title: Psychopathology in patients with endogenous Cushing's syndrome: 'atypical' or melancholic features.
abstract: OBJECTIVE
  Prolonged elevations of glucocorticoids have been linked to the effective disturbances experienced by patients with Cushing's syndrome. Major depression has been most commonly reported in patients with endogenous Cushing's syndrome. The purpose of this study was to determine whether these patients experience melancholic or 'atypical' subtype depression and to determine relations between current psychological functioning and factors such as duration and severity of Cushing's syndrome.
  
  
  METHODS
  We examined 33 adult patients with documented Cushing's syndrome and 17 hospitalized, matched controls, using standardized structured interviews and tests.
  
  
  RESULTS
  During the active phase of Cushing's syndrome (prior to and/or on admission), 66.7% of all patients reported histories meeting criteria for a psychiatric diagnosis. Of those with a diagnosis during Cushing's syndrome, 50% reported major depression. Upon presentation to this institution, atypical depression was the most common diagnosis involving 51.5% (n =17) of all enrolled patients. Of the 17 with atypical depression, 8 reported a co-morbid psychiatric disorder. The duration of Cushing's syndrome was an important factor in predicting whether patients sought psychological intervention or met criteria for psychiatric diagnosis.
  
  
  CONCLUSIONS
  Patients with active endogenous Cushing's syndrome exhibit significant psychopathology expressed primarily by atypical depression. Longer duration of Cushing's syndrome may place them at increased risk of such psychopathology.
authors.affiliation: University of Pittsburgh, USA.
authors.forename: L D
authors.initials: LD
authors.lastname: Dorn
authors.forename: E S
authors.initials: ES
authors.lastname: Burgess
authors.forename: B
authors.initials: B
authors.lastname: Dubbert
authors.forename: S E
authors.initials: SE
authors.lastname: Simpson
authors.forename: T
authors.initials: T
authors.lastname: Friedman
authors.forename: M
authors.initials: M
authors.lastname: Kling
authors.forename: P W
authors.initials: PW
authors.lastname: Gold
authors.forename: G P
authors.initials: GP
authors.lastname: Chrousos
mesh_terms: D000328:Adult; D003480:Cushing Syndrome / Q000523:psychology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales