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The Limited Utility of the Dexamethasone Suppression Test for the Diagnostic Process in Psychiatry

Published online by Cambridge University Press:  29 January 2018

Mathias Berger ,
Karl-Martin Pirke ,
Peter Doerr ,
Jürgen-Christian Krieg  and
Detlev von Zerssen
Mathias Berger*
Affiliation:
Max-Planck-Institut für Psychiatrie, Kraepelinstr. 10, D-8000 München 40 / Federal Republic of Germany
Karl-Martin Pirke
Affiliation:
Max-Planck-Institut für Psychiatrie, Kraepelinstr. 10, D-8000 München 40 / Federal Republic of Germany
Peter Doerr
Affiliation:
Max-Planck-Institut für Psychiatrie, Kraepelinstr. 10, D-8000 München 40 / Federal Republic of Germany
Jürgen-Christian Krieg
Affiliation:
Max-Planck-Institut für Psychiatrie, Kraepelinstr. 10, D-8000 München 40 / Federal Republic of Germany
Detlev von Zerssen
Affiliation:
Max-Planck-Institut für Psychiatrie, Kraepelinstr. 10, D-8000 München 40 / Federal Republic of Germany
*
∗Correspondence.
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Summary

In 231 psychiatric in-patients, the 1 mg or 1.5 mg DST with blood samples at 0900 h, 1600 h and 2300 h and a post-dexamethasone plasma cortisol threshold of ⩾ 5 μg/dl were tested for their differential diagnostic utility in clinical psychiatry. Neither test significantly separated endogenous depressed. patients from patients with other depressive or non-depressive psychiatric disorders. Studies of the 1 mg or 1.5 mg DST in 75 healthy subjects revealed about 12% of cortisol non-suppressors, when a post–dexamethasone cortisol threshold of ⩾ 5 μg/dl was used. This seemed to be an unacceptably low specificity of the test in normal subjects. A threshold criterion of ⩾ 8 μg/dl, however, yielded only 2.7% of non-suppressed normal subjects. Analyses of the DST data of the psychiatric patients, using a cortisol threshold of ⩾ 8 μg/dl, also failed to reveal a significantly higher specificity of the DST for endogenous depression. However, it was demonstrated that intervening variables such as stress due to hospital admission, drug withdrawal, suicidal turmoil, weight loss, as well as a low dexamethasone plasma level, enhance the rate of abnormal DST results in psychiatric in-patients, regardless of their diagnostic classification.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 145 , Issue 4 , October 1984 , pp. 372 - 382
Copyright
Copyright © 1984 The Royal College of Psychiatrists 

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References

Baldessarini, R. J., Finklestein, S. & Arana, G. W. (1983) The predictive power of diagnostic tests and the effect of prevalence of illness. Archives of General Psychiatry, 40, 569–73.CrossRefGoogle ScholarPubMed
Berger, M., Doerr, P., Lund, R., Bronisch, T. & von Zerssen, D. (1982a) Neuroendokrinologische Befunde und polygraphische Schlafuntersuchungen bei Patienten mit depressiven Syndromen. In Biologische Psychiatrie, (ed. Beckmann, H.). Stuttgart: Thieme.Google Scholar
Berger, M., Doerr, P., Lund, R., Bronisch, T. & von Zerssen, D. (1982b) Neuroendocrinological and neurophysiological studies in major depressive disorders: Are there biological markers for the endogenous subtype? Biological Psychiatry, 17, 1217–42.Google ScholarPubMed
Berger, M., Doerr, P., Lund, R., Bronisch, T., von Zerssen, D., Krieg, Ch. & Pirke, K. M. (1982c) Is the positive dexamethasone test in depressed patients a consequence of weight loss? Neuro-Endocrinology Letters, 4, 177.Google Scholar
Berger, M., Doerr, P., Lund, R., Bronisch, T., Pirke, K. M., Krieg, Ch. & von Zerssen, D. (1984) The effect of weight loss and of inappropriate plasma dexamethasone levels on the dexamethasone suppression test. Psychiatry Research (In press).CrossRefGoogle Scholar
Bethge, H., Nagel, A. M., Solbach, H. G., Wiegelmann, W. & Zimmermann, H. (1970) Zentrale Regulationsstörung der Nebennierenrindenfunktion bei der Anorexia nervosa. Materia Medica Nordmark, 22, 204–14.Google Scholar
