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.
|
Depression
on-line help & support
Mood
Disorder's
|
