Dysthymic Disorder
Dysthymic Disorder is characterized by chronic depression,
but with less severity than a major depression. The essential symptom for dysthymic
disorder is an almost daily depressed mood for at least two years, but without the
necessary criteria for a major depression. Low energy, sleep or appetite disturbances and
low self-esteem are usually part of the clinical picture as well. The diagnostic
criteria is as follows:
On the majority of days for 2 years or more, the patient reports
depressed mood or appears depressed to others for most of the day.
When
depressed, the patient has 2 or more of:
* Appetite decreased or increased
* Sleep decreased or increased
* Fatigue or low energy
* Poor self-image
* Reduced concentration or indecisiveness
* Feels hopeless
During
this 2 year period, the above symptoms are never absent longer than 2 consecutive months.
During
the first 2 years of this syndrome, the patient has not had a Major Depressive Episode.
The
patient has had no Manic, Hypomanic or Mixed Episodes.
The
patient has never fulfilled criteria for Cyclothymic
Disorder.
The
disorder does not exist solely in the context of a chronic psychosis (such as
Schizophrenia
or Delusional Disorder) .
The
symptoms are not directly caused by a general medical condition or the use of
substances, including prescription medications.
The
symptoms cause clinically important distress or impair work, social or personal
functioning.
Specify whether
Early onset, if it begins by age 20
Late onset, if it begins at age 21 or later
The only specifier that can apply is With Atypical
Features.
Associated Features
Depressed Mood
Somatic or Sexual Dysfunction
Guilt or Obsession
Addiction
Anxious or Fearful or Dependent Personality
Dramatic or Erratic or Antisocial Personality
Differential Diagnosis
Some disorders have similar or even overlapping symptoms. The clinician, therefore, in his
diagnostic attempt has to differentiate against the following disorders which need to be
ruled out to establish a precise diagnosis.
Psychiatric:
Manic, Mixed, or Hypomanic Episode; Mood Disorder Due to a
General Medical Condition; Substance-Induced Mood Disorder; Schizoaffective Disorder;
Schizophrenia; Delusional Disorder; Psychotic Disorder Not Otherwise Specified; dementia;
Major Depressive Disorder; chronic Psychotic Disorders; coexisting personality
disturbance.
Medical:
Organic Mood Syndromes caused by: Acquired Immune
Deficiency Syndrome (AIDS), Adrenal (Cushing's or Addison's Diseases), Cancer (especially
pancreatic and other GI), Cardiopulmonary disease, Dementias (including Alzheimer's
Disease); Epilepsy, Fahr's Syndrome, Huntington's Disease, Hydrocephalus,
Hyperaldosteronism, Infections (including HIV and neurosyphilis), Migraines,
Mononucleosis, Multiple Sclerosis, Narcolepsy, Neoplasms, Parathyroid Disorders (hyper-
and hypo-), Parkinson's Disease, Pneumonia (viral and bacterial), Porphyria, Postpartum,
Premenstrual Syndrome, Progressive Supranuclear Palsy, Rheumatoid Arthritis, Sjogren's
Arteritis, Sleep Apnea, Stroke, Systemic Lupus Erythematosus, Temporal Arteritis, Trauma,
Thyroid Disorders (hypothyroid and "apathetic" hyperthyroidism), Tuberculosis,
Uremia (and other renal diseases), Vitamin Deficiencies (B12, C, folate, niacin,
thiamine), Wilson's Disease.
Drugs:
Acetazolamine, Alphamethyldopa, Amantadine, Amphetamines,
Ampicillin, Azathioprine (AZT), 6-Azauridine, Baclofen, Beta Blockers, Bethanidine,
Bleomycin, Bromocriptine, C-Asparaginase, Carbamazepine, Choline, Cimetidine, Clonidine,
Clycloserin, Cocaine, Corticosteroids (including ACTH), Cyproheptadine, Danazol,
Digitalis, Diphenoxylate, Disulfiram, Ethionamide, Fenfluramine, Griseofulvin,
Guanethidine, Hydralazine, Ibuprofen, Indomethacin, Lidocaine, Levodopa, Methoserpidine,
Methysergide, Metronidazole, Nalidixic Acid, Neuroleptics (butyrophenones, phenothiazines,
oxyindoles), Nitrofurantoin, Opiates, Oral Contraceptives, Phenacetin, Phenytoin,
Prazosin, Prednisone, Procainamide, Procyclidine, Quanabenzacetate, Rescinnamine,
Reserpine, Sedative/Hypnotics (barbiturates, benzodiazepines, chloral hydrate),
Streptomycin, Sulfamethoxazole, Sulfonamides, Tetrabenazine, Tetracycline, Triamcinolone,
Trimethoprim, Veratrum, Vincristine.
Mood Disorder Episodes: |
Major | Manic | Mixed | Hypomanic |
Cause:
Genetic factors appear to be causative in Cyclothymia as
they do in the Bipolar Disorders. Many of those
affected have a family history of major depression, bipolar disorder, suicide or
alcohol/drug dependence.
Treatment:
Counseling and Psychotherapy [ See Therapy Section
]:
Psychotherapy ( both Group & Individual ) is the
treatment for choice for this psychological problem. Often, antidepressant medication is
also recommended because of the chronic nature of the depression in dysthymia.
Family-centered approaches differ from individual methods in their direct focus on the
"role of the sick member" in the family system rather than on the symptoms of
the identified patient. Psychotherapy is used to treat this
depression in several ways:
* First, supportive counseling can help to ease the pain,
and can address the feelings of hopelessness.
* Second, cognitive therapy is used to change the
pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that
create the depression and sustain it. Cognitive therapy can help the depressed person
recognize which life problems are critical, and which are minor. It also helps them to
learn how to accept the life problems that cannot be changed.
* Third, problem solving therapy is usually needed to
change the areas of the person's life that are creating significant stress, and
contributing to the depression. Behavioral therapy can help you to develop better coping
skills, and interpersonal therapy can assist in resolving relationship conflicts.
Pharmacotherapy [ See
Psychopharmacology Section ] :
Some individuals with dysthymic disorder respond well to
anti-depressant medication, in addition to psychotherapy, so an evaluation for medication
may be appropriate.
Antidepressant Drugs:
fluoxetine
imipramine
Antianxiety Drugs
amphetamines
barbiturates
benzodiazepines
Coding Notes
In children, the abnormal mood may be one of irritability
and the time required is only one year.
A Major Depressive Episode may precede Dysthymia if it has
remitted for a full two months before Dysthymia begins. Also, Dysthymia may begin first,
if it lasts at least two years before the major depression begins. In this case, the two
diagnoses may be made together.
After the first two years, Major Depressive Episodes may
also be diagnosed with Dysthymic Disorder, if the symptoms are met for both.
See our Mood Disorders Page for links
|
