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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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