History and exam

Key diagnostic factors

common

chronic mood disorder lasting greater than 2 years

Mood disorder needs to be 2 years or longer (1 year or longer in children/adolescents).

depressive symptoms present for most of the day, most days

Mood disturbance needs to be present 'more days than not'.

no periods of euthymia in the past 2 years (1 year for children or adolescents)

Part of the DSM-5-TR criteria: during the 2-year period, the person has not been without the symptoms for 2 months or longer.[1]

symptoms of major depression may be continuously present for 2 or more years

According to DSM-5-TR, criteria for a major depressive disorder may be continuously present for 2 years.

Other diagnostic factors

common

no symptoms of mania/hypomania or schizophrenia

According to DSM-5-TR, this is necessary for the diagnosis.[1]

Persistent depressive disorder is a 'unipolar' mood disorder. Presence of periods of elevated mood would result in a diagnosis of a bipolar mood disorder.

absence of underlying medical conditions, medication use, or substance abuse that could cause the mood disorder

Necessary for the diagnosis.

fatigue or low energy

According to DSM-5-TR, at least 2 of 6 depressive symptoms should be present.[1]

Depressive symptoms include: poor appetite or over-eating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness.

low self-esteem

According to DSM-5-TR at least 2 of 6 depressive symptoms should be present.[1]

Depressive symptoms include: poor appetite or over-eating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness.

poor concentration or difficulty making decisions

According to DSM-5-TR, at least 2 of 6 depressive symptoms should be present.[1]

Depressive symptoms include: poor appetite or over-eating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness.

feelings of hopelessness

According to DSM-5-TR, at least 2 of 6 depressive symptoms should be present.[1]

Depressive symptoms include: poor appetite or over-eating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness.

uncommon

poor appetite or over-eating

Patients with the dysthymia subtype of persistent depressive disorder are less likely to report appetite changes than patients with a chronic major depressive disorder.

According to DSM-5-TR, at least 2 of 6 depressive symptoms should be present.[1]

Depressive symptoms include: poor appetite or over-eating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness.

sleep disturbance

Includes insomnia or hypersomnia. Patients with the dysthymia subtype of persistent depressive disorder are less likely to report sleep changes than patients with a chronic major depressive disorder.

According to DSM-5-TR, at least 2 of 6 depressive symptoms should be present.[1]

Depressive symptoms include: poor appetite or over-eating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness.

Risk factors

weak

positive family history

One study showed an increase in forms of chronic depression in first-degree relatives of people with dysthymia,[25] but another study of male twins did not reveal an increase in rates of dysthymia in monozygotic versus dizygotic twins.[26]

female sex

The lifetime prevalence of dysthymia has been reported as about 2% in men and about 4% in women.[4] Both dysthymia and chronic major depression are about twice as frequent among women as among men.[8]

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