The dexamethasone suppression test as an adjunct in diagnosing depression.

Historically, affective disorders have been underdiagnosed among minorities, while schizophrenia is often overdiagnosed. Cultural differences in symptomatology, such as increased reports of auditory hallucinations, or language differences reportedly contribute to misdiagnoses in Hispanics. Consequently, we performed a thorough evaluation of Hispanic patients with a history of schizophrenia who remained diagnostic enigmas. Evaluation included the use of a Spanish-speaking interpreter, strict adherence to criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition (revised), and the dexamethasone suppression test. Five patients met criteria for major depression, and all but one were properly classified using the dexamethasone suppression test. Careful evaluation is needed with appropriate cultural and diagnostics support to avoid missing depression in Hispanics. The dexamethasone suppression test may be a useful adjunct in some difficult-to-diagnose patients.