Which clinical history findings are characteristic of persistent depressive disorder (dysthymia)?

Updated: Oct 01, 2019
  • Author: Jerry L Halverson, MD; Chief Editor: David Bienenfeld, MD  more...
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Answer

Patients with dysthymia often have a gloomy or negative outlook on life with an underlying sense of personal inadequacy. Compared with major depression, patients' histories tend to include more subjective symptoms, with fewer dramatic psychomotor disturbances or neurovegetative symptoms such as abnormal sleep, appetite, and libido. Some note a diurnal variation, with low energy, inertia, and anhedonia worst in the morning. People with dysthymia may exhibit decreased mental flexibility on neuropsychological testing.

To summarize, the most common symptoms include the following:

  • A negative, pessimistic, or gloomy outlook

  • Depressed mood

  • Restlessness

  • Anxiety

  • Neurovegetative symptoms - disturbed sleeping and feeding behaviors, lethargy; usually less marked than those seen in a major depressive episode

  • Loss of pleasurable feelings (anhedonia)

  • Tendency to spend little time engaged in leisure activities

  • Tendency to anticipate that future events and future affective experiences will be negative [22]

Alternative research criteria for dysthymic disorder also include irritability, excessive anger, and guilty brooding about the past.

A family history of a mood disorder is supporting evidence for the diagnosis. Of note, patients with dysthymia are more likely than patients with episodic major depression to have relatives with dysthymia or major depression. [23]

Although people with dysthymia often have social relationships, some research suggests that this population tends to invest most of their expendable energy into work, leaving little for social life or family and placing a strain on personal relationships.

As many as 15% of persons with dysthymia may have comorbid substance dependence. Since substance dependence can lead to symptoms similar to those caused by dysthymia, a detailed substance abuse history should always be obtained.

A physical and mental status examination is needed to confirm the diagnosis and to determine if comorbid diagnoses are present.

Although psychological tests, such as the Minnesota Multiphasic Inventory or the Rorschach, are not administered routinely in current clinical practice, these tests can be quite helpful for diagnostic purposes, ie, differential diagnosis.


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