The dexamethasone suppression test for diagnosis and prognosis in psychiatry. Commentary and review.
The dexamethasone suppression test for diagnosis and prognosis in psychiatry. Commentary and review.
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DOI：
10.1001/archpsyc.1985.01790350067012
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发表时间：
1985-12
影响因子：
--
通讯作者：
G. Arana;R. Baldessarini;M. Ornsteen
中科院分区：
文献类型：
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作者：
G. Arana;R. Baldessarini;M. Ornsteen
改良的地塞米松抑制试验（DST）在精神病学临床应用的生物学试验中得到了前所未有的评价。尚未证明其反映中枢神经系统或垂体水平的病理生理学变化，地塞米松本身的组织利用度可能影响试验结果。DST在重性抑郁症中的敏感性有限（在5,000多例病例中约为44%），但在精神病性情感障碍和混合型躁狂抑郁状态中的敏感性较高（67%至78%）。DST与对照受试者的高特异性（超过90%）与其他精神疾病（总体特异性为77%）相比没有保持，急性“痛苦”可能导致皮质醇的非抑制。该测试可能有权力区分严重的抑郁症，躁狂症，或急性精神病从慢性精神病（87%特异性）或恶劣心境（77%特异性）。DST状态增加了约11%的短期抗抑郁药反应的预测。不能维持皮质醇的正常抑制预示不良结局的建议是不可靠的。对DST不加批判的热情或过度的怀疑是没有根据的。
A modified dexamethasone suppression test (DST) has had unprecedented evaluation among biologic tests proposed for clinical use in psychiatry. It has not proved to reflect pathophysiologic changes at the level of the central nervous system or pituitary, and tissue availability of dexamethasone itself may contribute to test outcome. The sensitivity of the DST in major depression is limited (about 44% in over 5,000 cases) but is higher in psychotic affective disorders and mixed manic-depressive states (67% to 78%). The high specificity of the DST vs control subjects (over 90%) is not maintained vs other psychiatric disorders (77% specificity overall), and acute "distress" may contribute to nonsuppression of cortisol. The test may have power in differentiating severe melancholic depression, mania, or acute psychosis from chronic psychosis (87% specificity) or dysthymia (77% specificity). The DST status adds about 11% to the prediction of short-term antidepressant response. Suggestions that failure to maintain normal suppression of cortisol predicts poor outcome are not secure. Uncritical enthusiasm or excessive skepticism regarding the DST are unwarranted.