Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-25T16:09:34.488Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access

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

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, Psychiatrie Association (1980) Diagnostic and Statistical Manual of Mental Disorders (DSM-III) (3rd edn.) American Psychiatrie Association, Washington DCGoogle Scholar
Andreasen, N.C. (1982) Negative symptoms in schizophrenia: definition and reliability. Arch. Gen. Psychiatry 139, 297–302Google Scholar
Andreasen, N.C. (1983) The Scale for the Assessment of Negative Symptoms. University of lowa City, lowaGoogle Scholar
Abou-Saleh, M.T.Spalding, E.M.Kellett, J.M. & Coppen, A. (1987) Dexamethasone suppression test in dementia. Int. J. Geriatr. Psychiatry 2, 59–65CrossRefGoogle Scholar
Beckett, G.J.Gray, S.M. & Seth, J. (1982) Immunoassays for Clinical Chemistry (Hunter, W.M. & Corrie, J.E.T., eds.), 2nd edn., Churchill and Livingstone, London, pp. 201—202Google Scholar
Berger, M.Pirkie, K.-M.Doerr, P.Kreig, J.-C. & Von, Zerssen D. (1984) The limited utility of the dexamethasone suppression test for the diagnostic process in psychiatry. Br. J. Psychiatry 145, 372—382CrossRefGoogle Scholar
Bowie, P.C.W. & Beaini, A.L. (1985) Normalisation of the dexamethasone suppression test: a correlate of clinical improventent in printary depressives. Br. J. Psychiatry 147, 30–3510.1192/bjp.147.1.30CrossRefGoogle ScholarPubMed
Branconnier, R.J.Oxenkrug, G.F. & MeIntyre, L. (1984) Prediction of serum cortisol response to dexamethasone in normal volunteers: a multivariate approach. Psychopharmacology 84, 274–275CrossRefGoogle ScholarPubMed
Bueno, J.A.Sabanes, F. Gascon J.Gasto, C. & Salamoro, M. (1985) Dexamethasone suppression test in patients with panic disorder and secondary depression. Arch. Gen. Psychiatry 41, 723–724Google Scholar
Carroll, B.J.Feinberg, M.Greden, J.F.Tarika, J.Albala, A.Haskett, R.F.McIjamcs, N.Kronfol, Z.Lohr, N.Steiner, M.De Vigne, J.P. & Young, E. (1981) A specifie laboratory test for the diagnosis of melancholia. Standardisation, validation and clinical utility. Arch. Gen. Psychiatry 38, 15–22CrossRefGoogle Scholar
Carroll, B.J. (1982) The dexamethasone suppression test for melancholia. Br. J. Psychiatry 140, 292–304CrossRefGoogle ScholarPubMed
Coppen, A.Abou-Saleh, P.Miln, P.Metcalfe, J. & Bailey, J. (1983) Does dexamethasone suppression test prediet antidepressant treatment suceess? Br. J. Psychiatry 142, 498–504CrossRefGoogle Scholar
Dewan, M.J.Pandurangi, B.F.Levy, B.F.Bouchar, M.L. & Major, L.F. (1985) Are schizophrenies with abnormal dexamethasone suppression test results a distinct group? Acta Psychiatr. Scand. 72, 274–277CrossRefGoogle Scholar
Dilman, V.M.Lapin, I.P. & Oxenkrug, G.F. (1979) Serotonin and ageing.In: Serotonin in Health and Disease (Essman, W.B., ed.) Spectrum Publications, New YorkGoogle Scholar
Greden, J.F.Albala, A.A.Haskett, R.F.James, N.M.Goodman, L.Steiner, M. & Carroll, B.J. (1980) Normalisation of dexamethasone suppression test: a laboratory index of recovery from endogenous depression. Biol. Psychiatry 15, 449–458Google Scholar
Hallström, T.Samuelsson, S.Balldin, J.Walinder, J.Bengtsson, C.Nystrom, E.Andersch, B.Lindstedt, G. & Lundberg, P.-A. (1983) Abnormal dexamethasone suppression test in normal females. Br. J. Psychiatry 142, 489–497CrossRefGoogle ScholarPubMed
Herz, M.LGiovanni, A.F.Molnar, G. & Edwards, L. (1985) The dexamethasone suppression test in newly hospitalised schizophrenie patients. Am. J. Psychiatry 142/1, 127–129Google Scholar