Blumer, D., Roth, T. & Heilbronn, M. (1981) Biological markers for depression in chronic pain. American Psychiatric Association, 134th Annual Meeting, New Research Abstract 38.Google Scholar
Brown, W. A., Haier, R. J. & Qualls, C. B. (1980) Dexamethasone suppression test identifies subtypes of depression which respond to different antidepressants. Lancet, i, 928–9.Google Scholar
Brown, W. A., Haier, R. J., Qualls, C. B., Johnston, R. & Mayfield, D. (1979) The 24-hour dexamethasone suppression test in a clinical setting—relationship to diagnosis, symptoms, and response to treatment. American Journal of Psychiatry, 136, 543–7.CrossRefGoogle Scholar
Carney, M. W. P., Roth, M. & Garside, R. F. (1965) The diagnosis of depressive syndromes and the prediction of E.C.T. response. British Journal of Psychiatry, 111, 659–74.CrossRefGoogle ScholarPubMed
Carroll, B. J. (1982a) Clinical applications of the dexamethasone suppression test for endogenous depression. Pharmaco-psychiatry, 15, 19–24.CrossRefGoogle ScholarPubMed
Carroll, B. J. (1982b) The dexamethasone suppression test for melancholia. British Journal of Psychiatry, 140, 292–304.CrossRefGoogle ScholarPubMed
Carroll, B. J. (1983) Neuroendocrine diagnosis of depression: The dexamethasone suppression test. In Treatment of Depression: Old Controversies and New Approaches (eds. Clayton, P. J. & Barrett, J. E.), pp 1–30. New York: Raven Press.Google Scholar
Carroll, B. J., Feinberg, M., Greden, J. F., Haskett, R. F., Norman, McI. J., Steiner, M. & Tarika, J. (1980) Diagnosis of endogenous depression. Journal of Affective Disorders, 2, 177–94.CrossRefGoogle ScholarPubMed
Carroll, B. J., Feinberg, M., Greden, J. F., Norman, McI., J., Steiner, M., Tarika, J., Albala, A. A., Haskett, R. F., James, N. McL., Kronfol, Z., Lohr, N., Steiner, M., Vigne, J. P. de & Young, E. (1981a) A specific laboratory test for the diagnosis of melancholia. Archives of General Psychiatry, 38, 15–22.CrossRefGoogle ScholarPubMed
Carroll, B. J., Norman, McI., J., Steiner, M., Haskett, R. F., James, N. McL., Kronfol, Z., Young, E., Greden, J. F., Feinberg, M., Lohr, N., James, N. McL., Haskett, R. F., Albala, A. A., Vigne, J. P. de & Tarika, J. (1981b) Neuroendocrine evaluations of depression in borderline patients. Psychiatric Clinics of North America, 4, 89–99.CrossRefGoogle ScholarPubMed
Coccora, E. F., Prudic, J., Rothpearl, A., Nurnberg, H. G. & Davis, K. L. (1983) The Effect of Hospitalization on the DST. Abstract 82; presented at the Annual Meeting of the Society of Biological Psychiatry, New York.Google Scholar
Coryell, W., Gaffney, G. & Burkhardt, P. E. (1982) DSM-III melancholia and the primary-secondary distinction: A comparison of concurrent validity by means of the dexamethasone suppression test. American Journal of Psychiatry, 139, 120–2.Google ScholarPubMed
Crumley, F. E., Clevenger, J., Steinfink, D. & Oldham, D. (1982) Preliminary report on the dexamethasone suppression test for psychiatrically disturbed adolescents. American Journal of Psychiatry, 139, 1062–4.Google ScholarPubMed
Dewan, M. J., Pandurangi, A. K., Boucher, M. L., Levy, B. F. & Major, L. F. (1982) Abnormal dexamethasone suppression test results in chronic schizophrenic patients. American Journal of Psychiatry, 139, 1501–3.Google ScholarPubMed
Donohue, J. & Sgoutas, G. (1975) Improved radioimmunoassay of plasma cortisol. Clinical Chemistry, 21, 529–37.CrossRefGoogle Scholar
Doerr, P., Fichter, M., Pirke, K. M. & Lund, R. (1980) Relationship between weight gain and hypothalamic pituitary adrenal function in patients with anorexia nervosa. Journal of Steroid Biochemistry, 13, 529–37.CrossRefGoogle ScholarPubMed
Edelstein, C. K., Roy-Byrne, P., Fawzy, F. I. & Dörnfeld, L. (1983) Effects of weight loss on the dexamethasone suppression test. American Journal of Psychiatry, 140, 338–41.Google ScholarPubMed
