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Table of Contents
Vol. 34, No. 1, 2001
Issue release date: January–February 2001
Psychopathology 2001;34:29–35

Depressive Symptoms in Children and Adolescents with Dysthymic Disorder

Masi G. · Favilla L. · Mucci M. · Poli P. · Romano R.
Division of Child Neurology and Psychiatry, University of Pisa, IRCCS Stella Maris, Calambrone, Pisa, Italy

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This report examines clinical features of ‘pure’ dysthymic disorder (DD, without superimposed major depressive disorder, MDD) in a sample of children and adolescents. Profiles of symptomatology and comorbidity as a function of age and gender are described. The sample consisted of 48 subjects (22 males, 26 females, age range 7–18 years, mean age 12.1 years) screened from consecutively referred children and adolescents. All subjects were comprehensively diagnosed with structured diagnostic interviews (Schedule for Affective Disorders and Schizophrenia for School Age, Diagnostic Interview for Children and Adolescents-Revised), according to DSM-IV criteria. Depressed mood, irritability, loss of energy and fatigue, guilt and low self-esteem were present in more than 70% of the subjects. Differences in symptomatic profile between males and females were not significant. Children showed less symptoms than adolescents, but the symptomatic profile was comparable (only anhedonia was significantly more frequent in adolescents). Anxiety disorders were more commonly comorbid with DD, especially separation anxiety disorder in children (33%) and generalised anxiety disorder in adolescents (67%). Externalising disorders were less frequently represented in our sample (14%). An early diagnosis of ‘pure’ DD before the first episode of MDD is crucial for a timely intervention.

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  1. American Psychiatric Association: Diagnostic and Statistical Manual for Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
  2. Klein DN, Taylor EB, Dickstein S, Harding K: The early-late onset distinction in DSM-III-R Dysthymia. J Affective Disord 1988;14:25–33.
  3. Garrison CZ, Waller JL, Cuffe SP, McKeown RE, Addy CL, Jackson KL: Incidence of major depressive disorder and dysthymia in young adolescents. J Am Acad Child Adolesc Psychiatry 1997;36:458–465.
  4. Kashani JH, Carlson GA, Beck NC, Hoeper EW, Corcoran CM, McAllister JA, Fallahi C, Rosemberg TK, Reid JC: Depression, depressive symptoms and depressed mood among a community sample of adolescents. Am J Psychiatry 1987;144:931–934.
  5. Lewinshon PM, Hops K, Roberts RE, Seeley JR, Andrews JA: Adolescent psychopathology: Prevalence and incidence of depression and other DSM-III-R disorders in high school students. J Abnorm Psychol 1993;102:133–144.
  6. Masi G, Mucci M, Favilla L, Poli P: Dysthymic disorder in adolescents with intellectual disability. J Intellect Disabil Res 1999;43:80–87.

    External Resources

  7. Kovacs M, Akiskal S, Gatsonis C, Parrone PL: Childhood-onset dysthymic disorder. Arch Gen Psychiatry 1994;51:365–374.
  8. Klein DN, Riso LP, Donaldson RK, Schwartz JE, Anderson RL, Ouimette PC, Lizardi H, Aronson TA: Family onset of early-onset dysthymia: Mood and personality disorders in relatives of outpatients with dysthymia and episodic major depression and normal controls. Arch Gen Psychiatry 1995;52:487–496.
  9. Warner V, Mufson L, Weissmann MM: Offspring of high and low risk of depression and anxiety: Mechanism of psychiatric disorders. J Am Acad Child Adolesc Psychiatry 1995;34:786–797.
  10. Lizardi H, Klein DN, Ouimette PC, Riso LP, Anderson RL, Donaldson SK: Reports of the childhood home environment in early-onset dysthymia and episodic major depression. J Abnorm Psychol 1995;104:132–139.
  11. Klein DN, Riso LP, Anderson RL: DSM III dysthymia: Antecedents and underlying assumptions; in Chapman LJ, Chapman JP, Fowles DC (eds): Progress in Experimental Personality and Psychopathology Research. New York, Springer, 1993, vol 16, pp 222–253.
  12. Fine S, Moretti M, Haley G, Marriage K: Affective disorders in children and adolescents: The dysthymic disorder dilemma. Can J Psychiatry 1985;30:173–177.

