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Changes in DST status and plasma dexamethasone levels: Relations to clinical response with ECT
BtOL PSYCHIATRY 1990;27:41A- 179A
Dexamethasone Suppression Test
169A
DEXAMETHASONE SUPPRESSION TEST S a t u r d a y , M a y 12, 1 : 0 0 - 6 : 0 0 PM
Versailles Ballroom
289 NEGATIVE AND POSITIVE SYMPTOMS CORRELATE WITH POSTDEXAMETHASONE ,~c~pTren~,..,.,.,..~,,.,~IN UNMEDICATED SCHIZOPHRENICS William O. Faustman, Ph.D., Harvey A. Whiteford, M.B.B.S., F.R.A.NoZ.P., John W. Newcomer, M.D., John G. Csemansky, M.D. Stanford/Veterans Affairs Mental Health Clinical Research Center, Palo Alto CA 94304. Several works have suggested that the negative symptoms of schizophrenia are linked v'ith postdexamethasone (DEX) nonsuppression. Some of these works have employed negative symptom patients of rather advanced age (e.g., > - 60 years), a potential confound due to relations between age and nonsuppression. Accordingly, we administered 1 mg of DEX at 11:00 PM to 21 RDC-diagnosed, schizophrenic inpatients (mean age = 41.5 - 9.5 years). Serum cortisol levels were drawn at 8:00 AM and 4:00 PM the t~ext day. All pati~,nts had been psychotherapeutic medication free (except occasional chloral hydrate) for at least 14 days. Patients were rated Using the BPRS. Classical BPRS symptom clusters were formed for negative, positive, depressive, and paranoid symptoms. A significant (p < 0.05) direct correlation was found between negative symptoms and both 8.~'~3AM (rs = .47) and 4:00 PM (r~ = 0.45) poat-DEX cortisol levels. Although positive and negative symptoms were not correlated (r~ = - 0.17), there was a significant inverse correlation between positive symptoms and 8:00 AM (rs = --0.53) and 4:00 PM (rs = -- 0.46) cortisol levels. Paranoid and depressive symptoms were not related to post-DEX cortisol. The results support a correlation betw~n schizophrenic symptoms and po,st-DEX cortisol, an intriguing finding in light of recent works noting hippocampal pathology in schizophrenia and a role for the hippocampus in HPA axis functioning.
290 CHANGES IN DST STATUS AND PLASMA DEXAMETHASONE LEVELS: RELATIONS TO CLINICAL RESPONSE WITH ECT D.P. Devanand, M.D., Harold A. Sackeim, Ph.D., Thomas Cooper, M.:,~,., Ee-Sing Lo, Ph.D., Hana Novacenko, M.S., Joan Prudic, M.D., Frances Ross, R.N. New York State Psychiatric imtitute, College of PhysicMns and Surgeons of Columbia University, New York, NY 10~:32. Serial 1 mg dexamethasone supwession tests (DSTs) with cmtcurrent plasma dexamethasone assessments were conducted in 58 endogenous dep.,'essives treated with electroconvulsive therapy (ECT). Plasma control levels decreased significantly fr.-rn pretreatmem to immediately post-treatment and declined further during the first week following the ECT course, when patients remained drug free. Plasma dexamethasone levels showed an opposite pattern of progressive increases over these time points. Both plasma dexam¢thasone and postdexamethasone cortisol showed progressive changes during the week after ECT termination. Alterations in the bioavailability of dexamethasone ~ad in HPA axis function may not be complete immediately after ECT. This may partly account for previous htconsistencies in serial D~T findings with this treatme.nt modality. Clinical res.lmnse was associated with increase in plasma dexamethasone levels, whereas changes in postdexamethasone cortisol levels were inde~ndent of clinical outcome. With ECT, changes in plasma dexamethasone may be more related to changes h~ clinical state than changes in postdexanlethasone cortisol levels.
Dexamethasone Suppression Test
169A
DEXAMETHASONE SUPPRESSION TEST S a t u r d a y , M a y 12, 1 : 0 0 - 6 : 0 0 PM
Versailles Ballroom
289 NEGATIVE AND POSITIVE SYMPTOMS CORRELATE WITH POSTDEXAMETHASONE ,~c~pTren~,..,.,.,..~,,.,~IN UNMEDICATED SCHIZOPHRENICS William O. Faustman, Ph.D., Harvey A. Whiteford, M.B.B.S., F.R.A.NoZ.P., John W. Newcomer, M.D., John G. Csemansky, M.D. Stanford/Veterans Affairs Mental Health Clinical Research Center, Palo Alto CA 94304. Several works have suggested that the negative symptoms of schizophrenia are linked v'ith postdexamethasone (DEX) nonsuppression. Some of these works have employed negative symptom patients of rather advanced age (e.g., > - 60 years), a potential confound due to relations between age and nonsuppression. Accordingly, we administered 1 mg of DEX at 11:00 PM to 21 RDC-diagnosed, schizophrenic inpatients (mean age = 41.5 - 9.5 years). Serum cortisol levels were drawn at 8:00 AM and 4:00 PM the t~ext day. All pati~,nts had been psychotherapeutic medication free (except occasional chloral hydrate) for at least 14 days. Patients were rated Using the BPRS. Classical BPRS symptom clusters were formed for negative, positive, depressive, and paranoid symptoms. A significant (p < 0.05) direct correlation was found between negative symptoms and both 8.~'~3AM (rs = .47) and 4:00 PM (r~ = 0.45) poat-DEX cortisol levels. Although positive and negative symptoms were not correlated (r~ = - 0.17), there was a significant inverse correlation between positive symptoms and 8:00 AM (rs = --0.53) and 4:00 PM (rs = -- 0.46) cortisol levels. Paranoid and depressive symptoms were not related to post-DEX cortisol. The results support a correlation betw~n schizophrenic symptoms and po,st-DEX cortisol, an intriguing finding in light of recent works noting hippocampal pathology in schizophrenia and a role for the hippocampus in HPA axis functioning.
290 CHANGES IN DST STATUS AND PLASMA DEXAMETHASONE LEVELS: RELATIONS TO CLINICAL RESPONSE WITH ECT D.P. Devanand, M.D., Harold A. Sackeim, Ph.D., Thomas Cooper, M.:,~,., Ee-Sing Lo, Ph.D., Hana Novacenko, M.S., Joan Prudic, M.D., Frances Ross, R.N. New York State Psychiatric imtitute, College of PhysicMns and Surgeons of Columbia University, New York, NY 10~:32. Serial 1 mg dexamethasone supwession tests (DSTs) with cmtcurrent plasma dexamethasone assessments were conducted in 58 endogenous dep.,'essives treated with electroconvulsive therapy (ECT). Plasma control levels decreased significantly fr.-rn pretreatmem to immediately post-treatment and declined further during the first week following the ECT course, when patients remained drug free. Plasma dexamethasone levels showed an opposite pattern of progressive increases over these time points. Both plasma dexam¢thasone and postdexamethasone cortisol showed progressive changes during the week after ECT termination. Alterations in the bioavailability of dexamethasone ~ad in HPA axis function may not be complete immediately after ECT. This may partly account for previous htconsistencies in serial D~T findings with this treatme.nt modality. Clinical res.lmnse was associated with increase in plasma dexamethasone levels, whereas changes in postdexamethasone cortisol levels were inde~ndent of clinical outcome. With ECT, changes in plasma dexamethasone may be more related to changes h~ clinical state than changes in postdexanlethasone cortisol levels.