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29.07.2014

Chronic major depressive disorder dsm iv, chronic fatigue symptom treatment - Reviews

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Since the classic descriptions, depression has been conceived as an episodic and recurrent illness. This article provides an update on the diagnosis, causation, and treatment of chronic depressive problems, with a focus on the recently introduced diagnostic category of persistent depressive disorder (PDD).
In DSM-III and DSM-IV, the protracted forms of depression have been conceptualized as dysthymia and by the chronic specifier of major depressive episodes. In DSM-III and DSM-IV, dysthymia was trumped by MDD and was only diagnosed if the threshold for a major depressive episode was not met in the initial 2 years of symptoms. While the merger of dysthymia and chronic depression into PDD is well justified by their strong sequential comorbidity and similar implications for prognosis and treatment, several aspects of the new diagnosis are not well supported by evidence and may not be useful.
The assumption that most individuals with chronic depression also fulfill the dysthymia criteria may not hold consistently enough—it creates a group of individuals who suffer from chronic depression but do not receive the PDD diagnosis.
Current nosologies of depressive illnesses do not, however, do a very good job of categorizing chronic depression.
When DSM-IV addresses the course of illness, the situation becomes much more confusing and complicated.
When the validity of these distinctions is examined, it becomes apparent that this multitude of diagnoses does not reflect the clinical reality of chronic depressive illnesses.


The natural history of chronic depression was well described in the work of the NIH Collaborative Study on the Psychobiology of Depression. McCullough and colleagues4 compared 681 outpatients with chronic depression for a broad range of demographic, clinical, psychosocial, family history, and treatment response variables. Those who had suffered at least 2 major depressive episodes but without full interepisode recovery. Depression is startlingly common; "more common than hypertension in primary care medicine," according to one article. In a later section of this paper, we'll discuss some of the societal effects of depression. Figure 9: Relationship between dose and change in score on 21-item Hamilton Depression Scale. According to an estimate published in 1993, depression swallowed 43.7 billion dollars in direct costs, mortality costs, and loss of productivity the previous year.
Depressive episodes with clear onset and offset and sharp contrast with one’s usual mood and behaviors are perhaps the most conspicuous feature of severe mood disorders. Major depressive episodes could be specified as chronic if the full criteria were continuously met for 2 years or longer.


This new division of depressive disorders gives more weight to duration than to severity of symptoms. The term "double depression" was introduced by Keller and colleagues3 in 1982 to describe patients with MDD and a preexisting chronic minor depression (now called dysthymic disorder).
The symptomatic criteria for dysthymia differed in part from those for major depressive episode, with an emphasis on low self-esteem and hopelessness (Table 1). DSM-5 defines PDD on the basis of the set of symptoms for dysthymia, with the assumption that most individuals who meet the full symptoms for MDD also meet criteria for dysthymia. Although this term appears commonly in the clinical literature and comes closest to reflecting the clinical reality of chronic depression, it is not a DSM diagnosis and must be captured in DSM-IV by assigning 2 diagnoses (MDD and dysthymia). For dysthymic disorder, symptoms must present for 2 years (1 year in children and adolescents) with no absence of symptoms lasting more than 2 months. Also, there can be no major depressive episode during the first 2 years of the disturbance (1 year for children and adolescents).



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