情绪障碍患者的地塞米松抑制试验

The dexamethasone suppression test in patients with mood disorders.

作者信息

Rush A J, Giles D E, Schlesser M A, Orsulak P J, Parker C R, Weissenburger J E, Crowley G T, Khatami M, Vasavada N

机构信息

Mental Health Clinical Research Center, University of Texas, Southwestern Medical Center at Dallas, USA.

出版信息

J Clin Psychiatry. 1996 Oct;57(10):470-84. doi: 10.4088/jcp.v57n1006.

DOI:10.4088/jcp.v57n1006

PMID:8909334

Abstract

BACKGROUND

This study was undertaken to (1) determine whether the endogenous/nonendogenous mood disorder dichotomy is validated by the dexamethasone suppression test (DST); (2) determine whether other subtyping schemes (unipolar/bipolar, DSM-III melancholic/nonmelancholic, Winokur's family history subtypes) relate to the DST; (3) evaluate the relative contributions of symptom severity, weight loss, and other factors to DST status; and (4) assess the relative sensitivity of various post-dexamethasone cortisol determinations in the detection of dexamethasone nonsuppression.

METHOD

487 consecutive adult inpatients (N = 131) and outpatients (N = 356) with unipolar (N = 422) or bipolar disorder (N = 65) underwent the 1.0-mg DST. Nonsuppression was defined as at least one post-dexamethasone cortisol measurement > 4.0 micrograms/dL.

RESULTS

Nonsuppression occurred in 27% of all patients with major depression and 43% of all bipolar depressed phase patients. For outpatients, dexamethasone nonsuppression occurred in 35.2% of subjects with endogenous (unipolar + bipolar; N = 145) and 9.0% of those with nonendogenous (unipolar only; N = 211) depressions (single 4 p.m. post-dexamethasone cortisol). For inpatients, dexamethasone nonsuppression was found in 61.5% of subjects with endogenous (N = 104) and 18.5% of those with nonendogenous (N = 27) depressions (three post-dexamethasone cortisol determinations). For the inpatient and outpatient sample together, the DST had a sensitivity of 46.2% and a specificity of 89.9% in differentiating endogenous from nonendogenous major depressive episodes. Weight loss, gender, and symptom severity added little to the endogenous/nonendogenous dichotomy. The Research Diagnostic Criteria (RDC) primary/secondary and Winokur and colleagues' family history subtypes for unipolar depression were not strongly validated by the DST. The 4 p.m. and 11 p.m. samples together detected 91.0% of those inpatients with abnormal three-sample DST results. The 8 a.m. sample alone detected 30% of those, the 4 p.m. sample alone detected 67%, and the 11 p.m. sample alone detected 62%.

CONCLUSION

The RDC endogenous/nonendogenous dichotomy was validated by the DST.

摘要

背景

本研究旨在（1）确定地塞米松抑制试验（DST）是否能验证内源性/非内源性心境障碍二分法；（2）确定其他分型方案（单相/双相、DSM-III 忧郁症/非忧郁症、维诺克家族史亚型）是否与 DST 相关；（3）评估症状严重程度、体重减轻及其他因素对 DST 结果的相对影响；（4）评估地塞米松给药后不同时间点皮质醇测定在检测地塞米松不抑制情况时的相对敏感性。

方法

487 例连续的成年住院患者（n = 131）和门诊患者（n = 356），患有单相障碍（n = 422）或双相障碍（n = 65），接受了 1.0 毫克的 DST。不抑制定义为至少一次地塞米松给药后的皮质醇测量值>4.0 微克/分升。

结果

所有重度抑郁症患者中有 27%出现不抑制，所有双相抑郁发作期患者中有 43%出现不抑制。对于门诊患者，内源性抑郁症（单相+双相；n = 145）患者中 35.2%出现地塞米松不抑制，非内源性抑郁症（仅单相；n = 211）患者中 9.0%出现地塞米松不抑制（地塞米松给药后下午 4 点单次皮质醇测量）。对于住院患者，内源性抑郁症（n = 104）患者中 61.5%出现地塞米松不抑制，非内源性抑郁症（n = 27）患者中 18.5%出现地塞米松不抑制（地塞米松给药后三次皮质醇测定）。对于住院患者和门诊患者样本合计，DST 在区分内源性与非内源性重度抑郁发作时敏感性为 46.2%，特异性为 89.9%。体重减轻、性别和症状严重程度对内外源性二分法影响不大。研究诊断标准（RDC）的单相抑郁症原发性/继发性以及维诺克及其同事的家族史亚型未得到 DST 的有力验证。下午 4 点和晚上 11 点的样本一起检测出了 91.0%的住院患者，这些患者的三次样本 DST 结果异常。仅上午 8 点的样本检测出其中的 30%，仅下午 4 点的样本检测出 67%，仅晚上 11 点的样本检测出 62%。