Fichter, M., Pirke, K. M., Doerr, P. & Lund, R. (1981) Effect of behaviour therapy on weight gain, behaviour attitude, and endocrine parameters in anorexia nervosa. In Biological Psychiatry (Bio-Medical Press) (eds. Perris, C., Struwe, G. & Jansson, B.). Amsterdam: Elsevier.Google Scholar
Fraser, A. R. (1983) Choice of antidepressant based on the dexamethasone suppression test. American Journal of Psychiatry, 140, 786–7.Google ScholarPubMed
Graham, P. M., Booth, J., Boranga, G., Galhenage, S., Myers, C. M., Teoh, C. L. & Cox, I. S. (1981) The dexamethasone suppression test in mania. Journal of Affective Disorders, 4, 201–21.Google Scholar
Greden, J. F., Gardner, R., King, D., Grunhaus, L., Carrol, B. J. & Kronfol, Z. (1983) Dexamethasone suppression tests in anti-depressant treatment of melancholia. Archives of General Psychiatry, 40, 493–500.CrossRefGoogle Scholar
Haak, D., Vecsei, P., Lichtwald, K., Klee, H. R. & Gless, K. H. (1980) Some experiances on radioimmunoassays of synthetic glucocorticoids. Allergologie, 3, 259–67.Google Scholar
Haskett, R. F., Athanasios, P. Z., Albala, A. A. & Carroll, B. J. (1983) DST Performance during First 48 Hours of Admission. Abstract 100; presented at the Annual Meeting of the Society of Biological Psychiatry, New York.Google Scholar
Holsboer, F., Bender, W., Benkert, O., Klein, H. E. & Schmauss, M. (1980) Diagnostic value of dexamethasone suppression test in depression. Lancet 2, 706.CrossRefGoogle ScholarPubMed
Holsboer, F., Bender, W., Benkert, O., Klein, H. E., Schmauss, M., Liebl, R. & Hofschuster, E. (1982) Repeated dexamethasone suppression test during depressive illness. Journal of Affective Disorders, 4, 93–101.CrossRefGoogle ScholarPubMed
Hopkinson, G. (1981) A neurochemical theory of appetite and weight changes in depressive states. Acta Psychiatrica Scandinavica, 64, 217–25.CrossRefGoogle ScholarPubMed
Insel, T. R., Kalin, N. H., Guttmacher, L. B., Cohen, R. M. & Murphy, D. L. (1982) The dexamethasone suppression test in patients with primary obsessive-compulsive disorder. Psychiatry Research, 6, 153–60.CrossRefGoogle ScholarPubMed
Kalin, N. H., Risch, S. C., Janowsky, D. S. & Murphy, D. L. (1981) Use of the dexamethasone suppression test in clinical psychiatry. Journal of Clinical Psychopharmacology, 1, 64–9.CrossRefGoogle ScholarPubMed
Klein, H. E. The dexamethasone suppression test in psychiatry: Myth and realities. In Advances in Human Psychopharmacology Research Annual, Vol IV (ed. Burrows, G. D. and Werry, J. S. New York: Jai Press (in press) Google Scholar
Mason, J. W., Sachar, E. J., Fishman, J. R., Hamburg, D. A. & Handlon, J. H. (1965) Corticosteroid responses to hospital admission. Archives of General Psychiatry. 13, 1–8.CrossRefGoogle ScholarPubMed
McAllister, T. W., Ferrell, R. B., Price, T. R. P. & Neville, M. B. (1982) The dexamethasone suppression test in two patients with severe depression pseudodementia. American Journal of Psychiatry, 139, 479–81.Google ScholarPubMed
Meikle, A. W. (1982) Dexamethasone suppression test: Usefulness of simultaneous measurement of plasma cortisol and dexamethasone. Clinical Endocrinology, 16, 401–8.CrossRefGoogle Scholar
Meltzer, H. Y. & Fang, V. S. (1983) Cortisol determination and the dexamethasone suppression test. Archives of General Psychiatry. 40, 501–5.CrossRefGoogle ScholarPubMed
Meltzer, H. Y., Fang, V. S., Tricou, B. J., Robertson, A. & Piyaka, S. K. (1982) Effect of dexamethasone on plasma prolactin and cortisol levels in psychiatric patients. American Journal of Psychiatry, 139, 763–68.Google ScholarPubMed
Mendlewicz, J., Charles, G. & Franckson, J. M. (1982) The dexamethasone suppression test in affective disorders: Relationship to clinical and genetic subgroups. British Journal of Psychiatry, 141, 464–70.CrossRefGoogle ScholarPubMed
