Dysthymia

Unless otherwise indicated, answers are from DSM-IV-TR, First & Tasman or Tenth Ed of Sadock and Sadock.

As of 6Sep08.

Dysthymia - criteria

Q. Basic criteria for dysthymia?

Dysthymia - criteria

Ans. Key is “at least two years” of the following:

a. Sad moodb. Two or more of 1] under or overeating, 2]

over or under sleeping, 3] anergy; 4] low self-esteem; 5] difficulty focusing; 6] feeling hopeless.

c. Not part of another disorder, e.g., never been manic.

Specifiers

Q. What is “late onset” as to dysthymia?

Specifiers

Ans. 21 years old separates “early” from “late” onset.

Specifier

Q. Besides onsets, what other specifier applies to dysthymia?

specifier

Ans.

Atypical, same criteria as MDD.

Lab findings

Q. What are lab findings in dysthymia?

Lab findings

Ans. ¼ to ½ have polysomnographic abnormalities of:

- Decreased REM latency

- Increased REM density

- Reduced slow wave

Lab findings and meds

Q. Any treatment implications as to polysomnographic features?

Lab findings and meds

Ans.

May respond better to meds than those whose polysomnographic findings are normal.

Prevalence

Q. Prevalence of dysthymia?

Prevalence

Ans.

Lifetime: 6%

Community surveys: 3% at any one time

Familial pattern

Q. If a pt has dysthymia, is there an increased prevalence in first degree relatives for dysthymia? For MDD?

Familial pattern

Ans. For both.

Treatment

Q. Best treatment response is achieved, very generally, by?

Treatment

Ans. Use of both an antidepressant and CBT.

Meds for Dysthymia

Q. Sadock & Sadock recommend which meds?

Meds

Ans. SSRIs, venlafaxine, and bupropion. Also, for those not responding consider MAOIs or “judicious” use of amphetamines.