The effect of dexamethasone dosage upon plasma cortisol and dexamethasone during the DST

To investigate the effect of dexamethasone dosage upon the outcome of the dexamethasone suppression test (DST) and the role of concurrent plasma dexamethasone concentrations, four different dexamethasone dosages were administered to 119 hospitalized depressed patients (0.5 mg: n = 12; 1.0 mg: n = 30; 1.5 mg: n = 42; 2.0 mg: n = 35). Independent of the dosage, dexamethasone plasma concentrations at 4.00 p.m. were lower in DST non-suppressors than in suppressors, although differences were statistically significant only for the 1.5-mg and 2.0-mg dosages. Our findings confirm recent reports that the actual plasma concentration of dexamethasone at 4.00 p.m. does not determine DST outcome.     

The relationship between age and post-dexamethasone cortisol: A test of three hypotheses

Previous studies report that DST nonsuppressors are older than normal suppressors. Data are presented on 188 primary unipolar major depressive inpatients and 35 healthy controls. In males, age appeared to correlate positively with post-dexamethasone cortisols in depressed patients and normal controls, although mean levels were higher in depressives. Female controls showed no consistent relationship between age and post-dexamethasone cortisol. A positive relationship did exist for depressed women. However, the association disappeared when age-of-onset was entered into the model, suggesting that in females early onset may identify a subtype of depression with normal DST suppression.     

Relationship between salivary cortisol and depression in adolescent survivors of a major natural disaster

The purpose of this study was to determine the utility of salivary cortisol levels for screening mental states such as depression in adolescents following a natural disaster. We examined the relationship of salivary cortisol levels in adolescent survivors of the 2011 Tohoku Earthquake with the depression subscale of the 28-item General Health Questionnaire (GHQ). Subjects were 63 adolescent survivors (age = 14.29 years ± 0.51) who were administered the GHQ and provided saliva samples thrice daily (morning, afternoon and evening) over the course of 3 days. Based on the GHQ-depression subscores, subjects were divided into low and high depression groups. About 22 % of the subjects were classified into the high symptom group. When data collected over 3 days were used, a significant difference was observed between the two groups in the salivary cortisol levels at the evening time point as well the ratio of the morning/evening levels (p < 0.05). Analyzed by means of receiver-operating characteristic curves, the morning/evening ratios showed a good power in discriminating between subjects with and without depressive symptoms. Our study suggests that repeated measurement of salivary cortisol levels over 3 days has utility in screening for depressive states in adolescents following a natural disaster.     

Treatment of adolescents with major depression: implications of the DST and the melancholic clinical subtype

Of 38 adolescents hospitalized with major depression, 47% of those receiving psychosocial treatment alone responded. Of the non-responders then treated with combined tricyclic antidepressants and psychosocial treatment, 92% responded. The melancholic subtype and dexamethasone suppression test non-suppression were associated with failure to respond to psychosocial treatment alone. Implications for controlled studies are discussed.     

A relationship between prolactin levels and dexamethasone suppression test results in major depressive disorder

Fifteen patients with a major depressive disorder and 20 control subjects have completed a 1 mg Dexamethasone Suppression Test (DST) and on a separate day have had their prolactin and cortisol levels measured at 16.00 h. Among the depressed patients there was a significant positive correlation between the DST cortisol and the prolactin level, with abnormally elevated prolactin levels occurring in those depressed patients with very high DST cortisol (greater than 400 nmol/l) levels.     

Social influences on circulating levels of cortisol and prolactin in male talapoin monkeys

Three captive groups of adult talapoin monkeys (Miopithecus talapoin), each with four males and four or five ovariectomized, estrogen-treated females, were observed. Behavioral interactions were recorded and levels of cortisol and prolactin were measured. In each group, males formed a linear dominance order, determined by the direction of spontaneous aggression; highest male rank was associated with frequent socio-sexual interactions and lowest rank with infrequent socio-sexual behavior. The first study compared males' cortisol and prolactin titers when all males were either housed with estrogen-treated females, or singly caged. The two lowest-ranking males of each group had elevated cortisol levels when group-housed; prolactin levels did not reflect these changes. In the second study, males of one group interacted with females when only the lowest-ranking, or the highest-ranking, female was made attractive (i.e., received estradiol), while the other females were present, but not estradiol-treated. Across these conditions (1) frequencies of some socio-sexual and aggressive behaviors changed, (2) cortisol levels increased in all males, and (3) prolactin levels decreased in three of four males. Dissociation of changes in cortisol and prolactin titers suggests that these hormones may be differentially responsive to social modifications, not simply reflecting a single intervening variable, such as "stress."     