    External Resources

  13. Masi G, Mucci M, Favilla L, Romano R, Poli P: Symptomatology and comorbidity of Generalized Anxiety Disorder in children and adolescents. Compr Psychiatry 1999;40:210–215.
  14. Akiskal HS, Rosenthal TL, Haykal RF, Lemmi H, Rosenthal RH, Scott-Strauss A: Characteriological depression: Clinical and sleep EEG findings separating ‘subaffective dysthymias’ from ‘character spectrum disorders’. Arch Gen Psychiatry 1980;37:777–783.
  15. Angold A, Rutter M: Effect of age and pubertal status on depression in a large sample. Dev Psychopathol 1992;4:5–28.
  16. Cicchetti D, Toth SL: Developmental psychopathology and disorders of affect; in Cicchetti D, Cohen D (eds): Developmental Psychopathology. New York, Wiley and Sons, 1995, vol 2, pp 369–420.
  17. Chambers WJ, Puig-Antich J, Hirsch M, Paez P, Ambrosini PJ, Tabrizi MA, Davies M: The assessment of affective disorders in children and adolescents by semi-structured interview: Test-retest reliability of the Schedule for Affective Disorders and Schizophrenia for School Age Children Present Episode Version. Arch Gen Psychiatry 1985;42:696–702.
  18. Reich W, Shayka JI, Taibleson C: Diagnostic Interview for Children and Adolescents (DICA-R) (unpublished manuscript) St Louis, Division of Child Psychiatry, Washington University, 1991.
  19. Ferro T, Carlson GA, Grayson P, Klein DN: Depressive disorders: Distinctions in children. J Am Acad Child Adolesc Psychiatry 1993;33:664–670.
  20. Ryan ND, Puig-Antich J, Ambrosini PJ, Rabinovich H, Robinson D, Nelson B, Iyengar S, Twomey J: The clinical picture of major depression in children and adolescents. Arch Gen Psychiatry 1987;44:854–861.
  21. Klein DN: Depressive personality: Reliability, validity and relation to dysthymia. J Abnorm Psychol 1990;99:412–421.
  22. Angold A, Weissman MM, John K: Parent and child reports of depressive symptoms in children at low and high risk of depression. J Child Psychol Psychiatry 1987;28:901–915.
  23. Weissman MM, Wickramaratne P, Warner V, John K, Prusoff BA, Merikangas KR, Gammon GD: Assessing psychiatric disorders in children: Discrepancies between mothers’ and children’s reports. Arch Gen Psychiatry 1987;44:747–753.
  24. Walker M, Moreau D, Weissman MM: Parents’ awareness of children’s suicide attempts. Am J Psychiatry 1990;147:1364–1366.
  25. Masi G, Favilla L, Mucci M: Depression in children and adolescents. Eur J Pediatr Neurol 1998;2:287–295.
  26. Sherbourne CD, Wells KB: Course of depression in patients with comorbid anxiety disorders. J Affect Disord 1997;43:245–250.
  27. Akiskal HS: Dysthymia: Clinical and external validity. Acta Psychiatr Scand 1994;89(suppl 383):19–23.
  28. Asarnow JR, Ben-Meir S: Children with schizophrenia spectrum and depressive disorders: A comparative study of premorbid adjustment, onset pattern and severity of impairment. J Child Psychol Psychiatry 1988;29:477–488.

    External Resources

  29. Verhulst FC, Althaus M, Berden GFMG: The Child Assessment Schedule: Parent-child agreement and validity measures. J Child Psychol Psychiatry 1987;28:455–466.

    External Resources

  30. Granero Pérez R, Ezpeleta Ascaso L, Domenech Massons JM, Osa Chaparro N: Characteristics of the subject and interview influencing the test-retest reliability of the Diagnostic Interview for Children and Adolescents-Revised. J Child Psychol Psychiatry 1998;39:963–972.
  31. Edelbrock C, Costello AJ, Dulcan MK, Kalas R, Conover NC: Age differences in the reliability of the Psychiatric Interview of the Child. Child Dev 1985;56:265–275.
  32. Schwab-Stone M, Fallon T, Briggs M, Crowther B: Reliability of diagnostic reporting for children aged 6–11 years: A test-retest study of the Diagnostic Interview Schedule for Children-Revised. Am J Psychiatry 1994;151:1048–1054.
  33. Puig-Antich J, Chambers WJ, Tabrizi MA: The clinical assessment of current depressive episodes in children and adolescents: Interviews with parents and children; in Cantwell DP, Carlson GA (eds): Affective Disorders in Childhood and Adolescence – An Update. New York, Spectrums, 1983, pp 157–179.
  34. Keller MB: Course outcome and impact on the community. Acta Psychiatr Scand 1994;89(suppl 383):24–34.
  35. Kovacs M, Obrosky DS, Gatsonis D, Richards C: First-episode major depressive disorder and dysthymic disorder in childhood: Clinical and sociodemographic factors in recovery. J Am Acad Child Adolesc Psychiatry 1997;36:777–784.
  36. Cassano GB, Perugi G, Maremmani I, Akiskal HS: Social adjustment in dysthymia; in Akiskal HS, Burton SW (eds): Dysthymic Disorder. London, Gaskell, 1993, pp 78–85.

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