Metropolitan Life Insurance Company (1959) Statistical Bulletin, Vol. 40. New York: Metropolitan Life Insurance Company.Google Scholar
Newsom, G. & Murray, N. (1983) Reversal of dexamethasone suppression test non–suppression in alcohol abusers. American Journal of Psychiatry, 14, 353–4.Google Scholar
Peselow, E. D., Goldring, N., Fieve, R. R. & Wright, R. (1983) The dexamethasone suppression test in depressed outpatients and normal control subjects. American Journal of Psychiatry, 140, 245–7.Google ScholarPubMed
Pirke, K. M. & Stamm, D. (1972) Vergleich der Spezifität einfacher Methoden zur Bestimmung von Plasma Cortisol. Zeitschrift für Klinische Chemie und Klinische Biochemie, 10, 254–9.Google ScholarPubMed
Raskind, M., Preskind, E., Rivard, M.-F., Veith, R. & Barnes, R. (1982) Dexamethasone suppression test and cortisol circadian rhythm in primary degenerative dementia. American Journal of Psychiatry, 139, 1468–70.Google ScholarPubMed
Rudorfer, M. V. & Clayton, P. J. (1981) Depression, dementia, and dexamethasone suppression. American Journal of Psychiatry, 138, 701.Google ScholarPubMed
Rush, J., Giles, D. E., Roffwarg, H. P. & Parker, C. R. (1982) Sleep EEG and dexamethasone suppression test findings in outpatients with unipolar major depressive disorder. Biological Psychiatry, 17, 327–41.Google Scholar
Smith, S. R., Bledsoe, T. & Chhetri, M. K. (1975) Cortisol metabolism and the pituitary–adrenal axis in adults with protein caloric malnutrition. Journal of Clinical Endocrinology and Metabolism, 40, 43–52.CrossRefGoogle Scholar
Spar, J. E. & Gerner, R. (1982) Does the dexamethasone suppression test distinguish dementia from depression? American Journal of Psychiatry, 139, 238–40.Google ScholarPubMed
Spitzer, R. L., Endicott, J. E. & Robins, E. (1977) Research Diagnostic Criteria for a Selected Group of Functional Disorders, 3rd edition. New York: New York State Psychiatric Institute, Biometric Research.Google Scholar
Stokes, P. E., Stoll, P. M., Mattson, M. R. & Sollod, R. N. (1976) Diagnosis and psychopathology in psychiatric patients resistent to dexamethasone. In Hormones, Behavior, and Psychopathology, (ed. Sachar, E. J.) New York: Raven Press.Google Scholar
Swartz, C. M. & Dünner, F. J. (1982) Dexamethasone suppression testing of alcoholics. Archives of General Psychiatry, 39, 1309–12.CrossRefGoogle ScholarPubMed
Targum, S. D., Rosen, L. & Capodanno, A. E. (1983) The dexamethasone suppression test in suicidal patients with unipolar depression. American Journal of Psychiatry, 140, 877–9.Google ScholarPubMed
Tourigny-Rivard, M.-F., Raskind, M. & Rivard, D. (1981) The dexamethasone suppression test in an elderly population. Biological Psychiatry, 16, 1177–84.Google Scholar
Turner, W. J. (1982) Editorial: Dexamethasone suppression test: Problems and promise. Biological Psychiatry, 17, 1–2.Google Scholar
Wood, K., Harwood, H. & Coppen, A. (1983) Technique and accuracy of the dexamethasone suppression test. Archives of General Psychiatry, 40, 585.CrossRefGoogle Scholar
World Health Organization (1974) Glossary of Mental Dissorders and Guide to Their Classification for Use in Conjunction with the International Classification of Diseases, 8th Rev., Geneva.Google Scholar
Zerssen, D. von with the assistance of Koeller, D. M. (1976) Die Befindlichkeits–Skala. Weinheim: Beltz.Google Scholar
Zerssen, D. von (in press) Self–rating scales in the evaluation of psychiatric treatment. In Methodology in Evaluation of Psychiatric Treatment (ed. Helgason, T.). Cambridge: Cambridge University Press.Google Scholar
Zerssen, D. von, Berger, M. & Doerr, P. (1984) Neuroendocrine dysfunction in subtypes of depression. In Psychoneuroendocrine Dysfunction in Psychiatric and Neurological Illnesses. Influence of Psychopharmacological Agents (eds. Shah, N. S. & Donald, A. G.). New York: Plenum Publ. Co.Google Scholar
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