Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-06-01T04:33:06.632Z Has data issue: false hasContentIssue false
  • English
  • Français

Characteristics, recognition and treatment of dysthymics in primary care

Published online by Cambridge University Press:  16 April 2020

Y Lecrubier  and
E Weiller
Y Lecrubier
Affiliation:
INSERM U302, Pavillon Clérambault, Hôpital de la Salpêtrière, 47 Bd de l'Hôpital, F-75013Paris, France
E Weiller
Affiliation:
INSERM U302, Pavillon Clérambault, Hôpital de la Salpêtrière, 47 Bd de l'Hôpital, F-75013Paris, France
Get access

Summary

As part of the WHO-PPGHC study aimed to better understand the form, frequency and burden of psychiatric conditions in primary care throughout the world, the clinical characteristics of dysthymic patients consulting in primary care were examined. A total of 25,916 general health care attenders at 15 sites in 14 countries were screened using the 12-item General Health Questionaire (GHQ-12). Of those screened, 5,438 were assessed in detail using a Primary Health Care version of the Composite International Diagnostic Interview (CIDI-PHC) in conjunction with among others the Brief Disability Questionnaire (BDQ) and the 28-item General Health Questionnaire (GHQ-28). General practitioners (GPs) gave their opinion on the existence of a psychological problem and indicated what therapeutic intervention was proposed to patients they recognised as psychological cases. The estimated current prevalence of dysthymia as defined by the ICD-10 was 2.1%. The social disability was found to be substantial in patients with dysthymia (52.2% of patients moderately or severely disabled) similar to that observed in patients with Depressive Episode (DE) (57.4%). When both conditions were present, the level of disability was even higher (63.6%). The symptoms presented by dysthymic patients without DE were mostly those specific for the diagnosis of dysthymia (ie, tearful, hopeless, inability to cope, pessimism) while these symptoms were less frequent when dysthymia was complicated by a DE. On the contrary, fatigue and loss of interest were more rarely observed in “pure” dysthymics. In spite of a lower symptomatic severity about half of the patients with dysthymia were recognised as cases by their GPs, a proportion similar to those with DE. However, dysthymics without DE were not, in contrast to patients with DE or with dysthymia and DE, more treated with drugs than non-depressed patients.

