Dexamethasone suppression tests in patients with obsessive-compulsive disorder

Obsessive-compulsive disorder and major depressive disorder are associated by several lines of evidence. To explore the possible relationship between the two disorders, the authors administered 1-mg dexamethasone suppression tests to 18 patients with obsessive-compulsive disorder and 51 patients with major depressive disorder. None of the obsessive-compulsive patients were classified as nonsuppressors on the basis of a 4:00 p.m. serum cortisol level, whereas 37% of the depressed patients were nonsuppressors. The mean cortisol levels of the two groups differed significantly. Factors that may influence hypothalamic-pituitary-adrenal function, such as age, depressive symptoms, and severity of illness, are discussed in light of these results.     

Dexamethasone suppression test and primary obsessional compulsive disorder

This report explores the role played by DSM-III Major Depression in the Nonsuppressor status of a sample of 29 subjects suffering from DSM-III Obsessive Compulsive Disorder (OCD). Five subjects were found to be Nonsuppressors. Further analysis showed that it is likely that Nonsuppressor status depended upon the concomitant presence of Major Depression rather than upon the OCD itself.     

EEG-vigilance differences between patients with borderline personality disorder,patients with obsessive-compulsive disorder and healthy controls

The regulation of brain activation, as assessed with the EEG, is a state modulated trait. A decline to lowered EEG-vigilance states has been found to be associated with emotional instability in older studies, but has not been systematically studied in patients with borderline personality disorder (BPD). Twenty unmedicated BPD patients were compared to 20 unmedicated patients with obsessive-compulsive disorder (OCD) as well as 20 healthy controls concerning their EEG-vigilance regulation over a 5-min period assessed with an algorithm classifying every artefact-free 2-s EEG segment into the EEG-vigilance state (A1–A3, B (=non-A)). If the alpha power was posterior more than 55% of the whole alpha power (anterior + posterior) in the artefact-free EEG-segments, that segment was marked as A1, if it was anterior more than 55% of the whole alpha power, as A3. For A2 the following rule was defined: Posterior or anterior alpha between 50 and 55% of the whole alpha power. BPD patients showed significantly lower rates of EEG-vigilance state A compared to OCD patients, indicating a lowered EEG-vigilance. All three groups showed a decrease in the rate of EEG-vigilance state A over the 5 min recording period in line with a lowering of vigilance. The study provides evidence for a less stable regulation of EEG-vigilance in BPD compared to OCD patients and is in line with concepts postulating that the behavioural pattern with sensation seeking and impulsivity in BPD has a compensatory and autoregulatory function to stabilize activation of the CNS.     

Dexamethasone suppression test in hospitalized depressed patients with borderline personality disorder

There is considerable disagreement about the relationship between borderline personality disorder and the affective disorders. The authors report the results of a study of the relationship between dexamethasone suppression and depressive subtype in hospitalized depressed borderline patients. Twenty-three patients met research criteria for unipolar major depressive episode without psychosis of at least moderate severity. Thirteen patients also met criteria for borderline personality disorder. Dexamethasone suppression test (DST) results showed no significant correlation with either melancholia or borderline personality disorder alone. However, of the 13 borderlines, eight failed to suppress and six of those eight were not melancholic. The authors conclude that abnormal response to dexamethasone in nonmelancholic borderlines casts some doubt on the specificity of the DST for melancholia.     

Serotonergic responsivity in obsessive-compulsive disorder. Comparison of patients and healthy controls

To examine the "serotonin hypothesis" of obsessive-compulsive disorder (OCD), we studied the behavioral and neuroendocrine effects of metachlorophenylpiperazine (mCPP), a serotonergic agonist, in patients with OCD and healthy controls. Twelve patients and 20 controls were given a single dose of 0.5 mg/kg of mCPP, administered orally under double-blind, placebo-controlled, random-assignment conditions. Following mCPP, but not following placebo, patients with OCD experienced a transient but marked exacerbation of obsessive-compulsive symptoms. Moreover, compared with healthy controls, patients exhibited greater other behavioral (but not endocrinologic or thermal) changes after mCPP. These findings are consistent with a special role for the neurotransmitter serotonin in OCD psychopathology.     

Dexamethasone suppression tests in patients with panic disorder

Dexamethasone suppression tests were given to 10 patients with panic disorder and 22 depressed patients. All patients with panic disorder were normal suppressors, and nine depressed patients were nonsuppressors. The mean cortisol levels of the two groups differed significantly.     