Hirsch, S.R. (1982) Depression “ revealed” in schizophrenia. Br. J. Psychiatry 140, 421–424CrossRefGoogle Scholar
Holsboer, F.Lieb, R. & Hofschuster, E. (1982) Repeated dexamethasone suppression test during depressive illness: normalisation of test result compared with clinical improvement. J. Affective Disorders 4, 93–101CrossRefGoogle ScholarPubMed
Holsboer-Trachsler, E.Buol, C.Weidemann, K. & Holsboer, F. (1987) Dexamethasone suppression test in severe schizophrenie illness : effects of plasma dexamethasone and caffeine levels. Acta Psychiatr. Scand. 75, 608–613CrossRefGoogle Scholar
Johnson, D.A.W. (1982) Studies of depressive symptoms in schizophrenia: the prevalence of depression and its possible causes. Br. J. Psychiatry 139, 89–93CrossRefGoogle Scholar
Klein, H.E.Bender, W.Mayr, H.Niedersehweiberer, A. & Schntauss, M. (1984) The DST and its relationship to psychiatrie diagnosis, symptoms and treatment outcome. Br. J. Psychiatry 145, 591–599CrossRefGoogle Scholar
Krawiecka, M.Goldberg, D. & Vaughan, M. (1977) A standardised psychiatrie assessinent scale for rating chronic psychotic patients. Acta Psychiatr. Scand. 55, 299–308CrossRefGoogle Scholar
Munro, J.G.Hardiker, T.M. & Leonard, D.P. (1984) The dexamethasone suppression test in residual schizophrenia with depression. Am. J. Psychiatry 141/2, 250–252Google ScholarPubMed
Myers, E.D. (1984) Serial dexamethasone suppression tests in male chronic schizophrenie patients. Am. J. Psychiatry 141/7, 904–905Google Scholar
Overall, J.E. & Gorham, D.R. (1962) The brief psychiatrie rating scale. Psychol. Rep. 10, 799–812CrossRefGoogle Scholar
Roy, A.Thompson, R. & Kennedy, S. (1983) Depression in chronic schizophrenia. Br. J. Psychiatry 142, 465–470CrossRefGoogle ScholarPubMed
Saffer, D.Metcalfe, M. & Coppen, A. (1985) Abnormal dexamethasone suppression test in type II schizophrenia. Br. J. Psychiatry 147, 721–723CrossRefGoogle ScholarPubMed
Schweitzer, I.Maguire, K.P.Tiller, J.W.G.Gee, A.H.Harrison, L.C. & Davies, B.M. (1986) The effects of weight change on the dexamethasone suppression test in depressed and anorexie patients. Br. J. Psychiatry 149, 751–755CrossRefGoogle Scholar
Schweizer, E.E.Swenson, C.M.Winokur, A.Rickels, K. & Maislin, G. (1986) The dexamethasone suppression test in generalised anxiety disorder. Br. J. Psychiatry 149, 320–322CrossRefGoogle ScholarPubMed
Schrimanker, J.Soni, S.D. & Freeman, H.L. (1988) Dexamethasone suppression test in dementia and depression: clinical and biological correlates. Br. J. Psychiatry (in press)Google Scholar
Steardo, L.Barone, P.Monteleone, P.Lovino, M. & Cardone, G. (1987) Is the dexamethasone suppression test predictive of response to specifie antidepressant treatment in major depression? Acta Psychiatr. Scand. 76, 129–133CrossRefGoogle Scholar
Swarz, G.M. & Dunner, F.J. (1982) Dexamethasone suppression testing of alcoholics. Arch. Gen. Psychiatry 39, 1309–1312CrossRefGoogle Scholar
Targum, S.D. (1983) Neuroendocrine dysfunction in schizophrcniform disorder: correlation with six-month outcome. Am. J. Psychiatry 140/3, 309–313Google Scholar
Walsh, B.T.Lo, E.S.Cooper, T.Lindy, D.C.Roose, S.P.Gladis, M. & Glassman, A.H. (1987) Dexamethasone suppression test and plasma dexamethasone levels in bulimia. Arch. Gen. Psychiatry 44, 797–800CrossRefGoogle ScholarPubMed
Wik, G.Weisel, F.A.Eneroth, P.Sedvall, G. & Astrom, G. (1986) Dexamethasone suppression test in schizophrenie patients before and after neuroleptic treatment. Acta Psychiatr. Scand. 74, 161–167CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.