Dysthymia in a cross-cultural perspective.
ABSTRACT Dysthymia is a relatively less-studied condition within the spectrum of depressive disorders. New and important information about its status has emerged in recent scientific literature. This review highlights some of the findings of that literature.
Even though studies addressing the cross-cultural validity of dysthymia are being awaited, results of studies using comparable ascertainment procedures suggest that the lifetime and 12-month estimates of the condition may be higher in high-income than in low and middle-income countries. However, the disorder is associated with elevated risks of suicidal outcomes and comparable levels of disability whereever it occurs. Dysthymia commonly carries a worse prognosis than major depressive disorder and comparable or worse clinical outcome than other forms of chronic depression. Whereas there is some evidence that psychotherapy may be less effective than pharmacotherapy in the treatment of dysthymia, the best treatment approach is one that combines both forms of treatment.
Dysthymia is a condition of considerable public health importance. Our current understanding suggests that it should receive more clinical and research attention. Specifically, the development of better treatment approaches, especially those that can be implemented in diverse populations, deserves research attention.
- [Show abstract] [Hide abstract]
ABSTRACT: Dysthymic disorder and other chronic depressive disorders have recently been merged in DSM-5 into a 'persistent depressive disorder' category. As its introduction in DSM-III, the validity of dysthymic disorder has long been challenged, posing concerns regarding the validity of its successor - persistent depressive disorder. This review aims to present recent findings regarding the validity and utility of dysthymic disorder. Several recent studies raise questions regarding the validity of dysthymic disorder, namely, results indicating a significant overlap between dysthymic disorder and other mood and/or anxiety disorders, failure of such a diagnosis to predict illness outcome and the lack of any validation strategy identifying that it is a depressive entity or subtype. Research findings indicate that dysthymic disorder is a heterogeneous diagnosis encompassing many different depressive (and anxiety or personality weighted) conditions, and without clear evidence of its validity as a diagnostic entity. As dysthymic disorder is a key component of DSM-defined persistent depressive disorder - the latter is at similar risk of providing a heterogeneous domain diagnosis, and thus limiting identification of specific causative factors and preferential treatment modality.Current opinion in psychiatry 11/2013; · 3.57 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: In this paper, I develop a phenomenological description of lived autonomy and describe possible alterations of lived autonomy associated with chronic depression as they relate to specific psychopathological symptoms. I will distinguish between two types of lived autonomy, a pre-reflective type and a reflective type, which differ with respect to the explicitness of the action that is willed into existence; and I will relate these types to the classical distinction between freedom of intentional action and freedom of the will. I will then describe how a chronically depressed person habitually discloses her experiential workspace with an impaired scope of perceivable action-properties, and pre-reflectively values many of these perceived action-properties as demanding or devalues these properties as well as her own abilities and drive to perform the respective actions ('depressive habituality'). These alterations, typically experienced in a passive manner, imply an impairment of both types of lived autonomy. Drawing on first-hand accounts, I will then argue that small islands of lived autonomy, even of the reflective type, are possible if the afflicted identifies with at least some of her 'depressive disabilities' (i.e., her levelled amount of daily activities, her social retreat in certain periods). Lastly, I will compare this manner of life-conduct with the constellation of includence (Inkludenz), as described by Tellenbach, and discuss the limitations of this study.Theoretical Medicine and Bioethics 10/2012; · 0.78 Impact Factor
Article: Dysthymia in the Clinical Context[Show abstract] [Hide abstract]
ABSTRACT: Dysthymia is defined as a chronic mood disorder that persists for at least two years in adults, and one year in adolescents and children. According to DSM IV-TR, Dysthymia is classified into two subtypes: early-onset, when it begins before 21 years-old, and late onset Dysthymia, when it starts after this age. Before age 21, symptoms of conduct disorder, attention deficit disorder and hyperactivity with a few vegetative symptoms are usually present. It is important to distinguish it from other types of depression, as earlier as possible. This would allow providing these patients with the appropriate treatment to attenuate the impact of symptoms, such as poor awareness of self-mood, negative thinking, low self-esteem, and low energy for social and family activities, which progressively deteriorate their life quality. The etiology of Dysthymia is complex and multifactorial, given the various biological, psychological and social factors involved. Several hypotheses attempt to explain the etiology of Dysthymia, highlighting the genetic hypothesis, which also includes environmental factors, and an aminergic hypothesis suggesting a deficiency in serotonin, norepinephrine and dopamine in the central nervous system. From our point of view, dysthymia cannot be conceived as a simple mild depressive disorder. It is a distinct entity, characterized by a chronic depressive disorder which could persist throughout life, with important repercussions on the life quality of both patients and families.Revista Colombiana de Psiquiatría. 04/2013; 42(2):212-218.