Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-27T22:29:54.341Z Has data issue: false hasContentIssue false
  • English
  • Français

The dexamethasone suppression test and DSM-III-R diagnoses in suicide attempters

Published online by Cambridge University Press:  16 April 2020

Åsa Westrin ,
Karin Frii  and
Lil Träskman-Bendz
Åsa Westrin*
Affiliation:
Division of Psychiatry, Department of Clinical Neuroscience, Lund University, 221 85Lund, Sweden
Karin Frii
Affiliation:
Division of Psychiatry, Department of Clinical Neuroscience, Lund University, 221 85Lund, Sweden
Lil Träskman-Bendz
Affiliation:
Division of Psychiatry, Department of Clinical Neuroscience, Lund University, 221 85Lund, Sweden
*
*Corresponding author. E-mail address: [email protected] (Å.Westrin).
Get access

Abstract

Previous research on hypothalamic-pituitary adrenal (HPA) axis-activity in suicide attempter research has shown conflicting outcomes. The design of the present study was to test the influence of personality disorders and concominant axis I diagnoses on the dexamethasone suppression diagnostic test by use of multiple regression analyses. The sample consisted of 184 patients with a recent suicide attempt and 42 healthy controls. As expected, the lowest pre- and postdexamethasone cortisol levels were found in patients with personality disorders axis II, cluster B as compared to the other patients. The results remained significant when analysed for covariance with DSM-III-R axis I diagnoses, age or sex. Whether these low cortisol levels are due to previous experience of extreme stressful events or long-lasting burden, or whether they may be a consequence of biogenetic or psychological predisposal of interest, remains to be elucidated. Axis I comorbidity needs to be further examined.

