Harris ,
J. Shrimanker  and
J. McMurray
S.D. Soni
Affiliation:
Psychiatric Research Department, Salford Health Authority, Prestwich Hospital, Prestwich, Manchester, M25 7BL, UK
A. Mallik
Affiliation:
Psychiatric Research Department, Salford Health Authority, Prestwich Hospital, Prestwich, Manchester, M25 7BL, UK
V. Harris
Affiliation:
Psychiatric Research Department, Salford Health Authority, Prestwich Hospital, Prestwich, Manchester, M25 7BL, UK
J. Shrimanker
Affiliation:
Psychiatric Research Department, Salford Health Authority, Prestwich Hospital, Prestwich, Manchester, M25 7BL, UK
J. McMurray
Affiliation:
Psychiatric Research Department, Salford Health Authority, Prestwich Hospital, Prestwich, Manchester, M25 7BL, UK
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Summary

Dexamethasone suppresson test (DST) was administered to 26 chronic schizophrenic inpatients who were on stable doses of neuroleptics for over 3 months. Clinical assessments were made on the Brief Psychiatric Rating Scale (BPRS), the Manchester Scale (KGV) and the Scale for the Assessment of Negative Symptoms (SANS). Patients’ neuroleptic treatment was then stopped for 4 weeks and the clinical assessements and the DST repeated. Thirty two percent of the patients showed DST non-suppression which was mostly stable over the 4-week period of the study and was unaffected by the neuroleptic treatment. Contrary to some reports in the literature, the clinical rating scores (including those for depression and negative symptoms), in our patients, showed no relationship with the DST status. We suggest that the DST abnormality in chronic schizophrenies may result from two quite different mechanisms: one due to stress assoeiated with transient psychopathology such as agitation, anxiety, depression or psychotic perturbation which is transient, the other resulting from structural abnormalities in the brain and which remains stable over time.

Résumé

Résumé

Le test de freinage à lu dexaméthasone (DST) a été réalisé chez 26 patients schizophrénes chroniques hospitalisés et traités Par des posologies stables de neuroleptiques depuis plus de trois mois. Les évaluations cliniques ont été effectuées à l'aide de l’échelle abrégée d’évaluation psychiatrique (BPRS), de l’échelle de Manchester (KGV) et de l'échelle d’appréciation des symptômes déficitaires «négatifs (SANS)».

Les évaluations cliniques et le test à le DST ont été répetés 4 semaines après l’arrêt des traitements neuroleptiques. Chez 32% des patients, une absence de freinage au DST a été observée, résultat stable à l’issue des 4 semaines de l’étude, non lié au traitement neuroleptique. Contrairement à certains résultats publiés dans la littérature, les notes obtenues aux échelles d’évaluation (notamment les notes de dépression et des symptômes déficitaires) ne sont pas corrélées, dans cette étude, aux résultats du DST.

Nous pensons que les anomalies du DST chez les schizophrenes chroniques dépendent de deux facteurs distincts: le premier, lié au stress, qui accompagne les états psychopathologiques passagers comme l’agitation, l’anxiété, la dépression ou le trouble psychotique (lorsqu’il est transitoire); le second proviendrait, quant à lui, d’anomalies cérébrales structurelles stables dans le temps.

Keywords

dexamethasone suppression testchronic schizophreniatest de freinage à ta DSTschizophrénie chronique
Type
Original article
Information
Psychiatry and Psychobiology , Volume 3 , Issue 3 , 1988 , pp. 189 - 194
Copyright
Copyright © European Psychiatric Association 1988

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