Dysthymic disorder is a type of neurotic disorder characterized by a constantly sad mood, physical inactivity and general lethargy. Disease is accompanied by vegetative-somatic disorders and sleep disorders. He has such distinctive features as an optimistic outlook on the future, the preservation of the ability to work professionally, the absence of deep personality changes. For the diagnosis, a consultation with a neuropsychiatrist is necessary. Treatment is carried out by a combination of psychotherapeutic techniques with the use of medications (antidepressants, neuroleptics, psychostimulants, sedatives) and physiotherapy (hydrotherapy, reflexotherapy, electroson, massage).
ICD 10
F34.1 Dysthymia
General information
In neurology, psychology and psychiatry, along with the term “dysthymic disorder”, the name “neurotic depression” is also used, which was introduced into medicine back in 1895. In world practice, not all doctors tend to single out dysthymic disorder as an independent disease. For example, American experts include it in such a concept as situational depression.
The most susceptible to the development of dysthymic disorder are straightforward and purposeful people, categorical in their opinions, accustomed to restrain the external manifestations of their inner experiences. The second group in terms of the frequency of development of dysthymic disorder consists of people with low self-esteem, having difficulty making decisions and poorly adapting to changes in life.
Causes
Dysthymic disorder is a psychogenically conditioned condition, i.e. its occurrence is associated with external traumatic circumstances. Causal situations, as a rule, are particularly significant for the patient and have a long course. There are 2 main groups of traumatic situations that lead to dysthymic disorder.
- The first is numerous failures that occur in several areas of the patient’s activity at once and cause him to feel like a “failed life”.
- The second group is the so—called circumstances of emotional deprivation, when the patient is forced to hide some kind of relationship, cannot establish contact with a person close to him, is separated from loved ones, does not have the opportunity to do what he likes, etc.
Usually dysthymic disorder occurs against the background of long-term psychotraumatic circumstances. At the same time, the patient considers the situation unsolvable and directs his efforts not to find a solution to the problem, but to hide the negative emotions associated with it. This leads to the development of functional disorders in the central nervous system and, first of all, to vegetative-somatic disorders accompanying the onset of dysthymic disorder.
Symptoms
In the classical case, dysthymic disorder is characterized by a triad of typical symptoms: a decrease in vital activity and even some general lethargy, depressed mood, slow thinking and speech. At the beginning of the disease, a low mood background and general weakness are combined with various vegetative-somatic symptoms: dizziness, palpitations, fluctuations in blood pressure, decreased appetite, functional disorders of the gastrointestinal tract. As a rule, these manifestations force patients to visit a therapist who prescribes symptomatic therapy for them.
However, despite the ongoing therapeutic treatment, in patients with neurotic depression, a feeling of weakness progresses, persistent arterial hypotension develops, and spastic colitis often occurs. Patients note an even greater deterioration in mood, constant sadness and apathy, lack of positive emotions from joyful events.
Typically, a decrease in motor activity, poor facial expressions, slow pace of thinking, quiet and slow speech. A decrease in vital activity and apathy are manifested mainly when choosing entertainment or when it is necessary to contact someone, often without affecting the professional activity of the patient. On the contrary, many patients have a “flight to work” (especially if the causal situation is related to family relations).
In most cases, sleep disorders occur with dysthymic disorder. The most typical are difficulty falling asleep and night awakenings, accompanied by palpitations and a feeling of anxiety. However, unlike hypochondriac neurosis, they do not lead to fixation of the patient on unpleasant sensations in the cardiac region. In the morning, patients with dysthymic disorder note weakness and weakness characteristic of neurasthenia. They lack the typical increase in anxiety and longing in the morning for depressive disorder.
Unlike classical (psychotic) depression, with dysthymic disorder, clinical symptoms do not reach the degree of psychosis, but have a less deep neurotic severity. Patients with dysthymic disorder are able to maintain self-control, adequately perceive what is happening and do not lose contact with others. They do not have suicidal thoughts and are optimistic about the future.
Dysthymic disorder is not accompanied by a dreary hopeless view of the future, as it happens with psychotic depression. On the contrary, when thinking about their plans, patients do not seem to take into account the current unfavorable situation. This feature of psychogenic depression has been singled out by a number of authors as a symptom of “hope for a bright future”.
Diagnostics
The complexity of the diagnosis of dysthymic disorder is due to the fact that the patient himself does not associate his condition with psychogenic factors and in conversation with doctors never mentions the presence of a chronic traumatic situation. Therefore, manifestations of neurotic depression are often attributed to concomitant symptoms of somatic disease (vegetative-vascular dystonia, chronic gastritis, colitis, etc.). In this regard, it is important to consult such patients with a neuropsychiatrist, who conducts a thorough questioning of the patient aimed at determining the cause of the disease and identifying the experiences that torment him. In order to exclude somatic pathology, a patient with dysthymic disorder may be prescribed: consultation of a cardiologist and gastroenterologist, ECG, abdominal ultrasound, EEG, Echo-EG, etc.
It is necessary to differentiate dysthymic disorder from anxiety-phobic neurosis, hypochondriac neurosis, asthenia, neurasthenia and chronic fatigue syndrome. At the same time, when diagnosing dysthymic disorder, the possibility of combining depressive symptoms and other neurotic manifestations with the formation of hypochondriac-depressive, astheno-depressive, anxiety-depressive and phobic-depressive syndromes should be taken into account.
A thorough study of the patient’s anamnesis and mental status helps to differentiate dysthymic disorder from psychogenic depression and the depressive phase of manic-depressive psychosis, which are characterized by recurrent sudden character and significant mental disorganization of the personality.
Treatment
Effective therapy of dysthymic disorder is possible only with a combination of psychotherapeutic effects with the use of medications and physiotherapy techniques. In neurotic depression, psychotherapists widely use persuasion treatment, which consists in the logical elaboration of a traumatic situation in order to change the patient’s attitude to it. Additionally, autosuggestion is used — the patient pronounces certain phrases aimed at forming a new view of the situation.
The basis of drug treatment of dysthymic disorder is usually antidepressants (imipramine, amitriptyline, moclobemide, mianserin, citalopram, etc.). Depending on the characteristics of the course of the disease, the treatment regimen may include neuroleptics, psychostimulants, sedatives, nootropics, tranquilizers. However, even well-chosen drug therapy without concomitant psychotherapy gives only temporary or partial improvement.
Physiotherapeutic methods of influence, effective in dysthymic disorder, include: darsonval, electroson, massage of the neck-collar zone, general massage (aromatherapy, classical, acupressure, Ayurvedic, phytomassage), hydrotherapy, reflexotherapy. The selection of the optimal combination of physiotherapy procedures is carried out at the consultation of a physiotherapist, taking into account the individual characteristics of the patient.
Forecast
Under the condition of correct treatment, dysthymic disorder has a favorable prognosis with a full recovery of the patient and his return to a full life. In the case of a prolonged course, the neurosis transforms into a neurotic personality disorder.
