s209 NEUROENDOCRINE MARKERS OF AFFECTIVE DISORDER IN CHRONIC PAIN

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310 Slide J. Atkinson, E. Kremer, S. Risch, D. Janowsky, Department of

?i? 'i!" Psychiatry, UCSD School of Medicine, La Jolla, CA 92093. . . Aim of Investigation: Adrenal cortisol hypersecretion an

failure to suppress plasma cortisol after the overnight low dose dexametha- sone suppression test (DST) are relatively specific biological markers of the depressed state. Cortisol hypersecretion may also be associated with pain. This study examined plasma cortisol and prolactin response to dexa- methasone in psychiatric and chronic pain patients with and without depression.

Methods: Fifty-two chronic pain patients and 50 psychiatric patients were evaluated by psychiatric Research Diagnostic Criteria (RDC), over- night DST, and the Hamilton and Beck Depression scales. Plasma cortisol and prolactin were assessed by radioimmunoassay from samples taken at 0800, 1600 and 2300 hours pre- and post-dexamethasone. Data were analyzed by ANOVA and Fisher's test.

Results: For pain patients there was no reliable overall difference in cortisol secretory pattern between diagnostic groups. Frequency of non- suppression was reliably higher in pain patients with major depression than in those without psychiatric diagnosis (40% vs. 8%), but was common in other diagnostic groups. Psychogenic and organic pain did not differ in frequency of non-suppression. Pain patients had significantly greater mean cortisol than psychiatric subjects matched for diagnosis. By contrast, in pain patients non-suppression of cortisol was not associated with non- suppression of prolactin.

Conclusion: An abnormal DST occurs in a high percentage of pain patients with major depression, but other psychiatric disorders, especially de- mentia, may confound the test's specificity. The strategy of evaluating multiple neuroendocrine axes may help identify diagnostic subtypes of pain patients with and without affective illness.

RELATIONS BETWEEN ANXIETY, DEPRESSION ANY FAIN LE VELS IN CHRONIC PAIN PqT$ENTS. R. Masse\ ,' , Benedittis' R. No- 5 I , A.E. Panerai ' Silva3 , M.A: Villamira"' 'Institute of N&.~rosur

.;.;L)wi

gery, Pain Research & TreAtment Unit *Institute-of Psychology, Medical School, 311 Chair of Anestesiology, 4Department of Pharmacology, University of Milan, Milan, Italy

Aim of investigation: We purpose to survey the eventual car relation between anxiety and depression levels and pain inten- sity evaluations made by means of two analogic scales.

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Method: We proposed to 30 pts. (80% of them were affected with chronic headache) the following tests: 1) Anxiety Scale Questionnaire (ASQ); 2)Clinical Depression Questionnaire (CDQ); 3) Visual Analogue Scale (VAS); 4) Achromatic Scale of Greys (ASG). ASQ and CDQ, used together, are able to put the diffe rential diagnosis between anxious and depressive syndromes.-We also proposed the Sixteen Personality Factor Test (16 PF) to 12 pts. and the Illness Behaviour Questionnaire (IBQ) to other 12 pts. A comprehensive follow-up of all patients was perfor med.

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Results: A significant correlation between anxiety and de pression levels and pain intensity evaluations, made by means of VAS and ASG, comes out.

Conclusions: The results seem to confirm the hypotheses ac cording to which anxiety and depression are joined with chro nit pain and bias, in a significant way, the patients' evalug tion of pain intensity.

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