Magazine article Clinical Psychiatry News

Dexamethasone Suppression Test Can Indicate Suicide Risk

Magazine article Clinical Psychiatry News

Dexamethasone Suppression Test Can Indicate Suicide Risk

Article excerpt

MIAMI -- A dexamethasone suppression test can identify patients at increased risk of suicide, according to a follow-up study presented at the annual conference of the American Association of Suicidology.

Researchers striving to identify an endocrine basis for suicide have demonstrated that hyperarousal of the hypothalamic-pituitary-adrenal (HPA) axis, as manifested by a nonsuppressing dexamethasone suppression test (DST), can be an indirect predictor of suicide risk.

The DST fell out of favor in the late 1980s, when the National Institutes of Health and the American Psychiatric Association both determined that it lacked the sensitivity to diagnose major depression, the purpose for which it was touted throughout the earlier years of that decade, Dr. John Michael Bostwick said.

In the last few years, however, researchers have begun to resurrect the old data sets to see if DST status identifies subpopulations at risk for suicide. The technology has also advanced, and now there is an oral swab DST, so a blood draw is not required, he explained.

"A positive DST at any point back then seems to indicate an increased suicide risk down the road, which has implications for clinicians in assessing risk and implications for the role of the HPA axis in suicidal states," said Dr. Bostwick of Mayo Medical School, Rochester, Minn.

Dr. Bostwick and his colleagues compared 56 DST suppressors with 58 nonsuppressors identified in the mid-1980s. Participants received 1 mg dexamethasone at 11 p.m. on day 1, followed by three measurements of serum cortisol on day 2, according to the standard DST protocol. Nonsuppressors had 5 [mu]/dL cortisol or more at any collection time.

The researchers looked at death records an average of more than 15 years later to determine the number of suicides in each group. In the suppressor group, 45 participants were alive and 11 were dead, including one suicide. In the nonsuppressor group, 40 were alive and 18 were dead, including six suicides. The difference in the number of suicides between the two groups was statistically significant.

"We replicated Coryell's findings. We are very happy about that," Dr. Bostwick said. Dr. William Coryell and his colleagues found that 7 of 32 DST nonsuppressors committed suicide during an average follow-up of 10 years (Am. J. Psychiatry. 138[8]:1120-21, 1981.

Both nature and nurture contribute to how a person responds to stress, Dr. …

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