The dexamethasone suppression test and suicide prediction
The dexamethasone suppression test and suicide prediction
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DOI：
10.1176/appi.ajp.158.5.748
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发表时间：
2001-05-01
影响因子：
17.7
通讯作者：
Schlesser, M
中科院分区：
文献类型：
--
作者：
Coryell, W;Schlesser, M
目的：尽管与重度抑郁症相关的最终自杀风险很大，但临床医生缺乏强有力的预测因素来量化这些风险。本研究比较了人口统计学和历史危险因素与地塞米松抑制试验（DST）的有效性，DST是下丘脑-垂体-肾上腺（HPA）轴过度活跃的临床实用措施。1978年至1981年间，78名患有研究诊断标准重度抑郁症或情感性精神障碍（抑郁型）的住院患者进入了一项长期随访研究，此外，进行l-mg DST。在15年的随访期间，在这组的自杀人数进行了测定，并在文献中报道的四个人口统计学和历史的危险因素的预测有效性是一致的预测抑郁症患者自杀的预测有效性进行了比较的DST results.Results：32的78例患者有异常的DST结果。生存分析显示，这组患者最终自杀的估计风险为26.8%，而DST结果正常的患者仅为2.9%。没有人口统计学和历史的危险因素在研究中显着区分那些后来自杀的人从那些谁没有Conclusions：在努力预测和预防自杀行为的重度抑郁症患者，HPA轴多动，反映在DST的结果，可以提供一个工具，这是相当强大的比目前使用的临床预测。重性抑郁症自杀行为的病理生理学研究应强调HPA轴及其与5-羟色胺系统的相互作用。
Objective: Despite the substantial risks of eventual suicide associated with major depressive disorder, clinicians lack robust predictors with which to quantify these risks. This study compared the validity of demographic and historical risk factors with that of the dexamethasone suppression test (DST), a clinically practical measure of hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis.Method: Seventy-eight inpatients with Research Diagnostic Criteria major depressive disorder or schizoaffective disorder, depressed type, entered a long-term follow-up study between 1978 and 1981, and, in addition, underwent a l-mg DST. The number of suicides in this group during a 15-year follow-up period was determined, and the predictive validity of four demographic and historical risk factors reported in the literature to be consistently predictive of suicide in depressed patients was compared to the predictive validity of the DST results.Results: Thirty-two of the 78 patients had abnormal DST results. Survival analyses showed that the estimated risk for eventual suicide in this group was 26.8%, compared to only 2.9% among patients who had normal DST results. None of the demographic and historical risk factors examined in the study significantly distinguished those who later committed suicide from those who did not.Conclusions: In efforts to predict and prevent suicidal behavior in patients with major depressive disorder, HPA-axis hyperactivity, as reflected in DST results, may provide a tool that is considerably more powerful than the clinical predictors currently in use. Research on the pathophysiology of suicidal behavior in major depressive disorder should emphasize the HPA axis and its interplay with the serotonin system.