Keywords

Personality disorderDepressive disorderSuicide attemptsPituitary–adrenal systemCortisol
Type
Original article
Information
European Psychiatry , Volume 18 , Issue 7 , November 2003 , pp. 350 - 355
Copyright
Copyright © Éditions scientifiques et médicales Elsevier SAS.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington (DC): American Psychiatric Association; 1987 [revised].Google Scholar
Armanini, MPHutchins, CStein, BASapolsky, RM. Glucocorticoid endangerment of hippocampal neurons is NMDA-receptor dependent. Brain Res 1990;532:7–12.CrossRefGoogle ScholarPubMed
Baxter, LEdell, WGerner, RFairbanks, LGwirtsman, H. Dexamethasone suppression test and Axis I diagnoses of inpatients with DSM-III borderline personality disorder. J Clin Psychiatry 1984;45:150–3.Google ScholarPubMed
Beck, ATDavis, JHFrederick, CJPerlin, SPokorny, ASchulman, R, et al. Classification and nomenclature. In: Resnik, HPLHathorne, B, editors. Suicide prevention in the seventies. Washington (DC):: US Government Printing Office; 1972.Google Scholar
Beck, RWMorris, JBBeck, AT. Cross-validation of the Suicidal Intent Scale. Psychol Rep 1974;34:445–6.CrossRefGoogle ScholarPubMed
Beeber, ARKline, MDPies, RWManring, JM Jr. Dexamethasone suppression test in hospitalized depressed patients with borderline personality disorder. J Nerv Ment Dis 1984;172:301–3.CrossRefGoogle ScholarPubMed
Bergman, BBrismar, B. Hormone levels and personality traits in abusive and suicidal male alcoholics. Alcohol Clin Exp Res 1994;18:311–6.CrossRefGoogle ScholarPubMed
Bremner, JDRandall, PScott, TMBronen, RASeibyl, JPSouthwick, SM, et al. MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder. Am J Psychiatry 1995;152:973–81.Google ScholarPubMed
Bremner, JDRandall, PVermetten, EStaib, LBronen, RAMazure, C, et al. Magnetic resonance imaging-based measurement of hippocampal volume in posttraumatic stress disorder related to childhood physical and sexual abuse—a preliminary report. Biol Psychiatry 1997;41:23–32.CrossRefGoogle ScholarPubMed
Carrol, BJFeinberg, MGreden, JFTarika, JAlbala, AAHaskett, RF, et al. A specific laboratory test for the diagnosis of melancholia. Standardization, validation, and clinical utility. Arch Gen Psychiatry 1981;38:15–22.CrossRefGoogle Scholar
Carroll, BJGreden, JFFeinberg, MLohr, NJames, NMSteiner, M, et al. Neuroendocrine evaluation of depression in borderline patients. Psychiatr Clin North Am 1981;4:89–99.CrossRefGoogle ScholarPubMed
de la Fuente, JMMendlewicz, J. TRH stimulation and dexamethasone suppression in borderline personality disorder. Biol Psychiatry 1996;40:412–8.CrossRefGoogle ScholarPubMed
Driessen, MHerrmann, JStahl, KZwaan, MMeier, SHill, A, et al. Magnetic resonance imaging volumes of the hippocampus and the amygdala in women with borderline personality disorder and early traumatization. Arch Gen Psychiatry 2000;57:1115–22.CrossRefGoogle ScholarPubMed
Engstrom, GAlling, CGustavsson, POreland, LTraskman-Bendz, L. Clinical characteristics and biological parameters in temperamental clusters of suicide attempters. J Affect Disord 1997;44:45–55.CrossRefGoogle ScholarPubMed
Grossman, RYehuda, RSiever, L. The dexamethasone suppression test and glucocorticoid receptors in borderline personality disorder. Ann N Y Acad Sci 1997;821:459–64.CrossRefGoogle ScholarPubMed
Gunderson, JGSabo, AN. The phenomenological and conceptual interface between borderline personality disorder and PTSD. Am J Psychiatry 1993;150:19–27.Google ScholarPubMed
Gurvits, TVShenton, MEHokama, HOhta, HLasko, NBGilbertson, MW, et al. Magnetic resonance imaging study of hippocampal volume in chronic, combat-related posttraumatic stress disorder. Biol Psychiatry 1996;40:1091–9.CrossRefGoogle ScholarPubMed
Herman, JLPerry, JCvan der Kolk, BA. Childhood trauma in borderline personality disorder. Am J Psychiatry 1989;146:490–5.Google ScholarPubMed
Kin, NMNair, NPAmin, MSchwartz, GAhmed, SKHolm, P, et al. The dexamethasone suppression test and treatment outcome in elderly depressed patients participating in a placebo-controlled multicenter trial involving moclobemide and nortriptyline. Biol Psychiatry 1997;42:925–31.Google Scholar
Kontaxakis, VMarkianos, MVaslamatzis, GMarkidis, MKanellos, PStefanis, C. Multiple neuroendocrinological responses in borderline personality disorder patients. Acta Psychiatr Scand 1987;76:593–7.CrossRefGoogle ScholarPubMed
Korzekwa, MSteiner, MLinks, PEppel, A. The dexamethasone suppression test in borderlines: is it useful? Can J Psychiatry 1991;36:26–8.CrossRefGoogle ScholarPubMed
Krishnan, KRDavidson, JRRayasam, KShope, F. The dexamethasone suppression test in borderline personality disorder. Biol Psychiatry 1984;19:1149–53.Google ScholarPubMed
Lahmeyer, HWVal, EGaviria, FMPrasad, RBPandey, GNRodgers, P, et al. EEG sleep, lithium transport, dexamethasone suppression, and monoamine oxidase activity in borderline personality disorder. Psychiatry Res 1988;25:19–30.CrossRefGoogle ScholarPubMed
Lester, D. The dexamethasone suppression test as an indicator of suicide: a meta-analysis. Pharmacopsychiatry 1992;25:265–70.CrossRefGoogle ScholarPubMed
Mann, JJ. The neurobiology of suicide. Nat Med 1998;4:25–30.CrossRefGoogle ScholarPubMed
Ogata, SNSilk, KRGoodrich, SLohr, NEWesten, DHill, EM. Childhood sexual and physical abuse in adult patients with borderline personality disorder. Am J Psychiatry 1990;147:1008–13.Google ScholarPubMed
Pajer, KGardner, WRubin, RTPerel, JNeal, S. Decreased cortisol levels in adolescent girls with conduct disorder. Arch Gen Psychiatry 2001;58:291–302.CrossRefGoogle ScholarPubMed
Pfohl, BStangl, DZimmerman, M. The implications of DSM-III personality disorders for patients with major depression. J Affect Disord 1984;7:309–18.CrossRefGoogle ScholarPubMed
Soloff, PHGeorge, ANathan, RS. The dexamethasone suppression test in patients with borderline personality disorders. Am J Psychiatry 1982;139:1621–3.Google ScholarPubMed
Stein, MBKoverola, CHanna, CTorchia, MGMcClarty, B. Hippocampal volume in women victimized by childhood sexual abuse. Psychol Med 1997;27:951–9.CrossRefGoogle ScholarPubMed
Stein, MBYehuda, RKoverola, CHanna, C. Enhanced dexamethasone suppression of plasma cortisol in adult women traumatized by childhood sexual abuse. Biol Psychiatry 1997;42:680–6.CrossRefGoogle ScholarPubMed
Sternbach, HAFleming, JExtein, IPottash, ALGold, MS. The dexamethasone suppression and thyrotropin-releasing hormone tests in depressed borderline patients. Psychoneuroendocrinology 1983;8:459–62.CrossRefGoogle ScholarPubMed
Traskman, LAsberg, MBertilsson, LSjostrand, L. Monoamine metabolites in CSF and suicidal behavior. Arch Gen Psychiatry 1981;38:631–6.CrossRefGoogle ScholarPubMed
Uno, HTarara, RElse, JGSuleman, MASapolsky, RM. Hippocampal damage associated with prolonged and fatal stress in primates. J Neurosci 1989;9:1705–11.CrossRefGoogle ScholarPubMed
van der Kolk, BAPerry, JCHerman, JL. Childhood origins of self-destructive behavior. Am J Psychiatry 1991;148(12):1665–71.Google ScholarPubMed
Westrin, ÅEngstom, GEkman, RTraskman-Bendz, L. Correlations between plasma-neuropeptides and temperament dimensions differ between suicidal patients and healthy controls. J Affect Disord 1998;49:45–54.CrossRefGoogle ScholarPubMed
Virgin, CE JrHa, TPPackan, DRTombaugh, GCYang, SHHorner, HC, et al. Glucocorticoids inhibit glucose transport and glutamate uptake in hippocampal astrocytes: implications for glucocorticoid neurotoxicity. J Neurochem 1991;57:1422–8.CrossRefGoogle ScholarPubMed
Woodman, DDHinton, JWO’Neill, MT. Cortisol secretion and stress in maximum security hospital patients. J Psychosom Res 1978;22:133–6.CrossRefGoogle ScholarPubMed
Woolley, CSGould, EMcEwen, BS. Exposure to excess glucocorticoids alters dendritic morphology of adult hippocampal pyramidal neurons. Brain Res 1990;531:225–31.CrossRefGoogle ScholarPubMed
Yehuda, R. Biology of posttraumatic stress disorder. J Clin Psychiatry 2001;62:41–6.Google ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.