Pediatric Dysthymic Disorder Clinical Presentation

  • Author: Edwin S Rogers, PhD, ABPP; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Apr 19, 2012
 

History

The clinical history is crucial in making the diagnosis of dysthymic disorder. Behavioral assessment in pediatric patients must take into account the patient's current developmental stage and often includes information from additional sources, mainly parents and teachers. (In addition to taking the patient’s history, conducting a thorough physical examination is important, to rule out medical illness as a cause of symptoms.)

In the case of all suspected depressive disorders, suicidal ideation, homicidal ideation, and a history of behavior in which the patient has harmed himself/herself or others must be assessed during the initial presentation and throughout the course of treatment. Although these symptoms are more closely associated with more severe diagnoses than dysthymia, given the comorbidities in psychiatric illness, these factors need to be considered throughout the clinical process.

DSM-IV criteria

Diagnostic criteria taken from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), from the American Psychiatric Association (APA) are as follows[3] :

  • A - Depressed (or irritable) mood for most of the day for more days than not as indicated by subjective account or observation by others for at least 1 year; in children, the parental report may emphasize behavioral difficulties expressing depression, whereas the child can give a better account of internalizing symptoms, including suicidal ideation
  • B - The presence, while depressed, of 2 (or more) of the following: (1) poor appetite or overeating, (2) insomnia or hypersomnia, (3) low energy or fatigue, (4) low self-esteem, (5) poor concentration or difficulty making decisions, and (6) feelings of hopelessness
  • C - During the 1-year period of the disturbance, the person has never been without the symptoms in criteria A and B for more than 2 months at a time
  • D - No major depressive episode has been present during the first year of the disturbance; that is, the disturbance is not better accounted for by chronic major depressive disorder or major depressive disorder in partial remission
  • E - No manic episode, mixed episode, or hypomanic episode is noted, and criteria have never been met for cyclothymic disorder
  • F - The disturbance does not occur exclusively during the course of a chronic psychotic disorder, such as schizophrenia or delusional disorder
  • G - The symptoms are not due to the direct physiologic effects of a substance (eg, a drug of abuse, a medication) or a general medical condition (eg, hypothyroidism)
  • H - The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Additional symptoms

Symptoms associated with dysthymic disorder but not included in the formal diagnostic criteria are anger, feelings of being unloved, self-deprecation, anxiety, and disobedience.

The chronic course of dysthymic disorder can contribute to academic, social, and behavioral disruption, with profound effects on psychological and educational development. Children and adolescents with dysthymic disorder may develop more acute and intense depressive symptoms sufficient to meet the criteria for major depression.

Symptoms found primarily in children

Some symptoms of depressive disorders are more common in children than in adults. For example, irritability, social withdrawal, and somatic complaints (unexplained general medical complaints) are more likely to be observed in children. On the other hand, hypersomnia and psychomotor retardation are more common in adults. Children, particularly younger children, may display aggressive behavior and psychomotor agitation as aspects of dysthymic disorder.

Dysthymic disorder versus major depressive disorder

A considerable overlap of symptoms is observed between dysthymic disorder and major depressive disorder, and the relationship between them is the subject of ongoing debate. However, dysthymic disorder and major depressive disorder differ in terms of chronicity and pervasiveness.

Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Edwin S Rogers, PhD, ABPP  Clinical Psychologist, Director of Behavioral Medicine Fellowship, Professor, Department of Family Medicine, University of Tennessee Graduate School of Medicine

Edwin S Rogers, PhD, ABPP is a member of the following medical societies: Association for Behavioral Science and Medical Education, North American Primary Care Research Group, and Society of Teachers of Family Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Steven L Spalding, MD  Staff Physician, Family Medicine, Norton Community Medical Associates

Steven L Spalding, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Family Physicians, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

  1. Demir T, Karacetin G, Demir DE, Uysal O. Epidemiology of depression in an urban population of Turkish children and adolescents. J Affect Disord. Nov 2011;134(1-3):168-76. [Medline].

  2. Hetrick SE, Parker AG, Robinson J, Hall N, Vance A. Predicting Suicidal Risk in a Cohort of Depressed Children and Adolescents. Crisis. Jul 6 2011;1-8. [Medline].

  3. American Psychiatric Association. Dysthymic disorder. In: DSM-IV-TR 2000: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. American Psychiatric Press;2000: 376-381.

  4. Vance A, Sanders M, Arduca Y. Dysthymic disorder contributes to oppositional defiant behaviour in children with Attention Deficit Hyperactivity Disorder, combined type (ADHD-CT). J Affect Disord. Jun 2005;86(2-3):329-33. [Medline].

  5. Pietsch K, Allgaier AK, Frühe B, Rohde S, Hosie S, Heinrich M, et al. Screening for depression in adolescent paediatric patients: validity of the new Depression Screener for Teenagers (DesTeen). J Affect Disord. Sep 2011;133(1-2):69-75. [Medline].

  6. Bostic JQ, Wilens T, Spencer T, Biederman J. Juvenile mood disorders and office psychopharmacology. Pediatr Clin North Am. Dec 1997;44(6):1487-503. [Medline].

  7. Birmaher B, Brent D, Bernet W, et al. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry. Nov 2007;46(11):1503-26. [Medline].

  8. Jonsson U, Bohman H, von Knorring L, Olsson G, Paaren A, von Knorring AL. Mental health outcome of long-term and episodic adolescent depression: 15-year follow-up of a community sample. J Affect Disord. May 2011;130(3):395-404. [Medline].

