Dysthymia and

Cyclothymia

Nathanael S.
Dysthymia

• A mood disorder consisting of chronic depression with less

severe but longer lasting symptoms than MDD
• affects 5-6% of all persons
• more common in
• Women<64 age
• unmarried and young persons and in those with low incomes.
• first-degree relatives with MDD
• frequently coexists with other mental disorders – particularly MDD(75%)…..
anxiety disorders(50%), substance abuse(50%), and personality disorder(40%)
 DSM-5 Diagnostic Criteria for Dysthymia
A. Depressed mood for most of the day for atleast 2 years(1yr in children and
adolescents)
B. Presence, while depressed, of two(or more) of the following
A. Poor appetite or overeating
B. Insomnia/hypersomnia
C. Low energy or fatigue
D. Low self-esteem
E. Poor concentration or difficulty making decisions
F. Feelings of hopelessness

C. During the 2/1 yr period of disturbance, the individual has never been without the
symptoms in criteria A&B for >2months
D. Criteria for major depressive disorder may be xontunuously present for 2years
E. there has never been a manic/hypomanic episode and criteria have never been met
for cyclothymic disorder
F. Disturbance never been explained by other disorders
G. Symptoms not attributed to physiologic effects of a substance
H. The symptoms cause clinically significant distress/impairment
• DDx – identical to MDD
• Minor DD – episodes of depressive disorder less severe than MDD
- Episodic – b/n episodes – euthymic.( in dysthymia virtually no euthymic periods.
• Recurrent Brief Depressive Disorder – brief periods(<2weeks) depressive episodes
- Episodic disorder, their symptoms are more severe.

• Alcohol and Substance Abuse –

• Course
• half - Insidious onset of symptoms before 25 age.
• Suffer decades with the symptoms before seeking psychiatric help
• Progress - 20% - MDD , 15% - Bipolar II , 5% - Bipolar I
• Prognosis – Good with treatment.
• Combination of Pharmacotherapy with some form of psychotherapy.
• Hospitalization – Indications – severe symptoms , need for extensive diagnostic procedures,
suicidal ideation
Cyclothymia
• Episodes of hypomania and mild depression
• Chronic fluctuating mood disturbance.
• The changes in mood are irregular and abrupt.
• Patients often feel their moods are out of control and they may become involved in
unprovoked disagreements with friends, families
• Studies – two thirds exhibit personality disorders.
• Epidem. – 3-5% psychiatric outpatients.
• More common
• F:M – 3:2
• 15-25 age
• Family members with substance related disorder, Bipolar I disorder
DSM-5 Criteria
A. For at least 2 years (1 yr in children and adolescents) there have been
numerous periods with hypomanic symptoms that do not meet criteria
for a hypomania episode and numerous periods with depressive
symptoms that do not meet criteria for a major depressive episode.
B. During the above time frame, the hypomania
and depressive periods have been present for at least half the time and
the individual has not been without the symptoms for more than 2
months at a time.
C. Criteria for a major depressive, manic, or hypomanie episode have never
been met.
D. The symptoms in Criterion A are not better explained by other disorders.
E. The symptoms are not attributable to the physiological effects of a
substance or medical disorders.
• Half of patients – depression as their major symptom( seek
psychiatric help more likely than those with primarily hypomanic
symptoms
• DDx – all possible medical and substance related causes of depression
and mania.
• Rx – pharmacotherapy(mood stabilizers and antimanic drugs) and
psychotherapy.
REFERENCES
• Kaplan and saddock's synopsis of psychiatry 11th edition
• DSM 5
Thank you!!!