Pituitary-adrenal disinhibition as the independent variable in the assessment of behavioral symptoms.

The dexamethasone suppression test (DST) has proven to be of clinical utility in the diagnosticc assessment of patients with primary endogenous depressive illness. Studies comparing individuals who show suppression of plasma cortisol after dexamethasone with those showing nonsuppression have thus far been unable to elicit clinical variables that might differentiate the two groups. Some investigators have suggested as an alternative strategy the usage of the biological variable of interest as the independent rather than the dependent variable. In this study we compared the objective and subjective characteristics of 118 psychiatric inpatients who underwent the DST and were divided on the basis of their response into suppressor and nonsuppressor categories. In the first analysis the diagnostic classification of the patient was not considered. In a secondary analysis the clinical characteristics of only those patients with primary endogenous depression are examined. The data show that independent of diagnosis nonsuppressors are noted to have a greater incidence of subjective complaints. These differences between groups are no longer evident on discharge illustrating a significantly better prognosis for the nonsuppression group.