II. Epidemiology

  1. Prevalence
    1. General population: 3%
    2. Primary care: 5 to 15%
    3. Mental health: 22 to 36%
  2. Twice as common in women

III. Comorbid conditions

  1. Major Depression (Double Depression)
  2. Personality Disorder (50%)
    1. Avoidant Personality Disorder
    2. Self-defeating Personality Disorder
    3. Dependent Personality disorder
    4. Borderline Personality disorder
  3. Social Phobia (15%)
  4. Chronic Medical Conditions
    1. Cerebrovascular Accident
    2. Multiple Sclerosis
    3. Acquired Immunodeficiency Syndrome (AIDS)
    4. Premenstrual Dysphoric Disorder (PMS)
    5. Postcardiac transplantation
    6. Hypothyroidism
    7. Fibromyalgia
    8. Chronic Fatigue Syndrome
  5. Psychosocial stressors (losses)
    1. Death of spouse
    2. Changes in income or housing
    3. Abandonment by adult children

IV. Diagnosis: DSM IV Criteria

  1. Depressed mood for most of day
    1. Children: One year duration
    2. Adult: Two year duration
  2. Symptoms associated with depression (2 or more)
    1. Poor appetite or Overeating
    2. Insomnia or Hypersomnia
    3. Low energy or Fatigue
    4. Low self esteem
    5. Poor concentration or difficulty making decisions
    6. Feelings of hopelessness
  3. No symptom-free period >2 months (in 2 year period)
  4. No Major Depression during 2 year period
  5. No prior history of mania or Hypomania
  6. Symptoms not exclusively tied to chronic Psychosis
  7. No secondary cause for symptoms
    1. No concurrent Substance Abuse
    2. No general medical condition responsible for symptoms
  8. Symptoms result in impaired functioning or distress

V. Management

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Ontology: Dysthymic Disorder (C0013415)

Definition (MSH) Chronically depressed mood that occurs for most of the day more days than not for at least 2 years. The required minimum duration in children to make this diagnosis is 1 year. During periods of depressed mood, at least 2 of the following additional symptoms are present: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self esteem, poor concentration or difficulty making decisions, and feelings of hopelessness. (DSM-IV)
Definition (PSY) Chronic affective disorder characterized by either relatively mild depressive symptoms or marked loss of pleasure in usual activities.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D019263
ICD9 300.4
ICD10 F34.1
SnomedCT 192384008, 78667006
DSM4 300.4
English Dysthymic Disorders, Disorder, Dysthymic, Dysthymic disorder, DYSTHYMIC DIS, dysthymia (diagnosis), dysthymia, dysthymic disorder, Dysthymic Disorder, Dysthymic Disorder [Disease/Finding], dysthymic disorders, dysthymia disorder, Dysthymia, Dysthymia (disorder), disorder; dysthymic, dysthymic; disorder, Dysthymia, NOS
Dutch dysthymie, dysthym; stoornis, stoornis; dysthym, Dysthymie, dysthyme stoornis, Dysthyme stoornis
German Dysthymie, Dysthymia, dysthyme Stoerung, Dysthyme Störung
Italian Distimia, Disturbo distimico
Portuguese Distimia, Perturbação distímica, Transtorno Distímico
Spanish Distimia, distimia (trastorno), distimia, Trastorno distímico, Trastorno Distímico
Japanese 気分変調症, 気分変調性障害, キブンヘンチョウショウ, キブンヘンチョウセイショウガイ
Swedish Sinnesjämviktsstörningar
Czech dystymie, Dystymická porucha, Dystymie
Finnish Pitkäaikainen masennus
Russian DISTIMIIA, GIPOTIMIIA, ГИПОТИМИЯ, ДИСТИМИЯ
Korean 기분부전증
Polish Zaburzenia dystymiczne, Depresja utrwalona, Dystymia
Hungarian Dysthymia, Dysthymiás zavar
Norwegian Dystym lidelse, Dystymi, Dystym forstyrrelse
French Dysthymie, Trouble dysthymique