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HPA axis hyperactivity and recovery from functional psychoses.

W H Coryell¹, M Zimmerman

¹Department of Psychiatry, University of Iowa, Iowa City 52242.

The American Journal of Psychiatry

|April 1, 1989

Summary

The dexamethasone suppression test may predict psychosis recovery. High baseline cortisol levels indicate a better prognosis for patients with functional psychoses, regardless of diagnosis or illness duration.

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Area of Science:

Psychiatry
Endocrinology
Neuroscience

Background:

Functional psychoses present variable clinical courses, with limited predictors for patient outcomes.
Current prognostic factors for psychosis are mainly diagnosis and illness chronicity.
The dexamethasone suppression test (DST) shows potential as a prognostic indicator.

Purpose of the Study:

To investigate the dexamethasone suppression test as a prognostic factor in nonmanic psychoses.
To determine if baseline cortisol levels predict recovery from psychosis.
To assess the relationship between DST results, diagnosis, and episode chronicity.

Main Methods:

Administered the dexamethasone suppression test to 98 consecutively admitted patients with nonmanic psychoses.
Measured postdexamethasone cortisol levels at baseline.
Tracked patient recovery from psychosis at 1 year.

Main Results:

High baseline postdexamethasone cortisol levels (≥6 µg/dl) predicted recovery at 1 year.
This predictive value was independent of diagnosis and episode chronicity.
Diagnosis was also a significant predictor, though its correlation with test results was weak.

Conclusions:

The dexamethasone suppression test, specifically high baseline cortisol levels, offers a valuable prognostic tool for functional psychoses.
This test may help clinicians predict recovery independently of traditional factors like diagnosis and chronicity.
Further research into the DST's role in psychosis prognosis is warranted.

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