Steingard R, Biederman J, Keenan K, Moore C
Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114.
Biol Psychiatry. 1990 Aug 1;28(3):193-202. doi: 10.1016/0006-3223(90)90574-l.
The dexamethasone suppression test (DST) was administered as part of the initial clinical assessment to 83 children and adolescents who were consecutively referred for outpatient evaluation. All diagnoses were made clinically by a child psychiatrist according to DSM-III criteria. A weight-corrected dose of dexamethasone of 17 micrograms/kg was used. DSM-III diagnoses were made independent of DST results. Patients were stratified into four main diagnostic groups: major depressive disorder (MDD) (N = 27); attention deficit disorder with hyperactivity (ADDH) (N = 22); major depressive disorder plus attention deficit disorder with hyperactivity (MDD + ADDH) (N = 29); and psychiatric controls (PC) (N = 5). Rates of dexamethasone nonsuppression were found to be similarly elevated in children with MDD (29.6%), ADDH (22.7%), and MDD + ADDH (37.9%). All 5 psychiatric control patients had a normal postdexamethasone suppression (0%). A similar pattern of results emerged in a reexamination of the literature on available studies of DST in juveniles which revealed that children with major affective disorders, attention deficit disorder (ADDH), and anxiety disorders had comparable DST results that were significantly higher than the 5.6% rate found in normal controls. These findings provide further support for similarities in DST results between ADDH and MDD in outpatients. Although these results suggest a lack of specificity of the DST as a laboratory aid for the diagnosis of juvenile affective disorders, they are also consistent with findings indicating that the DST may be an index of clinical severity and other findings suggesting a possible association between ADDH and MDD. Despite its limitations, the DST may provide potentially useful clinical and research information regarding the pathophysiology of psychiatric disorders and in alerting clinicians to the presence of serious psychiatric disorders. The findings also stress the relevance of assessing comorbidity in interpreting DST results.
地塞米松抑制试验（DST）作为初始临床评估的一部分，应用于83名连续被转诊至门诊接受评估的儿童和青少年。所有诊断均由儿童精神科医生根据《精神疾病诊断与统计手册》第三版（DSM - III）标准临床做出。使用的地塞米松剂量经体重校正后为17微克/千克。DSM - III诊断独立于DST结果。患者被分为四个主要诊断组：重度抑郁症（MDD）（n = 27）；注意力缺陷多动障碍（ADDH）（n = 22）；重度抑郁症合并注意力缺陷多动障碍（MDD + ADDH）（n = 29）；以及精神科对照（PC）（n = 5）。发现重度抑郁症儿童（29.6%）、注意力缺陷多动障碍儿童（22.7%）和重度抑郁症合并注意力缺陷多动障碍儿童（37.9%）的地塞米松不抑制率同样升高。所有5名精神科对照患者地塞米松抑制试验后结果正常（0%）。对关于青少年DST现有研究的文献重新审查时出现了类似的结果模式，这表明患有重度情感障碍、注意力缺陷多动障碍（ADDH）和焦虑症的儿童具有可比的DST结果，且显著高于正常对照组的5.6%的比率。这些发现为门诊患者中ADDH和MDD在DST结果方面的相似性提供了进一步支持。尽管这些结果表明DST作为诊断青少年情感障碍的实验室辅助手段缺乏特异性，但它们也与表明DST可能是临床严重程度指标的发现以及其他表明ADDH和MDD之间可能存在关联的发现一致。尽管有其局限性，但DST可能提供有关精神疾病病理生理学的潜在有用的临床和研究信息，并提醒临床医生注意严重精神疾病的存在。这些发现还强调了在解释DST结果时评估共病的相关性。
