Dysthymic disorder DSM-IV-TR criteria Depressed mood for most of d day for more days that not, How

is ur mood? as indicated either by subjective account or observation by Hv u been feeling sad, blue, down or depressed? others for at least 2 yrs IF yes : how often? Notes : in children & adolescent mood can b irritable & For how long hv u felt this way? duration must be at least 1 yr Diagnostic note : to dx dysthymia u must ensure that MDD has not present during past 2 yrs Recently hv u been > severely depressed that usual? IF no : was there a time in d past 2 yrs lasting at least 2 weeks when u felt > severely depressed than usualy Presence, while depressed 2 of following : Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self esteem Poor [ ] or difficulty making decision Feeling hopeless During d 2 yr period ( 1 yr for children & adolescent) of During d dysthymia time period were u ever free of disturbance d person never been w/out the symptoms of depression or sadness for a couple of months or more? criteria A & B for 2/12 at a time Were u ever free of symptoms in B for a couple of months or more? No MDD has been present during 1st 2 yrs o disturbance (1 yr for children & adolescent) e:g disturbance is not better accounted for by chronic MDD or MDD, In Partial Remission Note : they may hv been a prev MDD episode provided there was a FULL remission (x significant s&s for 2/12) b4 dvlpmnt of Dysthymic dz. In addition, aftr initial 2 yrs (1 yr for children & adolescent) of Dysthymic dz there may B superimposed episodes o MDD, in which case both dx may be given when d criteria r met for MDD There never hv been : Manic episode Mixed episode Hypomaniac episode Criteria never hv met for Cyclothymic dz D disturbance does not occur exclusively during course of chronic Psychotic dz e:d schizo or delusional dz D symptoms r not d/t direct physiological effect of a substance or GMC D symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning Specify if Early onset If onset < age 21 y/o Late onset If onset age 21 y/o

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Dysthymic Disorder
Long standing, fluctuating, low grade depression, experienced as part of the habitual self & representing an accentuation of traits observed in depressive temperament Etiology Sleep studies Neuroendo. study Biological study 2 state markers of MDD & dysthymic px : rapid eye mvmnt (REM) latency REM density Study using adrenal axis & thyroid axis tested using dexa suppression test & thyrotropin- releasing hormone stimulation test : Px wif dysthymic dz r < likely to hv abnorm DST result that MDD px Psychosocial factors Using SAME cognitive theory of depression Disparity btwn actual & fantasized fantasies diminished self esteem & sense o helplessns DDX Minor depressive dz Recurrent brief depressive dz Btwn episode Minor DD Dysthymic dz Euthymic Yes No mood Brief period (<2 wks) during which depressive episode r present Differ w dysthymia : Hv episodic disorder Symptoms > severe MDD + dysthymic disorder = double depression Cognitive therapy Behavior therapy Insight-oriented (psychoanalytic) psychotherapy **

TX Px r taught new ways o thinking & behaving to replace faulty ve attitudes about themselves, world, future Attempts to relate dvlpmnt & maintenance o depressive symtp & maladaptive personality features to unresolved conflicts from early childhood current r/ship w parents, friends, & other r examined can get insight into depressive equivalent or into childhood dissappoiment Px current interpersonal xperiences & ways o coping w stress r examined to depressive symptoms & improve self esteem SSRI, buproprion, MOA inhibitors, antidepressant Only in : Severe symptoms Marked social or professional incapatation Need for extensive dx procedures Suicidal ideation

Interpersonal therapy Family & group therapy Pharmacotherapy Hospitalization

Cognitive theory Freud theory

" Dari Abu Abdul Rahman, Abdullah bin Umar r.a, berkata : Aku telah mendengar Rasulullah SAW bersabda : ' Islam itu didirikan atas lima ( pekara ) - Menyaksikan bahawa tiada Tuhan melainkan Allah, dan bahawasanya Muhammad itu Rasulullah, mendirikan sembahyang, mengeluarkan zakat, naik haji ke Baitullah dan puasa sebulan Ramadhan. "

Double depression Alcohol & substance abuse

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