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Type: Thesis
Title: The DST and psychiatry : possible effects on decision making, diagnosis and treatment
Author: Schrader, Geoffrey David
Issue Date: 1983
School/Discipline: School of Medicine : Psychiatry
Abstract: The introduction of a technique that purports to increase our understanding of a particular disorder leads inevitably to a reassessment of the existing body of knowledge about that disorder. Sometimes a re-evaluation of the methods of the discipline may occur. When one such innovation, the dexamethasone suppression test (DST), was introduced into clinical psychiatry at the Royal Adelaide Hospital, a study was conducted into its effects on diagnosis and treatment of depression. The results of this study, which are detailed in chapter Three of this dissertation, indicate that considerable changes in management (and also perhaps in thinking about clinical problems) occurred concurrently with the introduction of the DST. Specifically, the study showed increases in the diagnosis of biological depression and treatment with antidepressants. There htas no association between DST results and particular management plans. There was, however, a very strong association between requesting the DST and subsequent management with antidepressants . These results Ied to a re-evaluation of the literature of the development of the DST as a specific laboratory test for melancholia. Chapter Two follows Rubin and Mandell's hypothesis that elevated cortisol levels were a specific concomitant of depression, through nearly 20 years of research. In particular, the rapid increase in the literature on the DST in the early '80s is reviewed. The chapter ends with a discussion of Some very recent cautionary articles about the application of the DST to psychiatry. The results of the DST study led also to a re-evaluation of one of the fundamental processes of psychiatry and of all medicine, the process of clinical judgment. chapter one is concerned with decision making in psychiatry and how the process in psychiatry differs from that in general medicine. Issues of diagnosis are considered, along with the relevance of diagnosis to treatment. The notion of a psychiatrist's "set" with respect to management is commented upon, along with the notion of maximising utility with respect to diagnosis and treatment. The dissertation concludes with only conjectures to explain the results. Studies to address these conjectures could lead to a greater understanding, not only of the DST, but also to the process of clinical judgment in psychiatry.
Dissertation Note: Thesis (M. Clin. Sc.)--University of Adelaide, Dept. of Psychiatry, 1983
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