Abou-Saleh M T
Psychiatr Dev. 1985 Autumn;3(3):275-306.
The abnormal performance of the DST in depressive illness has been shown to be one of the most reproducible findings in biological psychiatry. Initial claims of its very high diagnostic specificity for the diagnosis of endogenous depression have not been substantiated: an abnormal response appears to reflect a biological dysfunction that cuts across the clinically established boundaries of psychiatric nosology. This lack of diagnostic utility does not reduce its prognostic value and abnormal DST response may indicate or reflect a versatile component in psychiatric disturbance and could serve therefore to predict or monitor the effects of physical and psychological intervention. Contributory factors to abnormal DST response are explored: factors such as stress, nutrition and age are reviewed and discussed. Concepts of biogenetic (neurohumoral) and psychological (psychodynamic and psychosocial) vulnerability and initiation/promotion are invoked and an integrated hypothesis is suggested: emotional strain provokes neurohumoral and neuroendocrine changes; these changes lead to vegetative disturbances including loss of appetite and weight with subsequent nutritional deficiencies that promote/reverse their neurohumoral and neuroendocrine changes. The role of 5-hydroxytryptamine is emphasized. Supportive evidence for aspects of this hypothesis is provided including animal studies and studies of the clinical and biological correlates of abnormal DST response.
地塞米松抑制试验（DST）在抑郁症中的异常表现已被证明是生物精神病学中最具重复性的发现之一。最初声称其对诊断内源性抑郁症具有极高的诊断特异性，但并未得到证实：异常反应似乎反映了一种生物学功能障碍，这种障碍跨越了临床既定的精神疾病分类界限。这种缺乏诊断效用并不降低其预后价值，DST异常反应可能表明或反映了精神障碍中的一个多方面因素，因此可用于预测或监测身心干预的效果。探讨了导致DST异常反应的因素：对压力、营养和年龄等因素进行了综述和讨论。引入了生物遗传学（神经体液）和心理学（心理动力学和社会心理）易感性及引发/促进的概念，并提出了一个综合假设：情绪紧张引发神经体液和神经内分泌变化；这些变化导致植物神经功能紊乱，包括食欲不振和体重减轻，随后出现营养缺乏，进而促进/逆转其神经体液和神经内分泌变化。强调了5-羟色胺的作用。提供了支持该假设各方面的证据，包括动物研究以及对DST异常反应的临床和生物学相关性的研究。
