UW cases: persistent depressive Flashcards
(9) A 24-year-old woman comes to the office for a preemployment health evaluation before starting a job at a day care. When asked how she is doing, the patient says, “I was dating a guy, but he stopped returning my phone calls last week, so I’m feeling pretty low. My mom says that he wasn’t the right match for me and that I can’t rely on men to feel good about myself. I’ve had low self-esteem for as long as I can remember, and my mood has always been down, probably since high school.” She has had no appetite changes or sleep disturbances. Although the patient dates, she has never had a serious relationship because she believes she is unattractive and does not have much to contribute. The patient describes having a close relationship with her mother, with whom she has been living since graduating from college, and likes watching movies and cooking with her. In review of systems, she indicates intermittent headaches, occasional abdominal bloating and constipation, and fatigue. Vital signs are normal. Physical examination and routine laboratory evaluation show no abnormalities. She has no thoughts of suicide. Which of the following is the most likely diagnosis in this patient?
Persistent depressive disorder (PDD) (dysthymia)
Chronic, low-grade depression that lasts for years. Diagnosis requires depressed mood more days than not for ≥2 years (1 year in children) and ≥2 additional depressive symptoms.
(9) This patient reports chronically low mood since high school (ie, at least 6 years), low self-esteem (eg, believes she is unattractive, does not have much to contribute), and fatigue, thus meeting the criteria for PDD. In addition, PDD can include superimposed major depressive episodes that may be either intermittent or persistent (ie, full major depressive criteria met for last 2 years). If major depressive episodes have not also occurred, PDD is a pure dysthymic syndrome subtype.
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(9) Tx of Persistent depressive disorder (PDD) (dysthymia)?
Treatment of PDD with or without a history of a major depressive episode includes antidepressants, psychotherapy, or a combination thereof.
