Comment| Volume 22, ISSUE 5, P618-628, May 1987

Diagnostic utility of the dexamethasone suppression test

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      This article discusses the current controversy surrounding the diagnostic utility of the Dexamethasone Suppression Test, addresses the questions raised by the recent editorial by Ross in this journal, discusses the general principles behind the development of tests, and estimates their diagnostic utility. This discussion aims to clarify some aspects of the controversy. It presents an operational analysis of the Dexamethasone Suppression Test as utilized at a state hospital. This operational analysis shows that the test may be useful in distinguishing schizophrenia from psychotic depression, and mania from schizophrenia. Furthermore, it shows that the test is not useful as a screening test. These results are compared with those obtained by other investigators. The authors further show how test results can be used rationally by clinicians by so-called threshold analysis. Clinical data from a state hospital are used to illustrate this.
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        • Arana GW
        • Barreira PJ
        • Cohen BM
        • Lipinski JF
        • Fogelson D
        The Dexamethasone Suppression Test in psychotic disorder.
        Am J Psychiatry. 1983; 140: 1521-1523
        • Baldessarini RJ
        • Finkelstein S
        • Arana GW
        The predictive power of diagnostic tests and the effect of prevalence of illness.
        Arch Gen Psychiatry. 1983; 40: 569-573
        • Baroon S
        • Wolfe H
        Measuring the Effectiveness of Medical Decision. An Operations Research Approach.
        Charles C Thomas, Chicago1972
        • Bushyhead JB
        • Christian-Szalanki JJ
        Feedback and the illusion of validity in a medical clinic.
        Med Dec Making. 1981; 1: 115-123
        • Carroll BJ
        Clinical applications of the Dexamethasone Suppression Test for endogenous depression.
        Pharmacopsychiatria. 1982; 15: 19-25
        • Carroll BJ
        • Feinberg M
        • Greden J
        • Tarika J
        • Albala AA
        • Haskett RF
        • James NMcI
        • Kronfol Z
        • Lohn N
        • Steiner M
        • Devigne JP
        • Young E
        A specific laboratory test for the diagnosis of melancholia.
        Arch Gen Psychiatry. 1981; 38: 15-22
        • Davidson JRT
        • Upper S
        • Zung WWK
        • Krishnan KRR
        • Mahorney S
        Validation of four definitions of melancholia by the Dexamethasone Suppression Test.
        Am J Psychiatry. 1984; 141: 1220-1223
        • Dewan MJ
        • Pandurangi AK
        • Boucher ML
        Abnormal Dexamethasone Suppression Test results in chronic schizophrenic patients.
        Am J Psychiatry. 1982; 139: 2051-2503
        • Doubilet P
        A mathematical approach to interpretation and selection of diagnostic tests.
        Med Dec Making. 1983; 3: 175-195
        • Eisenberg JM
        • Hershey JC
        Derived thresholds determining the diagnostic probabilities at which clinicians initiate testing and treatment.
        Med Dec Making. 1983; 3: 155-167
        • Elstein AS
        • Shulman LS
        • Sprafka SA
        Medical Problem Solving. An Analysis of Clinical Reasoning.
        Harvard University Press, Cambridge, MA1978
        • Evans DL
        • Nemeroff CB
        The DST in mixed bipolar disorder.
        Am J Psychiatry. 1983; 140: 615-617
        • Feinstein AR
        On the Sensitivity, Specificity and Discrimination of Diagnostic Tests. Clinical Biostatics.
        C.V. Mosby, St. Louis1977
        • Graham PM
        • Booth J
        • Baranga G
        Dexamethasone Suppression Test in mania.
        J Affect Dis. 1982; 4: 202-211
        • Insel JR
        • Goodwin FK
        The Dexamethasone Suppression Test: Promises and problems of diagnostic laboratory tests in psychiatry.
        Hosp Comm Psychiatry. 1983; 34: 1131-1138
        • Jenike MA
        • Albert MS
        The Dexamethasone Suppression Test in patients with presenile and senile dementia of the Alzheimer type.
        J Am Geriatr Soc. 1984; 32: 441-444
        • Kerr TA
        • Schapiro K
        • Roth M
        The relationship between the Maudsley personality inventory and the course of affective disorders.
        Br J Psychiatry. 1970; 116: 11-20
        • Krishnan KRR
        • Pelton S
        Interictal EEG in epilepsy.
        Lancet. 1984; i: 569
        • Krishnan KRR
        • Maltbie AA
        • Davidson JRT
        Abnormal Cortisol suppression in bipolar patients with simultaneous manic and depressive symptoms.
        Am J Psychiatry. 1983; 140: 203-205
        • Pauker SG
        • Kassirer JP
        The threshold approach to clinical decision making.
        N Engl J Med. 1980; 302: 1109-1117
        • Ransahoff D
        • Feinstein AR
        Problems of spectrum and bias in evaluating the efficacy of diagnostic tests.
        N Engl J Med. 1978; 229: 926-929
        • Raskin M
        • Peskin E
        • Rivard F
        • Tournigny N
        DST and cortisol circadian rhythm in primary degenerative dementia.
        Am J Psychiatry. 1981; 139: 1468-1471
        • Ross C
        Biological tests for mental illness. Their use and misuse.
        Biol Psychiatry. 1986; 21: 431-435
        • Stokes PE
        • Store PM
        • Koslow SH
        • Maas JW
        • Davis JM
        • Susan AC
        • Robins EL
        Pretreatment DST and hypothalamopituitary adrenal function in depressed patients and control groups.
        Arch Gen Psychiatry. 1984; 41: 257-267
        • Vecchio TJ
        Predictive value of a single diagnostic test in unselected populations.
        N Engl J Med. 1966; 274: 1171-1173