Tandon R, Mazzara C, DeQuardo J, Craig K A, Meador-Woodruff J H, Goldman R, Greden J F
Schizophrenia Program, University of Michigan Medical Center, Ann Arbor 48109-0120.
Biol Psychiatry. 1991 May 15;29(10):953-64. doi: 10.1016/0006-3223(91)90353-n.
To relieve confusion about the clinical correlates and prognostic implications of the dexamethasone suppression test (DST) in schizophrenia, we conducted a DST in 44 schizophrenic inpatients at drug-free baseline and approximately 4 weeks after neuroleptic treatment. Patients were rated on positive, negative, and depressive symptoms at both times. A head computed tomography (CT) scan was performed and measures of ventricle-brain ratio (VBR) obtained. Clinical improvement was monitored at four weeks, and longer-term outcome assessed at 1 year. Seventeen of the 44 patients were DST nonsuppressors at baseline, and five of these remained nonsuppressors at 4 weeks posttreatment. Postdexamethasone plasma cortisol levels were correlated with negative symptoms at baseline (r = 0.45; p less than 0.01), but not after 4 weeks of neuroleptic treatment. Postdexamethasone plasma cortisols were not related to global severity, positive, or depressive symptoms at either timepoint or to VBR. Persistent nonsuppression was associated with poor outcome, but baseline postdexamethasone cortisol levels were unrelated to outcome at 4 weeks and 1 year. The literature on DST in schizophrenia is reviewed and attempts are made to reconcile discrepant findings and to discuss pathophysiological implications.
为消除关于地塞米松抑制试验（DST）在精神分裂症中的临床关联和预后意义的混淆，我们对44例精神分裂症住院患者在无药物基线期及抗精神病药物治疗约4周后进行了DST。在两个时间点均对患者的阳性、阴性和抑郁症状进行了评分。进行了头部计算机断层扫描（CT）并获得了脑室脑比率（VBR）测量值。在4周时监测临床改善情况，并在1年时评估长期预后。44例患者中有17例在基线期为DST非抑制者，其中5例在治疗后4周仍为非抑制者。地塞米松后血浆皮质醇水平在基线期与阴性症状相关（r = 0.45；p < 0.01），但在抗精神病药物治疗4周后无相关性。地塞米松后血浆皮质醇在两个时间点均与总体严重程度、阳性或抑郁症状或VBR无关。持续非抑制与预后不良相关，但基线期地塞米松后皮质醇水平与4周和1年时的预后无关。本文回顾了精神分裂症中DST的相关文献，并试图调和不一致的研究结果并讨论病理生理意义。
