Which findings on a mental status exam 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

The mental status examination findings in a person with dysthymic disorder are similar to those seen in major depressive episodes.

Some depressed people are less attentive to their appearance, with decline in attention to dress or grooming. Speech may be slowed or show diminished emotional prosody. Mood is likely to be low, with a congruent affect.

Some observable signs of depressed affect include decreased eye contact, slumped posture, and diminished range of facial expression.

With dysthymia alone, one would expect the patient to retain the ability to convey his or her thoughts in a linear and logical manner and would not expect disorganization in speech or behavior.

Hallucinations or delusions would not be explained by dysthymia and should prompt consideration of other diagnoses.

A safety evaluation is an essential part of any mental status examination; the clinician should inquire about suicidal and homicidal thoughts and plans in persons with dysthymia as they would during any psychiatric examination.

Other thought content could be consistent with sad, hopeless, or guilty themes. One would not expect disruption of intellect, orientation, memory, [25] or abstraction from dysthymia alone.

A mental status examination for a person with dysthymia might include the following:

  • Patient is alert, attentive, and fully oriented

  • She appears her stated age and is appropriately and casually dressed, although slightly unkempt, with wrinkled clothing

  • Her mood is stated as depressed and her affect is mood congruent, with avoidant eye contact, less spontaneous movement and gesture, and occasional tearfulness

  • Her thoughts are linear and logical, with themes reflecting low self-esteem

  • She expresses guilt that does not rise to a delusional level; she denies paranoid, religious, grandiose, and bizarre delusions and none are apparent

  • She denies hallucinations and does not appear to respond to internal stimuli

  • She denies current suicidal and homicidal ideation, intent, and plan and demonstrates good judgment, as evidenced by her seeking treatment for her depressed mood

  • She has good impulse control

  • Her intellect is estimated to be average

  • No deficits are detected in her immediate, short-term, and long-term memory and she is able to interpret proverbs appropriately


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