Keywords

dysthymiaprimary carerecognitiontreatment
Type
Research Article
Information
European Psychiatry , Volume 13 , Issue 4 , July 1998 , pp. 198 - 202
Copyright
Copyright © Elsevier, Paris 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akiskal, HSDysthymic disorder: psychopathology of proposed chronic depressive sybtypes. Am J Psychiatry 1983; 140: 11–20Google Scholar
Akiskal, HSDysthymia: clinical and external validity. Acta Psychiatr Scand 1994 89 suppl 383 19–23CrossRefGoogle Scholar
Akiskal, HS, Rosenthal, TL, Haykal, RF, Lemmi, H, Rosenthal, RH, Scott-Strauss, ACharacterologic depressions: Clinical and sleep EEG findings separating “subaffective dysthymias” from “character spectrum disorders”. Arch Gen Psychiatry 1980; 37: 777–783CrossRefGoogle Scholar
Akiskal, HS, Lemmi, H, Dickson, H, King, D, Yerevanian, B, Van Valkenberg, CChronic depressions. Part 2. Sleep EEG differentiation of primary dysthymic disorders from anxious depressions. J Affective Disord 1984; 6: 287–295CrossRefGoogle ScholarPubMed
Bronisch, T, Wittchen, H, Krieg, C, et al.Depressive neurosis Acta Psychiatr Scand 1985 71 237–248CrossRefGoogle ScholarPubMed
Charney, DS, Nelson, JC, Quinlan, DMPersonality traits and disorder in depression. Am J Psychiatry 1981; 138: 1601–1604Google ScholarPubMed
Goldberg, DP, Williams, PA users guide to the General Health Questionnaire: (GHQ). Windsor: Nfer-Nelson; 1988Google Scholar
Goldberg, DP, Lecrubier, YForm and frequency of mental disorders across centres. In: Ustün, TB, Sartorius, N eds. Mental illness in general health care. An international study. New York: John Wiley & Sons Ltd; 1995; 323–334Google Scholar
Keller, MB, Shapiro, RW“Double Depression”: superimposition of acute depressive episodes on chronic depressive disorders. Am J Psychiatr 1982; 139: 438–442Google ScholarPubMed
Keller, MB, Lavori, PW, Endicot, J, et al.“Double Depression” two-year follow-up Am J Psychiatr 140 1983 689–694Google ScholarPubMed
Koenigsberg, HW, Kaplan, RD, Gilmore, MM, et al.The relationship between syndrome and personality disorder in DSM-III: experience with 2,462 patients Am J Psychiatry 1985 142 207–212Google ScholarPubMed
Lecrubier, Y, Weiller, E, Bisserbe, JCPharmacological treatment of dysthymia with MAOIs and new other compounds. In: WHO eds. Expert Series in Neurosciences 1997. Geneva: WHO; 1997; 103–109Google Scholar
Lecrubier, YPharmacotherapy of chronic minor depression and/or dysthymia. In: WHO eds. WHO Expert Series in Neurosciences 1997. Geneva: WHO; 1997; 124–130Google Scholar
Pfohl, B, Stangle, D, Zimmerman, MThe implications of DSM III personality disorders for patients with major depression. J Affective Disord 1984; 7: 309–318CrossRefGoogle ScholarPubMed
Robins, LN, Helzer, JE, Weissmann, MM, et al.Lifetime prevalence of specific psychiatric disorders in three sites Arch Gen Psychiatry 1984 41 949–958CrossRefGoogle ScholarPubMed
Rosenthal, TL, Akiskal, HS, Scott-Strauss, A, Rosenthal, RH, Davis, MFamilial and developmental factors in characterologic depressions. J Affect Disord 1981; 3: 183–192CrossRefGoogle Scholar
Rounsaville, BJ, Sholomskas, D, Prissof, BAChronic mood disorders in depressed outpatients. J Affective Disord 1980; 2: 73–88CrossRefGoogle Scholar
Sartorius, N, Üstün, TB, Costa e Silva, JA, et al.An international study of psychological problems in primary care. Preliminary report from the World Health Organization collaborative project on ‘Psychological Problems in General Health Care’ Arch Gen Psychiatr 1993 50 819–824CrossRefGoogle Scholar
Stewart, AL, Hays, RD, Ware, JEThe MOS short form general health survey: reliability and validity in a patient population. Med Care 1988; 26: 724–735CrossRefGoogle Scholar
Tyrer, PTowards rational therapy with monoamine oxidase inhibitors. Br J Psychiat 1976; 128: 354–360CrossRefGoogle ScholarPubMed
Von Korff, M, Üstün, TBMethods of the WHO Collaborative Study on ‘Psychological Problems in General Health Care”. In: Üstün, TB, Saltorius, N eds. Mental Illness in General Health Care. An International Study. Chichester: Wiley; 1995; 19–36Google Scholar
Ware, JEJ, Sherboume, CDThe MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30: 473–483CrossRefGoogle ScholarPubMed
Weissman, MM, Klerman, GLThe chronic depressive in the community: under-recognized and poorly treated. Compr Psychiatr 1977; 18: 523–531CrossRefGoogle Scholar
West, ED, Dally, PJEffect of iproniazide in depressive syndromes. Br Med J 1959; 1: 1491–1494CrossRefGoogle Scholar
World Health Organization The primary health care version of the Composite International Diagnostic Interview: CIDI-PHC. Geneva: WHO; 1991Google Scholar
Submit a response

Comments

No Comments have been published for this article.