Effects of caloric restriction and exercise on B-endorphin, ACTH and cortisol circulating levels in obesity

B-Endorphin (B-Ep), ACTH and cortisol circulating levels, before and after a two months therapy with a hypocaloric diet and an increase in physical exercise, were measured by RIA in 17 obese female subjects. After therapy, the body weight excess fell from 56.6 +/- 22.2% to 38.6 +/- 22.1% (p less than 0.01). Plasma levels of B-Ep decreased from 18.3 +/- 12.5 fmol/ml to 6.4 +/- 3.5 fmol/ml (p less than 0.01); those of ACTH from 46.8 +/- 22.8 pg/ml to 31.2 +/- 11.6 pg/ml (p less than 0.01); and those of cortisol from 15.9 +/- 4.6 micrograms% to 10.3 +/- 2.5 micrograms% (p less than 0.01). The reduction of the elevated plasma B-Ep levels found in obese subjects is related principally to the diet therapy. Thus, as shown in experimental animals, excessive feeding results in an increased hypothalamic-pituitary secretion of B-Ep.     

The overlap between depression and anxiety on different levels of psychopathology

Symptoms, syndromes, and diagnoses (DSM-III-R) for depression and anxiety were assessed and evaluated in 150 psychiatric outpatients. It was hypothesized that the coexistence of depression and anxiety within subjects strongly depends on the psychopathological level determined. The results confirmed this assumption. Overlap proportions for symptoms were almost twice as high as for diagnoses (52% vs. 29%). Intermediary rates were obtained for syndromes. Implications of these results for research on anxious depression, often considered to be qualitatively distinct from pure depression or anxiety disorders, are discussed.     

Study of the diagnostic value of the dexamethasone suppression test in endogenous depression

The diagnostic value of the dexamethasone suppression test (DST) in "endogenous" depression was evaluated in 209 psychiatric inpatients. A high incidence of abnormal DST results was observed in "endogenous" depressives (52%), schizo-affective (69%) and borderline patients (38%). However, 25% of the patients with other psychiatric disease also failed to suppress on the DST. Diagnostic criteria, previous history of alcoholism, psychiatric drug treatment, age and sex did not significantly affect DST performance. The present data do not indicate that the DST represents a highly specific marker of "endogenous" depression.     

Interaction of 5-HTTLPR genotype and unipolar major depression in the emergence of aggressive/hostile traits

Objective

The 5-HTTLPR polymorphism has been associated both with depression and aggression/hostility. The multidirectional association between depression, aggression and the s allele may be important, since all these phenomena are related to suicidal behavior. Our aim was to investigate the association between 5-HTTLPR and aggressive/hostile traits in depressed patients and controls.

Methods

137 depressive and 118 control women completed the Buss-Durkee Hostility Inventory and were genotyped for 5-HTTLPR. BDHI scores in the different groups were investigated by Generalized Linear Model Analysis. Association between dependent and independent variables in the model was tested by the likelihood ratio Chi-square statistic.

Results

Diagnosis and genotype showed a significant association with several aggressive/hostile traits. Interaction of the two main effects was also significant in case of several subscales. Post hoc analyses indicated a significant association between BDHI subscales and s allele only in the depressed group.

Limitation

Only women were studied and since gender differences are present both in aggressive behavior and putatively in the behavioral effects of 5-HTTLPR genotype, our findings pertain only to females.

Conclusion

Our results indicate a robust relationship between aggression/hostility and 5-HTTLPR genotype, but this association is more marked in the presence of depression. The presence of the s allele thus not only contributes to a higher risk of depression, but in depressives also leads to higher aggression/hostility. Our results have important implications for suicide research, since the s allele is associated with violent suicide, and this association may be mediated through the emergence of increased aggression/hostility in depressed patients carrying the s allele.     

The unipolar-bipolar depressive dichotomy and the relationship between afternoon prolactin and cortisol levels

Afternoon prolactin and cortisol levels were measured in 29 patients suffering from a current major depressive episode. Among the 15 unipolar depressed patients the afternoon prolactin and cortisol levels were positively correlated, but 14 bipolar depressed patients did not show a similar relationship, and had prolactin levels lower than the unipolar patients. This finding adds to the growing list of ways in which the neurobiology of bipolar and unipolar depression may differ.     

Emotional bias and waking salivary cortisol in relatives of patients with major depression

BACKGROUND: Biases in the processing of emotional information have been shown to be abnormal in subjects with major depression, both during an episode and after full recovery. However, it is unclear whether these biases are a cause or an effect of the depression. This study set out to explore whether such biases represent a vulnerability factor for depression by looking at unaffected first-degree relatives of those with major depressive disorder. We also measured waking salivary cortisol, as the regulation of the hypothalamo-pituitary-adrenal (HPA) axis is thought to be impaired in depressive disorder. METHOD: Twenty-five female relatives and 21 age-matched controls completed a facial expression recognition task, an emotional categorization task with positive and negative personality characteristics, and had their waking salivary cortisol measured on a work day and a non-work day. RESULTS: The depressed relative group was significantly faster to recognize facial expressions of fear than controls. The depressed relative group also showed significantly increased reaction time to recognize positive versus negative personality characteristics in the categorization task. There was no difference in waking salivary cortisol between groups, although there was an effect of work day versus non-work day. CONCLUSIONS: Subtle biases in the processing of emotional information may exist in the unaffected first-degree relatives of those with depression. As such, this may represent a familial vulnerability factor to developing a depressive illness.     

