PCN 605 Topic 4 DQ 1

PCN 605 Topic 4 DQ 1

What are some of the challenges in diagnosing an individual with persistent depressive disorder or cyclothymic disorder versus their more severe counterparts? Explain with examples.

ANS:

In DSM-III and DSM-IV, the protracted forms of depression have been conceptualized as dysthymia and by the chronic specifier of major depressive episodes. Dysthymia was characterized by milder symptoms not fully meeting criteria for MDD, but lasting 2 years or longer and meriting clinical attention because of the cumulative burden of long-standing symptoms. The symptomatic criteria for dysthymia differed in part from those for major depressive episode, with an emphasis on low self-esteem and hopelessness.

In DSM-III and DSM-IV, dysthymia was trumped by MDD and was only diagnosed if the threshold for a major depressive episode was not met in the initial 2 years of symptoms. Major depressive episodes could be specified as chronic if the full criteria were continuously met for 2 years or longer. The validity of dysthymia and its separation from MDD has been repeatedly discussed and questioned.3 When individuals with dysthymia were followed over long periods, it became clear that most of them also developed major depressive episodes, which suggests that dysthymia and major depressive episodes are phases of the same disorder rather than separate conditions.4 Dysthymia and MDD also run in the same families and respond to the same treatments. On the other hand, both dysthymia and chronic depression are associated with more impairment, comorbidity, and suicide risk than less persistent forms of depression. Chronic depression and dysthymia were merged into PDD in DSM-5. This new division of depressive disorders gives more weight to duration than to severity of symptoms. DSM-5 defines PDD on the basis of the set of symptoms for dysthymia, with the assumption that most individuals who meet the full symptoms for MDD also meet criteria for dysthymia. However, because of differences in symptomatic criteria, some individuals with chronic major depressive episodes will not meet the DSM-5 criteria for PDD.

Adrianna Nelson

http://www.psychiatrictimes.com/special-reports/persistent-depressive-disorder-dysthymia-and-chronic-depression-update-diagnosis-treatment