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Dysthymic Disorder: Differential Diagnoses & Workup
Updated: Dec 5, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Other Problems to Be Considered
Mood disorder due to a general medical condition
Alcohol-induced mood disorder
Substance-induced mood disorder
Alcohol or substance use or abuse
Personality disorder
Schizoaffective disorder
Bereavement
Adjustment disorder with depressed mood
Adjustment disorder with mixed anxiety and depressed mood
Depressive disorder not otherwise specified
Seasonal affective disorder
Growth retardation
Language disorder: Mixed
Language disorder: Phonology
Language disorder: Receptive
Language disorder: Stuttering
Somatoform disorder: Hypochondriasis
Workup
Laboratory Studies
- Perform laboratory studies in patients with dysthymic disorder only when the history and physical examination suggest their relevance.
Imaging Studies
- Few, if any, studies use either structural (ie, CT scan, MRI) or functional (ie, positron emission tomography [PET], single-photon emission computed tomography [SPECT], magnetic resonance spectroscopy [MRS]) imaging in the diagnosis of dysthymia in pediatric patients.
Other Tests
- The American Academy of Child and Adolescent Psychiatry (AACAP) recommends screening of children and adolescents for depressive symptoms, specifically sad mood, irritability, and anhedonia. If these symptoms are present most of the time, affect the child's psychosocial functioning, or are greater than the expected level for the child's developmental stage, then further evaluation for the presence of depression should be undertaken.
- Assessment of dysthymic disorder in children can be accomplished in several ways. The AACAP recommends a comprehensive mental health diagnostic evaluation as the single most useful tool in the diagnosis of depressive disorders. Standardized diagnostic interviews, conducted by clinicians or lay examiners, are often used in research settings and have been psychometrically studied. Self-report questionnaires have been developed but mainly serve as screening tools and may not reflect diagnostic criteria for dysthymic disorder. Likewise, ratings by teachers, parents, and peers may be helpful as part of the overall assessment of the depressed pediatric patient but, of course, are not be sufficient to make a diagnostic determination.
- According to the AACAP, a comprehensive mental health diagnostic evaluation consists of separate or conjoint interviews by a trained clinician with the patient and the parents or caregivers. Contact with other informants (eg, teachers, primary care physicians) is helpful. A mental status examination, modified as necessary for the patient's developmental age, should be part of the assessment. Physical examination and, as noted above, laboratory tests as suggested by the physical examination are often helpful in ruling out general medical conditions that may produce depressive symptoms. In addition, the mental health professional should obtain information about the following:
- Risk factors for suicidal or homicidal actions (ie, age, sex, stressors, comorbid conditions, hopelessness, impulsivity)
- Protective factors for suicidal or homicidal actions (eg, religious belief, concern about hurting family)
- Comorbid psychiatric diagnoses
- Psychosocial problems
- Academic problems
- Recent and historical negative life events
- Family psychiatric history and presence of family psychopathology
- Level of social support
- Medical history
- Current and past use of medications
- Substance use
- An assessment of global functioning will be useful in determining current impairment, if any, in life tasks.
- The Child Assessment Schedule (CAS), administered by a trained clinician, reliably and validly assesses dysthymic disorder, as does the Interview Schedule for Children (ISC). Another widely used research scale, the Schedule for Affective Disorders and Schizophrenia in School-Age Children (K-SADS), does not assess dysthymia as a separate diagnostic category. Other structured interview schedules for use with lay interviewers do not differentiate dysthymic disorder from generalized depression.
- Self-report measurement scales, such as the Children's Depression Inventory (developed from the Beck Depression Inventory) and the Reynolds Child and the Reynolds Adolescent depression scales, can be very helpful when used as screening tools. They have the advantage of also providing a means of assessing treatment response when used as repeated measures. Indications of depression on self-report scales should be followed with a more thorough assessment by a physician or mental health professional. Multiple informants and multiple methods (eg, self-report, interview, observations) provide the most thorough picture of the extent of depression and the level of impairment of functioning.
More on Dysthymic Disorder |
| Overview: Dysthymic Disorder |
 Differential Diagnoses & Workup: Dysthymic Disorder |
| Treatment & Medication: Dysthymic Disorder |
| Follow-up: Dysthymic Disorder |
| References |
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References
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Further Reading
Keywords
dysthymic disorder, mood disorder, dysthymia, depressive neurosis, neurotic depression, depressive personality, depression, irritable mood, diminished appetite, increased appetite, insomnia, hypersomnia, low energy, fatigue, poor self-esteem, concentration difficulties, decision-making difficulties, feelings of hopelessness, suicide, suicidal thoughts, suicidality, bipolar disorder, anxiety disorder, conduct disorder, enuresis, encopresis, sexual abuse, hyperactivity, learning disabilities, attention deficit hyperactivity disorder, ADHD, schizophrenia, social withdrawal, hypersomnia, major depressive disorder
