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Dysthymic Disorder

Updated : November 17, 2022





Background

Persistent major depression & dysthymic disorder are combined into the term persistent depressive disorder (dysthymia) in the Diagnostic & Statistical Manual, Fifth Edition (DSM-5) of the American Psychiatric Association. A depressive mood condition called severe depressive condition has an early and sneaky beginning, as well as a chronic duration (i.e., in adolescence, initial adulthood, or childhood).

There is a higher chance of co-occurring psychological disorders & substance misuse disorders with early symptoms (i.e., under age 21). Although dysthymia was once thought to be less serious than chronic depression, its effects—which include serious cognitive deficits, an increase in morbidity due to physical illness, or an increased risk of death now widely acknowledged to be catastrophic.

Comparing anxious and anergic dysthymia:

Anxiety dysthymia & anergic dysthymia were suggested as the two subtypes of dysthymia by Niculescu & Akisal. The subset of sufferers with anxiety dysthymia was said to have overt symptoms of poor self-esteem, restlessness without a purpose, and sensitivity to interpersonal rejection.

Additionally, they described these individuals as being more open to receiving aid, more likely to attempt suicide less violently, and responding better to selective SSRIs (serotonin reuptake antidepressants).

It should be noted that double depression, defined as having at least one traumatic event, is thought to occur in approximately 75 percent of patients with dysthymia. Dysthymia patients who have depressed instances frequently do so for lengthier stretches of time before fully recovering.

The following are the precise DSM-5 characteristics for persistent depression illness (dysthymia):

The depressed mood throughout the majority of the day, on a regular basis, as demonstrated by either a personal account or by third parties observations, for at least two years. The duration should be at least one year for children and teenagers, and the mood might well be irritated.

Presence of two (or even more) of the following symptoms while depressed:

  • Decreased appetite and overeating
  • Hypersomnia and Insomnia
  • Lack of fatigue or energy
  • Having trouble focusing or making judgments
  • a sense of helplessness
  • Lack of confidence

Epidemiology

According to the best estimations, there is a greater than 25% lifetime chance of severe depression, with a peak incidence of roughly 5%. Dysthymia has a 6% lifetime prevalence in the community. An approximated 36% of people receiving outpatient mental care therapy are suffering from dysthymia. and severity is defined.

According to one study, the NHANES III (National Health and Nutrition Examination Survey 3), African & Mexican Americans are more likely than Caucasians to suffer from dysthymia. Females outnumber males with serious depressive illnesses, with a female-to-male ratio of 2:1 throughout their reproductive years.

The two sexes appeared to be impacted roughly equally around puberty and then after menopause. Dysthymia affects survival more adversely in males than in females in the elderly, although being substantially more common in females.

Anatomy

Pathophysiology

The good clinical reactions of dysthymia to serotonergic & noradrenergic medicines, such as SSRIs, SNRIs (serotonin/norepinephrine reuptake inhibitors), & antidepressants, show that serotonin & noradrenergic pathways are involved in dysthymia.

Even though the HPA axis has been poorly explored in dysthymic conditions, defects in neuroendocrine pathways, particularly thyroid & hypothalamic-pituitary-adrenocortical (HPA) systems, have been associated with depressive conditions generally.

The major depressive disorder has also been linked to cytokines & inflammation, although a connection to dysthymia has still not been conclusively proven.

Etiology

Although the exact cause of dysthymia is unknown, it is likely complex.

When determining the origin of dysthymia, a biopsychosocial formulation that considers the interaction of genetic predispositions, psychosocial factors, medical issues, and coping mechanisms is useful.

The following are some instances of typical influencing elements:

Genetic propensity

Biological elements, like changes in endocrine systems, neurotransmitters, and inflammatory mediators

Persistent medical condition

Chronic stress, especially when coupled with thoughts of helplessness or despair

Psychosocial elements, such as loneliness in society and losses

Antisocial, dependent, histrionic, borderline, histrionic, depressive, and Schizotypal personality characteristics: those with these characteristics are more likely to experience dysthymic disease.

Imaginative coping mechanisms

These are more prevalent in people with dysthymia than problem-solving and cognitive restructuring techniques, and they may contribute to or maintain dysthymia.

According to data from polysomnograms and EEG (electroencephalograms), about 25percent of people with dysthymia experience sleep modifications that are comparable to those experienced by people with major depressive disorder. These changes include shortened REM latency, enhanced rapid eye movement (REM) density, and irregular sleep patterns.

Genetics

Prognostic Factors

Chronic dysthymia is a given. Throughout the duration of the illness, there could be times of euthymia or depression. 46 to 71% of people with dysthymia experienced remission at follow-up points varying from 1 to 6 years, according to a comprehensive analysis of epidemiologic research.

The lowest response rates are linked to comorbidities, including anxiety & depressive personality illness. Persistent stress is linked to symptoms that are more severe and have a poorer chance of healing.

