Dysthymia is defined as a low mood occurring for at least two years, along with at least two

other symptoms of depression.

Examples of symptoms include lost interest in normal activities, hopelessness, low self-esteem,
low appetite, low energy, sleep changes and poor concentration.

Dysthymic disorder, often called a persistent depressive disorder, or just dysthymia, is a chronic
type of depression that can last for years if untreated. This article will cover what dysthymic
disorder is and things that you should be aware of, and how you can get help if you believe you
have dysthymia.

B.HISTORY COLLECTION

HISTORY COLLECTION
I. IDENTIFICATION
Name: I. N

Sex: Female

Age: 37years old

Marital status: Single

Place of birth: Eastern

Bugesera District

Bigger Sector

kanzenzi Cell

Ngamba village

Sibling’s position: 5th

Profession: Accountant

Religion: catholic

Nationality: Rwandese

Admission date:
II. CHIEF COMPLAINT
The patient has been brought by her brother because of having physical and verbal aggressively,
total insomnia, and logorrhea.

III. ANTECEDENT/PEVIOUS MENTAL HISTORY

It is the 3rd crisis and all were trigged by stopping medications.

IV. FAMILY HISTORY: The client was born in a family of six children, three boys and three
girls, and she occupies the 5th place her both parents and her 2 brothers with 1 sister have been
killed in 1994 Genocide and remained five children who are all married except the client who
lives with her brother who is married having two children.

Her Uncle was mentally ill but died in 2008 with other medical condition not mental problem.

Genogram:
+ +

+ + +

Live together
V. MEDICAL AND SURGICAL: None

VI. GYNECOLOGICAL HISTORY: She is still single with no gynecological problems.

VII. JUDICIAL HISTORY: None

VIII. PHYSICAL EXAMINATIONS

i) General appearance: she is weak due to side effects of drugs.

ii) HEENT: Patient does not have any problem in eyes with no jaundice, moisture mouth; pink
tongue with no sore throat neck is flexed, proper hairs, etc.
iii) Respiratory system: no any problem in respiration presented or observed to the client.
iv) Cardiovascular system: no problem indicated to the heart with normal heart sounds.

v) Nervous system: normal sensations, shaking due to side effects of drugs, pupils are reacting
to light, with GCS of 15/15.

vi) GI: No abdominal tenderness or distended

vii) Urinary system: no complaints of urination with normal urine output.

viii) Integumentary system: she has scars on the legs and left arm due to wounding during 2nd
crisis.
ix. Vital signs: Blood pressure: 118/75mmhg
Pulse: 88 bpm
Temperature: 36.70c
Respiration rate: 18 bpm
X. PSYCHIATRIC CONDITIONS

General appearance: she is a middle size girl who is well dress compared to the time of
admission. She appears her stated age, with no agitation or hyperactivity compared to before.

Affect and mood: Appropriate affect, and labile mood.

Perception: she no longer has hallucinations and no illusion as before.

Thought and speech: Has a normal flow of speech compared to before where she had logorrhea.
Her thoughts full of hopelessness and low self-esteem but no delusions.

Orientation: she is oriented to time, place and to person.

Memory and concentration: she has the ability to recall past and recent history of her life.

Judgment and impulse control: she has ability to plan for his future

Insight: negative

Vegetative symptoms: normal level of energy

Maintains normal sleep cycle

MULTIAXIAL DIAGNOSIS
Axis I: Dysthymia

Axis II: neither mental retardation nor personality disorder

Axis III: NONE

AXIS IV: Job stress and excessive losses

XI. COMPLEMENTARY EXAMS

-Full blood count (FBC): NORMAL RESULTS

-HIV Test: Neg.

Signs and symptoms

Dysthymia characteristics include an extended period of depressed mood combined with at least
two other symptoms which may include insomnia or hypersomnia, fatigue or low energy, eating
changes (more or less), low self-esteem, or feelings of hopelessness. Poor concentration or
difficulty making decisions are treated as another possible symptom. Irritability is one of the
more common symptoms in children and adolescents.

Diagnosis of dysthymia can be difficult because of the subtle nature of the symptoms and
patients can often hide them in social situations, making it challenging for others to detect
symptoms. Additionally, dysthymia often occurs at the same time as other psychological
disorders, which adds a level of complexity in determining the presence of dysthymia,
particularly because there is often an overlap in the symptoms of disorders.[12]

There is a high incidence of comorbid illness in those with dysthymia. Suicidal behavior is also a
particular problem with those with dysthymia. It is vital to look for signs of major
depression, panic disorder, generalized anxiety disorder, alcohol and substance use disorders,
and personality disorder.

Causes

There are no known biological causes that apply consistently to all cases of dysthymia, which
suggests diverse origin of the disorder. [12] However, there are some indications that there is a
genetic predisposition to dysthymia: "The rate of depression in the families of people with
dysthymia is as high as fifty percent for the early-onset form of the disorder".[9] Other factors
linked with dysthymia include stress, social isolation, and lack of social support.[12]

In a study using identical and fraternal twins, results indicated that there is a stronger likelihood
of identical twins both having depression than fraternal twins. This provides support for the idea
that dysthymia is in part caused by heredity.

Co-occurring conditions

Dysthymia often co-occurs with other mental disorders. A "double depression" is the occurrence
of episodes of major depression in addition to dysthymia. Switching between periods of
dysthymic moods and periods of hypomanic moods is indicative of cyclothymia, which is a mild
variant of bipolar disorder.

