Fast Five Quiz: Mood Disorders

Stephen Soreff, MD

Disclosures

October 01, 2019

In the DSM-5, persistent depressive disorder (dysthymia) is a depressive mood disorder characterized by a chronic course and an early, insidious onset (ie, in childhood, adolescence, or early adulthood). Early onset (ie, before age 21 years) is associated with higher risk for comorbid personality disorders and substance use disorders.

Although dysthymia has been traditionally considered less severe than major depressive disorder, the consequences of dysthymia are increasingly recognized as grave; they include severe functional impairment, increased morbidity from physical disease, and increased risk for suicide.

Compared with major depression, patients with dysthymia tend to have more subjective symptoms, with fewer dramatic psychomotor disturbances or neurovegetative symptoms, such as abnormal sleep, appetite, and libido. In other words, these patients do not exhibit the severe, debilitating symptoms associated with major depression.

Some patients report a diurnal variation, with low energy, inertia, and anhedonia that is worse in the morning. People with dysthymia may exhibit decreased mental flexibility on neuropsychological testing.

To summarize, the most common symptoms include the following:

  • A negative, pessimistic, or gloomy outlook

  • Depressed mood

  • Restlessness

  • Anxiety

  • Neurovegetative symptoms: disturbed sleeping and feeding behaviors, lethargy; usually less marked than those seen in a major depressive episode

  • Loss of pleasurable feelings (anhedonia)

  • Tendency to spend little time engaged in leisure activities

  • Tendency to anticipate that future events and future affective experiences will be negative

The Third National Health and Nutrition Examination Survey (NHANES III) found that dysthymia is more common among African Americans and Mexican Americans than among white Americans.

Although still unclear, the cause of dysthymia is probably multifactorial. Common contributing factors include the following:

  • Genetic predisposition

  • Biological factors, such as alterations in neurotransmitters, endocrine, or inflammatory mediators

  • Chronic stress, particularly with feelings of hopelessness or helplessness

  • Chronic medical illness

  • Psychosocial factors, such as social isolation, losses, or poverty

  • Ruminative coping strategies: As opposed to problem-solving or cognitive restructuring strategies, these are common among people with dysthymia and may predispose to or sustain dysthymia

  • Antisocial, borderline, dependent, depressive, histrionic, or schizotypal personality traits: People diagnosed with these are at an increased risk for developing dysthymic disorder

Dysthymia is more of a persistent condition rather than an acute illness. It can be the result of ongoing physical problems and negative environmental situations. Patients with dysthymia often have a less than optimistic view of life.

Read more about dysthymia.

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