Hypothalamic-pituitary axis response to a 0.25-MG dexamethasone test in women with fibromyalgia.

Fibromyalgia has been reported as having some clinical overlap with both depression and emotionally-unstable disorders, although both types of disorders present different cortisol suppression response to dexamethasone. In this study we investigated the hypothalamic-pituitary-adrenal system (HPA) in the fibromyalgic syndrome (FMS) using a dexamethasone suppression test (DST) of 0.25 mg designed to specifically detect cortisol hypersuppression. We studied 59 women (20 patients and 39 healthy controls) to whom the DST was administered together with a battery of psychometric tests. In our results, patients with FMS had significant lower levels of basal cortisol pre- and post-DST compared with control subjects. However, cortisol suppression rate in patients after DST was not significantly different than in controls. As other syndromes like post-traumatic stress disorder or emotionally unstable personality disorders, also related with high incidence of severe trauma, FMS patients presented significant low basal cortisol. However, they did not have cortisol hypersuppression as is commonly found in the mentioned disorders. The relation of FMS with lifetime traumas and with emotional instability should be further investigated in order to improve psychological treatment approaches for these patients.LAY SUMMARYPatients with fibromyalgic syndrome have basal hypocortisoism but no cortisol hypersuppression after dexamethasone infusion compared to control subjects, as other trauma-related syndromes.

[Contributions of cortisol suppression tests to understanding of psychiatric disorders: a narrative review of literature]. / Aportaciones de los tests de supresión de cortisol al conocimiento de los trastornos psiquiátricos: revisión narrativa de la literatura.

Activity of the hypothalamic-pituitary-adrenal axis had been studied for the past half century, when some researchers noted that some patients with Cushing's syndrome and severe mood disorders had high baseline cortisol levels, which resulted in an inhibited response in the 1mg dexamethasone suppression test. Altered dexamethasone suppression test results were subsequently found in many psychiatric diseases, including anorexia nervosa, obsessive-compulsive disorder, degenerative dementia, bipolar disorders, and schizophrenia. The relationship between high baseline cortisol levels and stress has also been studied. Some researches on the genesis of borderline personality disorder focused on traumatic childhood backgrounds. Other investigations aimed at elucidating the relationship between traumatic backgrounds and some psychiatric disorders noted that patients with post-traumatic stress disorder and borderline personality disorder showed an enhanced cortisol suppression with low cortisol doses (0.5 mg). Recent studies showed that use of an ultra-low dose of cortisol during the dexamethasone suppression test may be helpful for detecting disorders with hyperactivity of the hypothalamic-pituitary-adrenal axis. Recent advances in neuroimaging support the existence of hyperactivity of the hypothalamic-pituitary-adrenal axis in patients with borderline personality disorder, relating a decreased pituitary gland volume to major traumatic backgrounds and suicidal attempts. The purpose of this paper is to make a narrative review of research using dexamethasone suppression test in psychiatric disorders, in order to ascertain its value as a supplemental diagnostic test or as a prognostic marker.

Psicosis inducidas por estados excepcionales de conciencia / No disponible

No disponible

Estados excepcionales de conciencia y consumo de sustancias psicotropas / No disponible

No disponible

Brief cognitive-behavioral therapy with fibromyalgia patients in routine care.

OBJECTIVE: The purpose of the present study was to evaluate the effectiveness of a brief cognitive-behavioral therapy (CBT) group intervention for fibromyalgia syndrome in routine care. METHOD: Thirty-four female outpatients who participated in a 5- to 6-week group CBT program were assessed for depression (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory), coping strategies (Coping Questionnaire for Chronic Pain), physical functioning (Fibromyalgia Impact Questionnaire), and somatization (Health Attitude Survey) at 3 time points (baseline, pretreatment, and posttreatment) using a pre-post, quasi-experimental design. RESULTS: Twenty-three female outpatients (68% of the initial sample) for which data were available in all 3 time points were included in the analyses. No changes were found during the waiting period. During the treatment period, there were significant reductions in depression (P = .001) and anxiety (P = .006) symptoms and an increased use of distraction skills (P < .001). The analysis of rate of change showed a significant correlation between anxiety and depression (P = .004), but not between these variables and the use of distraction as a coping strategy. CONCLUSION: Brief group CBT is effective in reducing emotional distress in female patients with long-standing fibromyalgia syndrome in the context of routine care. Attention-distraction skills appear to be amenable to change by means of brief CBT, but further research is needed to clarify their contribution to short-term clinical improvement.