The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges

BACKGROUND: Specific serum IgE is considered as one of the important diagnostic measures in the diagnostic work-up of food allergy. OBJECTIVE: To evaluate the role of specific serum IgE in predicting the outcome of oral food challenges, and to determine threshold concentrations of specific serum IgE that could render double-blind, placebo-controlled food challenges unnecessary. METHODS: In 501 children (median age 13 months), 992 controlled oral challenges were performed with cow's milk (CM), hen's egg (HE), wheat and soy. 440/501 (88%) children suffered from atopic dermatitis. For all children, specific IgE concentrations in serum were determined. Sensitivity, specificity, positive and negative predictive values, receiver operator characteristics-curves as well as predictive decision points were calculated. RESULTS: Four hundred and forty-five out of 992 oral food challenges with allergens were assessed as positive. Sensitivity of specific serum IgE was 97% for HE, 83% for CM, 69% for soy, and 79% for wheat. Specificity was 51% for HE, 53% for CM, 50% for soy, and 38% for wheat. Calculating 90%, 95% and 99% predicted probabilities using logistic regression revealed predictive decision points of 6.3, 12.6, and 59.2 kU/L for HE, respectively. Subdividing our children in those of below or above 1 year of age resulted in a markedly different predicted probability for HE. For CM, only the 90% predicted probability (88.8 kU/L) could be calculated. No decision points could be determined for CM, wheat and soy. CONCLUSION: In general, specific serum IgE levels showed a correlation with the outcome of positive oral food challenges for CM and HE. Meaningful predictive decision points can be calculated for HE, which may help to avoid oral food challenges in some cases. However, data need to be ascertained for each allergen separately. Furthermore, the age of the patient population under investigation must also be taken into account.     

The cortisol suppressing effect of dexamethasone and oxazepam in depressed patients; significance of spontaneous levels and interindividual distribution

In 72 hospitalized depressed patients afternoon plasma cortisol (15.00-15.20) was measured in three ways: spontaneous (n = 72), 16 h after administration of 2 mg dexamethasone (n = 71) and 2 h after administration of 45 mg oxazepam (n = 28) or 60 mg oxazepam (n = 37). When cortisol values were log-transformed the histograms and probit functions of spontaneous cortisol levels and cortisol levels after oxazepam suppression suggested log-normal distributions. However, for cortisol levels after suppression with dexamethasone the probit function was sigmoidal, suggesting non-normality. In addition the histogram for this parameter had two peaks. The most pronounced suppression with dexamethasone was obtained in patients with low spontaneous cortisol levels. In contrast the somewhat weaker cortisol suppressing effect of 45 or 60 mg oxazepam appeared not to be influenced by the spontaneous cortisol level.     

Clinical and psychosocial factors associated with the outcome of unipolar major depression: a one year prospective study

BACKGROUND: The role of psychosocial and clinical variables in the prediction of major depression is controversial. In a previous paper, we obtained a one-year predictive multivariate model of non-remission for major depression, based on the presence of a personality disorder, a low self-esteem and a low satisfaction with social support. OBJECTIVES: To evaluate more in depth both personality disorders and psychosocial variables as predictors of outcome. METHODS: A prospective study on 57 consecutive outpatients with major depressive episodes were followed-up monthly during one year. Clinical and psychosocial variables were registered, including personality (DSM-IV criteria and IPDE structured interview), previous quality of life, self-esteem, social support and dyadic adjustment. Remission was defined as a HDS score less than 8. Univariate and multivariate (logistic regression) analyses were applied. RESULTS: 68% of the patients reached remission at 12 months. Personality disorder (diagnosed clinically but not according to IPDE), and previous quality of life were the variables more consistently associated to remission at 12 months. Among follow-up variables, remission at 3 months was strongly associated with remission. CONCLUSIONS: Our findings confirm the importance of the clinical diagnosis of personality disorder in the major depression outcome. However, more studies are needed to clarify the divergence between clinical and structured interview guided diagnosis. With the exception of quality of life, psychosocial variables had a weak and non consistent relationship with outcome.     

The major histocompatibility complex influences the ethiopathogenesis of MS-like disease in primates at multiple levels

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease primarily affecting the central nervous system. Of the many candidate polymorphic major histocompatibility complex (MHC) and non-MHC genes contributing to disease susceptibility, including those encoding effector (cytokines and chemokines) or receptor molecules within the immune system (MHC, TCR, Ig or FcR), human leukocyte antigen (HLA) class II genes have the most significant influence. In this article we put forward the hypothesis that the influence of HLA genes on the risk to develop MS is actually the sum of multiple antigen presenting cell (APC) and T-cell interactions involving HLA class I and class II molecules. This article will also discuss that, because of the genetic and immunologic similarity to humans, autoimmune models of MS in non-human primates are the experimental models “par excellence” to test this hypothesis.