The dexamethasone suppression test in child and adolescent psychiatry

: The dexamethasone suppression test was performed on 67 children and adolescents who were hospitalized in the child psychopathology unit of Herold Hospital (Paris). We used the DSM-III diagnostic criteria. After 10 preliminary trials using 2 mg/1.73 m2 of dexamethasone, 63 trials were conducted with a dosage of 1 mg/1.73 m2. In 19 cases of anorexia nervosa, non-suppression was associated with the weight reduction, with no other significance attached to the results. In 30 pubertal cases, 11 out of the 20 depressed patients escaped from dexamethasone suppression while none of the 10 non-depressed patients did. Those 5 adolescents who were categorized as depressed with psychotic features all escaped suppression. Criteria of specificity and more specifically the role of weight loss, are discussed. In 8 prepubertal patients (under Thirteen) the 4 depressed cases showed no escape response but this response was noted in 2 out of the 4 other children. These results suggest the presence of neuroendocrinological alterations in depressed pubertal children similar to those observed in some depressed adults. We could not find similar alterations in our small sample of non pubertal children.