Theory of mind in obsessive-compulsive disorder: Comparison with healthy controls

AimTheory of mind (ToM) is the ability to represent one's own or another's mental states and has been found to be impaired in many psychiatric disorders. Our objective was to compare ToM abilities of patients with obsessive-compulsive disorder (OCD) with healthy controls and to investigate the relation between some illness features, other cognitive functions and ToM abilities of patients.MethodThirty OCD patients and age, sex and education matched 30 healthy controls were compared according to their performances on ToM tasks (including first and second order false belief, hinting task and double-bluff task), verbal memory processes test, Weschler memory test (WMT) (logical memory, visual reproduction and digit span sub-tests), stroop test.ResultsPatients’ performances were worse than healthy controls on all of the ToM tasks, but the results were significant for only for double-bluff task (t = ?3.992, df = 36.157, p < 0.01). Performance on double-bluff task was significantly and positively correlated with visual reproduction-immediate recall (r = ?0.411, p < 0.05) and visual reproduction-delayed recall (r = 0.478, p < 0.05), hinting task was significantly and positively correlated with verbal memory (r = 0.481, p < 0.05).ConclusionThese results show “basic” ToM abilities of OCD patients are generally preserved, but they show significant reduction in their “advanced” ToM abilities, which seem to be related to their reduced memory capacities. The possible reasons for the relation between memory and ToM impairments, as well as the clinical significance of ToM deficits in OCD are discussed.     

强迫症患者血小板5-羟色胺、血浆催乳素及地塞米松抑制试验的研究

目的　从神经递质与神经内分泌角度探讨强迫症的生化病理机制。方法　采用高效液相色谱法及放射免疫测定法 ,分别测定 2 9例强迫症患者和 2 8名正常对照者血小板 5 羟色胺 (5 HT)含量及血浆催乳素 (PRL)含量 ,并进行地塞米松抑制试验 (DST)。结果　强迫症组血小板 5 HT水平[(0 8± 1 0 )nmol/10 9个血小板 ]低于正常对照组 [(1 4± 1 2 )nmol/10 9个血小板 ],差异有显著性 (P <0 0 5 ) ;而血浆PRL水平 [(337± 192 )nmol/L]与对照组 [(2 87± 116 )nmol/L]相比 ,差异无显著性 (P >0 0 5 ) ;强迫症组于晨 8时的血浆基础皮质醇含量 [(375± 15 2 )nmol/L]高于正常对照组 [(2 6 2± 138)nmol/L],差异有非常显著性 (P <0 0 1) ,其DST阳性率为 2 4 %～ 17% ,与正常对照组 (14 %～ 11% )相比 ,差异无显著性 (P >0 0 5 )。结论　强迫症患者存在 5 HT能低下和神经内分泌功能的紊乱 ,强迫症的 5 HT能假说能解释其某些内分泌功能紊乱。     

Dexamethasone suppression test in children with major depressive disorder.

The authors report a study of 24-hour serial cortisol determinations, measured during baseline and after the administration of 0.25 and 0.5 mg of dexamethasone in a sample of predominantly outpatient children with major depressive disorder, nonaffective psychiatric controls, and normal controls. In this sample, 24-hour baseline cortisol and the dexamethasone suppression test (DST) do not discriminate between the three groups. In addition, the authors measured 24-hour serum dexamethasone levels. There were no significant between group differences in serum dexamethasone. These results raise questions as to the utility of this test in the diagnosis of affective disorders in children. Possible reasons for the discrepancies in the dexamethasone suppression test results between in- and outpatient studies are discussed.     

Dexamethasone suppression test, schizophrenia and movement disorder

The dexamethasone suppression test (DST) was administered to 20 patients with schizophrenic illness. Ten of these patients also had tardive dyskinesia (TD). The scores on TD and parkinsonism scales were significantly higher in DST nonsuppressors. There was also a significant positive correlation between the post-dexamethasone cortisol level and the movement disorder scales.     

Neopterin levels and dexamethasone suppression test in obsessive-compulsive disorder

Neopterin, a biopterin precursor that is released by macrophages, is an important immunological marker in psychiatric disorders. It has been reported that glucocorticoids may cause suppression of cell-mediated immunity and consequently result in decreased neopterin levels. In the present study, we evaluated whether dexamethasone suppression test (DST) and neopterin findings were associated with pure obsessive-compulsive disorder (OCD) patients (OCD-D group) and the concomitant OCD and depression (OCD+D group). The sample comprised 44 patients with OCD (27 with OCD-D and 17 with OCD+D) and 30 control subjects. There was significantly higher DST nonsuppression in the OCD+D group than in the OCD-D group. With regard to mean neopterin levels, there was no significant difference between the OCD-D group and the control group, but there was a statistically significant difference between the OCD+D group and the control group. The OCD+D group had significantly lower neopterin levels than the 20 OCD-D group. We suggest that this distinction may reflect the fact that glucocorticoids can lead to suppression of cell-mediated immunity and consequently can result in decreased neopterin levels. In conclusion, our results suggest that not the OCD-D group had normal neopterin levels and DST results, and also that OCD may be a heterogeneous subtype characterized by some biological indicators or anxiety and affective disorders.     