"At least three-quarters of patients with dysthymia also have a chronic physical illness or another
psychiatric disorder such as one of the anxiety disorders, cyclothymia, drug addiction, or
alcoholism".[9] Common co-occurring conditions include major depression (up to 75%), anxiety
disorders (up to 50%), personality disorders (up to 40%), somatoform disorders (up to 45%) and
substance use disorders (up to 50%).[12] People with dysthymia have a higher-than-average
chance of developing major depression.[14] A 10-year follow-up study found that 95% of
dysthymia patients had an episode of major depression.[15] When an intense episode of depression
occurs on top of dysthymia, the state is called "double depression.
Double depression

Double depression occurs when a person experiences a major depressive episode on top of the
already-existing condition of dysthymia. It is difficult to treat, as sufferers accept these major
depressive symptoms as a natural part of their personality or as a part of their life that is outside
of their control. The fact that people with dysthymia may accept these worsening symptoms as
inevitable can delay treatment. When and if such people seek out treatment, the treatment may
not be very effective if only the symptoms of the major depression are addressed, but not the
dysthymic symptoms. 

Pathophysiology

There is evidence that there may be neurological indicators of early onset dysthymia. There are
several brain structures (corpus callosum and frontal lobe) that are different in women with
dysthymia than in those without dysthymia. This may indicate that there is a developmental
difference between these two groups.[17]

Another study, which used fMRI techniques to assess the differences between individuals with
dysthymia and other people, found additional support for neurological indicators of the disorder.
This study found several areas of the brain that function differently. The amygdala (associated
with processing emotions such as fear) was more activated in dysthymia patients. The study also
observed increased activity in the insula (which is associated with sad emotions). Finally, there
was increased activity in the cingulate gyrus (which serves as the bridge between attention and
emotion).

A study comparing healthy individuals to people with dysthymia indicates there are other
biological indicators of the disorder. An anticipated result appeared as healthy individuals
expected fewer negative adjectives to apply to them, whereas people with dysthymia expected
fewer positive adjectives to apply to them in the future. Biologically these groups are also
differentiated in that healthy individuals showed greater neurological anticipation for all types of
events (positive, neutral, or negative) than those with dysthymia. This provides neurological
evidence of the dulling of emotion that individuals with dysthymia have learned to use to protect
themselves from overly strong negative feelings, compared to healthy people.
There is some evidence of a genetic basis for all types of depression, including dysthymia. A
study using identical and fraternal twins indicated that there is a stronger likelihood of identical
twins both having depression than fraternal twins. This provides support for the idea that
dysthymia is caused in part by heredity.

Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), published by

the American Psychiatric Association, characterizes dysthymic disorder. The essential symptom
involves the individual feeling depressed for the majority of days, and parts of the day, for at
least two years. Low energy, disturbances in sleep or in appetite, and low self-esteem typically
contribute to the clinical picture as well. Sufferers have often experienced dysthymia for many
years before it is diagnosed. People around them often describe the sufferer in words similar to

During a majority of days for two years or more, the adult patient reports depressed mood, or
appears depressed to others for most of the day.

1. When depressed, the patient has two or more of:

1. decreased or increased appetite
2. decreased or increased sleep (insomnia or hypersomnia)
3. Fatigue or low energy
4. Reduced self-esteem
5. Decreased concentration or problems making decisions
6. Feelings of hopelessness or pessimism
Prevention

Though there is no clear-cut way to prevent dysthymia from occurring, some suggestions have
been made. Since dysthymia will often first occur in childhood, it is important to identify
children who may be at risk. It may be beneficial to work with children in helping to control their
stress, increase resilience, boost self-esteem, and provide strong networks of social support.
These tactics may be helpful in warding off or delaying dysthymic symptoms.

Treatments

Persistent depressive disorder can be treated with psychotherapy and pharmacotherapy. The

overall rate and degree of treatment success is somewhat lower than for non-chronic depression,
and a combination of psychotherapy and pharmacotherapy shows best results.
Therapy
Psychotherapy can be effective in treating dysthymia. In a meta-analytic study from 2010,
psychotherapy had a small but significant effect when compared to control groups. However,
psychotherapy is significantly less effective than pharmacotherapy in direct comparisons.[31]
There are many different types of therapy, and some are more effective than others.

 The empirically most studied type of treatment is cognitive-behavioral therapy. This type
of therapy is very effective for non-chronic depression, and it appears to be also effective for
chronic depression.
 Cognitive behavioral analysis system of psychotherapy (CBASP) has been designed
specifically to treat PDD. Empirical results on this form of therapy are inconclusive. While
one study showed remarkably high treatment success rates,[33] a later, even larger study
showed no significant benefit of adding CBASP to treatment with antidepressants.
 Schema therapy and psychodynamic psychotherapy have been used for PDD, though
good empirical results are lacking.
 Interpersonal psychotherapy has also been said to be effective in treating the disorder,
though it only shows marginal benefit when added to treatment with antidepressants.
Medications
In a meta-analytic study from 2005, it was found that SSRIs and TCAs are equally effective in
treating dysthymia. They also found that MAOIs have a slight advantage over the use of other
medication in treating this disorder. However, the author of this study cautions that MAOIs
should not necessarily be the first line of defense in the treatment of dysthymia, as they are often
less tolerable than their counterparts, such as SSRIs.