Misuse of the dexamethasone suppression test as a diagnostic tool

The diagnostic reliability and appropriateness of use of the Dexamethasone Suppression Test (DST) were assessed by a retrospective chart survey of ninety-nine psychiatric admissions to a community hospital. A change in psychiatric diagnosis between admission and discharge occurred in one-third of the patients. The diagnostic change appeared to be associated with the DST result more than the clinical findings. Such reliance on the test was not justified as the observed diagnostic confidence of the DST in supporting a diagnosis of major depression was only 38 percent. These findings suggest a misuse of the test as a diagnostic tool in routine practice.