Dexamethasone suppression test in patients with Parkinson's disease

The Dexamethasone Suppression Test (DST), supposed to effectively distinguish between endogenous and nonendogenous depression, was performed in a group of 34 patients with Parkinson's disease. Abnormal DST results were observed in 50% of the patients. The patients were clinically divided into subgroups of depressed and nondepressed parkinsonians. Abnormal DST results were significantly more frequent in depressed (75%) than in nondepressed parkinsonians (27.7%).     

The dexamethasone suppression test in healthy controls

We have summarized the results of 53 studies which examined the dexamethasone suppression test in normal controls. Only 3.6% of 687 0800 hr postdexamethasone cortisol levels were above 5 micrograms/dl. Corresponding figures for 1600 hr and 2300 hr cortisol levels were 7.4% (85/1144) and 6.3% (28/434), respectively. Neither the type of assay (competitive protein binding or radioimmunoassay) nor mean/median age of the subjects was associated with non-suppression rates.     

Abnormal P600 in obsessive-compulsive disorder. A comparison with healthy controls

Recently, the P600 component of the event-related potential (ERP), a waveform that is thought to be generated and/or modulated by the anterior cingulate gyrus and basal ganglia has been considered as an index of second pass-parsing processes of information processing, having much in common with working memory (WM) operation. Moreover, dysfunction of these brain structures as well as WM deficits have been implicated in the pathophysiology of obsessive-compulsive disorder (OCD). The present study is focused on P600 elicited during a WM test in OCD patients compared with healthy controls. Twenty drug-free OCD patients and an equal number of normal subjects matched for age, sex and educational level were studied via a computerized version of the Wechsler digit span test. Auditory P600 was measured during the anticipatory period of this test. The patient group, as compared with healthy controls, showed significantly enhanced amplitudes of P600 at the right temporoparietal area and prolonged latencies at the right parietal region. Moreover, the memory performance of patients was significantly impaired. These findings may indicate that OCD patients manifest abnormal aspects of second pass-parsing processes of information processing as they are reflected by P600 amplitudes and latencies.     

Abnormal dexamethasone suppression test in primary obsessive-compulsive patients: A confirmatory report

The dexamethasone suppression test (DST) was administered after baseline cortisol measurements in 20 patients (10 males, 10 females) who met DSM-III criteria for obsessive-compulsive disorder (OCD). Six patients (30%) showed an abnormal escape from dexamethasone suppression. DST suppressors vs. DST nonsuppressors showed no differences in age, rate of secondary depressive disorders, or scores on the Hamilton Rating Scale for Depression, the Minnesota Multiphasic Personality Inventory D scale, or OCD rating scales. Surprisingly, there was a trend for suppressors to have a stringer family history of depressive disorders, and for nonsuppressors to include an excess of male subjects. Moreover, there was a significant correlation between levels of cortisol before and after DST. In five of six nonsuppressors, both depressive symptoms and obsessive- compulsive behaviors showed a diminution in response to antidepressant therapy combined, in one case, with intensive behavior therapy. The relationships between OCD and endogenous depression, as well as the specificity of the DST, are discussed.     

Dexamethasone suppression test in depressive stroke patients

Depressive psychiatric patients often shown non-suppression to the dexamethasone suppression test (DST). Stroke patients shows a high frequency of depression. In the present study the DST was studied in 76 stroke patients and 26 controls. No difference was found in frequency of non-suppression to the DST between depressive and non-depressive stroke patients. It was found that postdexamethasone plasma cortisol level at 08 a.m. was significantly higher in patient with the lesion in the right hemisphere compared to patients with the lesion in the left hemisphere.     

Dexamethasone suppression test and mood response to methylphenidate in primary depression

Thirty-four patients who met Research Diagnostic Criteria for the diagnosis of major depressive disorder, primary subtype, were given the dexamethasone suppression test (DST) and a methylphenidate challenge. The two tests divided the patients along the following lines: One group did not suppress cortisol and failed to respond to methylphenidate, while the other group did suppress cortisol and had a positive mood response to methylphenidate. In an open clinical trial, the former group responded preferentially to amitriptyline and the latter group responded preferentially to imipramine.