Use of the dexamethasone suppression test with DSM-III criteria in psychiatrically hospitalized adolescents

Abstract

Although developmental factors may complicate the assessment of major affective disorder in the adolescent patient, studies suggest that the same descriptive criteria used in the assessment of the adult patient can be utilized to diagnose major depression in the adolescent patient. In order to determine if the dexamethasone suppression test (DST) has a similar sensitivity and specificity for DSM-III major depression in adolescents compared to that found in adult patients, we administered the DST to 55 adolescents admitted to an inpatient psychiatric unit. Each of the adolescents exhibited depressive symptoms; 23 fulfilled DSM-III criteria for major depressive syndromes (20 major depression; 3 schizoaffective), and 32 fulfilled the criteria for other DSM-III diagnoses. Of the 23 patients with major affective disorder, 10 (43%) exhibited nonsuppression of serum cortisol after dexamethasone. Of the 32 patients with depressive symptoms and other diagnoses, five (16%) exhibited nonsuppression; on follow up, three of the five nonsuppressors fulfilled criteria for major depression. These findings suggest that DSM-III criteria can be used to diagnose major depression in the adolescent patient and that the DST may play an important role in detecting or confirming the diagnosis of major depressive disorders in adolescent patients.