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Diagnosis and Assessment
Published in Melisa Robichaud, Naomi Koerner, Michel J. Dugas, Cognitive Behavioral Treatment for Generalized Anxiety Disorder, 2019
Melisa Robichaud, Naomi Koerner, Michel J. Dugas
Major depressive disorder (or depression) is characterized by persistent feelings of sadness and loss of interest in previously enjoyed activities for a period of at least two weeks. Persistent depressive disorder (previously dysthymia) is a more chronic form of depression, as symptoms must be present for at least two years. There are two main reasons why discriminating between these disorders and GAD can prove to be a challenge. First, there is an overlap in terms of associated symptoms. Specifically, poor concentration, sleeping difficulties, and fatigue are associated with GAD, depression, and dysthymia. Second, depressed or dysthymic individuals are prone to rumination, that is, a passive and repetitive focus on one’s distress and the meaning of that distress (Nolen-Hoeksema, 1998). This kind of dwelling thought process could easily resemble GAD worry. Moreover, GAD and depression/dysthymia have been found to co-occur quite frequently. As such, it is important to determine whether clients are suffering from either one or both disorders in order to begin developing a proper treatment strategy.
Seeking Help for Mental Health Problems Early
Published in Leanne Rowe, Michael Kidd, Every Doctor, 2018
Dysthymia is a chronic mood disturbance present on most days over a span of at least two years. The symptoms are not as severe as those for major depression, but it can be just as damaging as symptoms may last longer.
Deliberate self-harm II: self-injury
Published in MS Thambirajah, Case Studies in Child and Adolescent Mental Health, 2018
Although she was unhappy and miserable, there was no evidence of clinical depression. There was no pervasive depression in her mood or anhedonia (loss of enjoyment). In fact, she wanted to be out with her peers enjoying life. It was her inability to find the right friends that made her sad and angry. In psychiatric literature, the feeling of chronic, low grade depression has been described as dysthymia (see later). One of the important factors that contributed to the self-harming behaviour was the unavailability of the parents both physically and emotionally. They appeared to be spending little time with Emma or at home for that matter. For reasons of their own they had an active social life that excluded Emma. The reasons for this were unclear. It was likely that, following the marital problems, they had organised their lives in such a way to enhance their relationship that did not factor Emma into the relationship equation. Perhaps they felt that now that Emma was grown up she did not need them. The net result was that Emma felt rejected and isolated by both the family and her peer group. The various factors that contributed to Emma’s self-injurious behaviour are shown in Figure 15.1.
Subthreshold depression – concept, operationalisation and epidemiological data. A scoping review
Published in International Journal of Psychiatry in Clinical Practice, 2023
Hans-Peter Volz, Johanna Stirnweiß, Siegfried Kasper, Hans-Jürgen Möller, Erich Seifritz
Regarding clinical issues, the routine application of a scale – even a self-evaluation scale like the PHQ-9 – is not feasible, since clinicians do not use scales in the routine setting. In different settings, however, this is strongly recommended, especially to document long-term changes. In this context, a definition based on the DSM- or ICD-system is needed, since clinicians are familiar with these diagnostic categories. As SD is, like MD, probably an episodic disorder, the same definition as for dysthymia (in ICD-10) could be used in order to describe symptom severity (“A chronic depression of mood […] which is not sufficiently severe […] to justify a diagnosis of severe, moderate, or mild recurrent depressive disorder). However, the duration should be at least 14 days (as is the case for depressive episodes) but shorter than two years (to be distinguished from dysthymia). The disadvantage of this proposal based purely on clinical categories is the overlap with the DSM definition of minor depression (i.e., the total number of symptoms not exceeding 4).
Perspectives on the success rate of current antidepressant pharmacotherapy
Published in Expert Opinion on Pharmacotherapy, 2022
Treatment responsivity depends in no small part on how well- versus ill-defined the target of treatment actually is. Antidepressant medications are not necessarily indicated or evidence-based for free-standing phenomena such as ‘unhappiness’ or ‘suicidal ideation’ or ‘low self-esteem’ as deconstructed from the broader syndrome of major depression, even though these symptoms actually have their own individual ICD-10 codes (R45.2, R45.851, and R45.81, respectively). ‘Clinical depression’ generally connotes a major depressive syndrome but can also include related phenomena such as low grade persistent depression (formerly designated as dysthymia). Adjustment disorders with depressed mood (sometimes called ‘situational depressions’ in the vernacular) are often regarded as being more the substrate of psychotherapy than pharmacotherapy, although a modest literature suggests that depressive symptoms in complicated grief (sans a major depression) may improve with bupropion [42] or synergistically when citalopram is added to psychotherapy (but no benefit emerged with citalopram alone) [43].
The importance of suicide risk assessment in patients affected by neurofibromatosis
Published in International Journal of Psychiatry in Clinical Practice, 2021
Isabella Berardelli, Annalisa Maraone, Daniele Belvisi, Massimo Pasquini, Sandra Giustini, Emanuele Miraglia, Chiara Iacovino, Maurizio Pompili, Marianna Frascarelli, Giovanni Fabbrini
Our observation that psychiatric disturbances were more frequent in NF1 patients than in healthy controls is in line with previous studies. In a 12-year longitudinal follow-up study on 48 patients with NF1, Zöller and Rembeck (1999) observed the presence of psychiatric diseases in one-third of patients, with 21% having a diagnosis of dysthymia. Symptoms of depression and anxiety, as well as higher levels of perceived stress and lower levels of self-esteem, were more frequent in the 248 NF patients (133 with NF1 and 94 with NF2) than in the general population (Wang et al. 2012). An epidemiological study found that major depressive disorders in NF1 patients had a 12-month prevalence of 6.6% and a lifetime prevalence of 16.2% (Kessler et al. 2003). More recently, in a large study conducted on 498 adults with NF1, Cohen et al. (2015) found a higher prevalence of depression (61% in females, 43% in males, and 55% in the total study population) when compared to prior studies (Zöller and Rembeck 1999; Wang et al. 2012). In this study, higher levels of depressive symptoms were also significantly associated with poorer quality of life (Cohen et al. 2015). Some studies in NF1 patients that evaluated the impact of disease severity (including disfiguring cutaneous tumours, complete hearing loss, facial weakness, and chronic disabling pain due to schwannomatosis) on depressive and anxiety symptoms and levels of stress and self-esteem are still controversial (Wolkenstein et al. 2003; Page et al. 2006).