  9. US Food and Drug Administration. FDA Public Health Advisory, October 27, 2003. Reports of suicidality in pediatric patients being treated with antidepressant medications for major depressive disorder (MDD). Available at http://www.fda.gov/Drugs/DrugSafety. Accessed Apr 11, 2012.

  10. US Food and Drug Administration. FDA Public Health Advisory, March 22, 2004. Worsening Depression and Suicidality in Patients Being Treated With Antidepressant Medications. Available at http://www.fda.gov/Drugs/DrugSafety. Accessed Apr 11, 2012.

  11. Cheung A, Sacks D, Dewa CS, Pong J, Levitt A. Pediatric prescribing practices and the FDA Black-box warning on antidepressants. J Dev Behav Pediatr. Jun 2008;29(3):213-5. [Medline].

  12. Simon GE, Savarino J, Operskalski B. Suicide risk during antidepressant treatment. Am J Psychiatry. Jan 2006;163(1):41-7. [Medline]. [Full Text].

  13. [Best Evidence] Bridge JA, Iyengar S, Salary CB, et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA. Apr 18 2007;297(15):1683-96. [Medline].

  14. Akiskal HS, Cassano GB, eds. Dysthymia and the Spectrum of Chronic Depressions. ed. Guilford Publications; 1997.

  15. Birmaher B, Ryan ND, Williamson DE, et al. Childhood and adolescent depression: a review of the past 10 years. Part I. J Am Acad Child Adolesc Psychiatry. Nov 1996;35(11):1427-39. [Medline].

  16. Brieger P, Marneros A. Dysthymia and cyclothymia: historical origins and contemporary development. J Affect Disord. Sep 1997;45(3):117-26. [Medline].

  17. Dahl RE, Brent D. Affective disorders and suicide. In: Rudolph AM, Hoffman JI, Rudolph CD, eds. Rudolph's Pediatrics. Appleton & Lange; 1996:170-3.

  18. Dwivedi KN, Varma VP, eds. Depression in Children and Adolescents. ed. Singular Publishing Group; 1997.

  19. Garrison CZ, Waller JL, Cuffe SP, et al. Incidence of major depressive disorder and dysthymia in young adolescents. J Am Acad Child Adolesc Psychiatry. Apr 1997;36(4):458-65. [Medline].

  20. Goodman SH, Schwab-Stone M, Lahey BB. Major depression and dysthymia in children and adolescents: discriminant validity and differential consequences in a community sample. J Am Acad Child Adolesc Psychiatry. Jun 2000;39(6):761-70. [Medline].

  21. Green SM, ed. Tarascon Pocket Pharmacopoeia 2001: Deluxe Lab-Coat Pocket Edition. 2nd ed. Tarascon Publishing; 2000:185.

  22. Hammen C, Rudolph K, Weisz J, et al. The context of depression in clinic-referred youth: neglected areas in treatment. J Am Acad Child Adolesc Psychiatry. Jan 1999;38(1):64-71. [Medline].

  23. Kashani JH, Allan WD, Beck NC Jr, et al. Dysthymic disorder in clinically referred preschool children. J Am Acad Child Adolesc Psychiatry. Oct 1997;36(10):1426-33. [Medline].

  24. Kazdin AE, Marciano PL. Childhood and adolescent depression. In: Mash EJ, Barkley RA, eds. The Treatment of Childhood Disorders. 2nd ed. Guilford Publications; 1998:211-248.

  25. Klein DN, Norden KA, Ferro T, et al. Thirty-month naturalistic follow-up study of early-onset dysthymic disorder: course, diagnostic stability, and prediction of outcome. J Abnorm Psychol. May 1998;107(2):338-48. [Medline].

  26. Kovacs M, Obrosky DS, Gatsonis C, Richards C. First-episode major depressive and dysthymic disorder in childhood: clinical and sociodemographic factors in recovery. J Am Acad Child Adolesc Psychiatry. Jun 1997;36(6):777-84. [Medline].

  27. Masi G, Favilla L, Mucci M. Depressive disorder in children and adolescents. Europ J Paediatr Neurol. 1998;2(6):287-95. [Medline].

  28. Medical Economics Staff. Physicians' Desk Reference 2000. 54th ed. Medical Economics Co; 2000.

  29. Pataki CS. Mood disorders and suicide in children and adolescents. In: Sadock BJ, Sadock VA, eds. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. Vol 2. Lippincott Williams & Wilkins; 2000:2740-57.

  30. Prescott CA, McArdle JJ, Hishinuma ES, et al. Prediction of major depression and dysthymia from CES-D scores among ethnic minority adolescents. J Am Acad Child Adolesc Psychiatry. May 1998;37(5):495-503. [Medline].

  31. Reynolds WM, Johnston HF, eds. Handbook of Depression in Children and Adolescents. ed. Kluwer Academic Publishers; 1994.

  32. Rickert VI, Wiemann CM, Berenson AB. Ethnic differences in depressive symptomatology among young women. Obstet Gynecol. Jan 2000;95(1):55-60. [Medline].

  33. Samaan RA. The influences of race, ethnicity, and poverty on the mental health of children. J Health Care Poor Underserved. Feb 2000;11(1):100-10. [Medline].

  34. Sanders M, Arduca Y, Karamitsios M, et al. Characteristics of internalizing and externalizing disorders in medication-naive, clinically referred children with attention deficit hyperactivity disorder, combined type and dysthymic disorder. Aust N Z J Psychiatry. May 2005;39(5):359-65. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.