Most patients can expect to significantly improve over time with appropriate care. When managing depressive conditions, as is the case with other mood illnesses, more emphasis is being placed on aiming for remission as opposed to the response.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

chromium 

200 mcg orally daily twice a day



 

chromium 

200 mcg orally daily twice a day



 

Media Gallary

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719439/

Dysthymic Disorder

Updated : November 17, 2022




Persistent major depression & dysthymic disorder are combined into the term persistent depressive disorder (dysthymia) in the Diagnostic & Statistical Manual, Fifth Edition (DSM-5) of the American Psychiatric Association. A depressive mood condition called severe depressive condition has an early and sneaky beginning, as well as a chronic duration (i.e., in adolescence, initial adulthood, or childhood).

There is a higher chance of co-occurring psychological disorders & substance misuse disorders with early symptoms (i.e., under age 21). Although dysthymia was once thought to be less serious than chronic depression, its effects—which include serious cognitive deficits, an increase in morbidity due to physical illness, or an increased risk of death now widely acknowledged to be catastrophic.

Comparing anxious and anergic dysthymia:

Anxiety dysthymia & anergic dysthymia were suggested as the two subtypes of dysthymia by Niculescu & Akisal. The subset of sufferers with anxiety dysthymia was said to have overt symptoms of poor self-esteem, restlessness without a purpose, and sensitivity to interpersonal rejection.

Additionally, they described these individuals as being more open to receiving aid, more likely to attempt suicide less violently, and responding better to selective SSRIs (serotonin reuptake antidepressants).

It should be noted that double depression, defined as having at least one traumatic event, is thought to occur in approximately 75 percent of patients with dysthymia. Dysthymia patients who have depressed instances frequently do so for lengthier stretches of time before fully recovering.

The following are the precise DSM-5 characteristics for persistent depression illness (dysthymia):

The depressed mood throughout the majority of the day, on a regular basis, as demonstrated by either a personal account or by third parties observations, for at least two years. The duration should be at least one year for children and teenagers, and the mood might well be irritated.

Presence of two (or even more) of the following symptoms while depressed:

  • Decreased appetite and overeating
  • Hypersomnia and Insomnia
  • Lack of fatigue or energy
  • Having trouble focusing or making judgments
  • a sense of helplessness
  • Lack of confidence

According to the best estimations, there is a greater than 25% lifetime chance of severe depression, with a peak incidence of roughly 5%. Dysthymia has a 6% lifetime prevalence in the community. An approximated 36% of people receiving outpatient mental care therapy are suffering from dysthymia. and severity is defined.

According to one study, the NHANES III (National Health and Nutrition Examination Survey 3), African & Mexican Americans are more likely than Caucasians to suffer from dysthymia. Females outnumber males with serious depressive illnesses, with a female-to-male ratio of 2:1 throughout their reproductive years.

The two sexes appeared to be impacted roughly equally around puberty and then after menopause. Dysthymia affects survival more adversely in males than in females in the elderly, although being substantially more common in females.

The good clinical reactions of dysthymia to serotonergic & noradrenergic medicines, such as SSRIs, SNRIs (serotonin/norepinephrine reuptake inhibitors), & antidepressants, show that serotonin & noradrenergic pathways are involved in dysthymia.

Even though the HPA axis has been poorly explored in dysthymic conditions, defects in neuroendocrine pathways, particularly thyroid & hypothalamic-pituitary-adrenocortical (HPA) systems, have been associated with depressive conditions generally.

The major depressive disorder has also been linked to cytokines & inflammation, although a connection to dysthymia has still not been conclusively proven.

Although the exact cause of dysthymia is unknown, it is likely complex.

When determining the origin of dysthymia, a biopsychosocial formulation that considers the interaction of genetic predispositions, psychosocial factors, medical issues, and coping mechanisms is useful.

The following are some instances of typical influencing elements:

Genetic propensity

Biological elements, like changes in endocrine systems, neurotransmitters, and inflammatory mediators

Persistent medical condition

Chronic stress, especially when coupled with thoughts of helplessness or despair

Psychosocial elements, such as loneliness in society and losses

Antisocial, dependent, histrionic, borderline, histrionic, depressive, and Schizotypal personality characteristics: those with these characteristics are more likely to experience dysthymic disease.

Imaginative coping mechanisms

These are more prevalent in people with dysthymia than problem-solving and cognitive restructuring techniques, and they may contribute to or maintain dysthymia.

According to data from polysomnograms and EEG (electroencephalograms), about 25percent of people with dysthymia experience sleep modifications that are comparable to those experienced by people with major depressive disorder. These changes include shortened REM latency, enhanced rapid eye movement (REM) density, and irregular sleep patterns.

Chronic dysthymia is a given. Throughout the duration of the illness, there could be times of euthymia or depression. 46 to 71% of people with dysthymia experienced remission at follow-up points varying from 1 to 6 years, according to a comprehensive analysis of epidemiologic research.

The lowest response rates are linked to comorbidities, including anxiety & depressive personality illness. Persistent stress is linked to symptoms that are more severe and have a poorer chance of healing.

Most patients can expect to significantly improve over time with appropriate care. When managing depressive conditions, as is the case with other mood illnesses, more emphasis is being placed on aiming for remission as opposed to the response.

chromium 

200 mcg orally daily twice a day



chromium 

200 mcg orally daily twice a day



https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719439/

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