Grossman Robert, Yehuda Rachel, New Antonia, Schmeidler James, Silverman Jeremy, Mitropoulou Vivian, Sta Maria Nelly, Golier Julia, Siever Larry
Department of Psychatry Bronx VeteransAffairs medical Center, Bronx, NY, USA.
Am J Psychiatry. 2003 Jul;160(7):1291-8. doi: 10.1176/appi.ajp.160.7.1291.
Previous studies using the 1.0-mg dexamethasone suppression test (DST) in subjects with personality disorders have produced mixed results. However, these studies focused on major depression and did not consider the possible effects of the comorbidity of posttraumatic stress disorder (PTSD). PTSD has been shown to be associated with increased cortisol suppression. To investigate the effect of PTSD, the authors conducted a 0.5-mg DST, which is more sensitive than the 1.0-mg DST for detection of increased cortisol suppression, in a group of subjects with personality disorders.
Subjects with personality disorders (N=52) ingested 0.5 mg of dexamethasone. Pre- and postfasting blood samples were drawn for measurement of cortisol levels. A three-way analysis of covariance was used to test for the main effects of major depression, PTSD, and gender on percent cortisol suppression, with plasma dexamethasone concentration as a covariate. Secondary analyses assessed for main and interaction effects of age at which trauma(s) occurred and a diagnosis of borderline personality disorder.
Neither major depression nor gender had a significant effect on percent cortisol suppression. Subjects with PTSD had significantly higher percent cortisol suppression than subjects with major depression. Age at which trauma(s) occurred and a borderline personality disorder diagnosis had no significant main or interaction effects on cortisol suppression.
A high level of cortisol suppression was associated with PTSD in subjects with personality disorder. This finding is similar to published findings for PTSD subjects without personality disorders. Major depression, gender, age when trauma(s) occurred, and a diagnosis of borderline personality disorder did not have significant main or interaction effects on cortisol suppression.
既往针对人格障碍患者使用1.0毫克地塞米松抑制试验（DST）的研究结果不一。然而，这些研究聚焦于重度抑郁症，并未考虑创伤后应激障碍（PTSD）共病可能产生的影响。已有研究表明，PTSD与皮质醇抑制增加有关。为探究PTSD的影响，作者对一组人格障碍患者进行了0.5毫克DST，该试验在检测皮质醇抑制增加方面比1.0毫克DST更敏感。
人格障碍患者（N = 52）服用0.5毫克地塞米松。在空腹前后采集血样以测量皮质醇水平。采用三因素协方差分析，以血浆地塞米松浓度作为协变量，检验重度抑郁症、PTSD和性别对皮质醇抑制百分比的主效应。二级分析评估了创伤发生时的年龄以及边缘型人格障碍诊断的主效应和交互效应。
重度抑郁症和性别对皮质醇抑制百分比均无显著影响。患有PTSD的患者的皮质醇抑制百分比显著高于患有重度抑郁症的患者。创伤发生时的年龄和边缘型人格障碍诊断对皮质醇抑制均无显著的主效应或交互效应。
人格障碍患者中，高水平的皮质醇抑制与PTSD相关。这一发现与无人格障碍的PTSD患者的已发表研究结果相似。重度抑郁症、性别、创伤发生时的年龄以及边缘型人格障碍诊断对皮质醇抑制均无显著的主效应或交互效应。
