MDD vs Dysthymia

Question: “Pick one of the cases presented in the Morrison chapter on mood disorders. Summarize the main points of the case. How can you apply this example to your work and making an accurate diagnosis when mood symptoms are presented?”

Robert: Overview & Main Points

Morrison (2013) provides an example of an individual with a dual diagnosis of MDD and dysthymia. He expresses a history of dysthymic symptoms that extends back to his childhood alongside a pronounced major depressive episode more recently. I found this case very helpful in differentiating between dysthymia and MDD. While fairly clear in theory, case studies like these are helpful in allowing me to understand “what this looks like in real life”.

Dysthymia History

The DSM-5 describes this disorder as the presentation of at least two depressive symptoms for a minimum of two years (American Psychiatric Association, 2013). Morrison (2014) adds that this disorder can best understood as a chronic state that infrequently elicits complaints from a client. Additionally this disorder is significantly less severe than MDD and excludes symptoms of psychosis or S.I. Robert’s depressive symptoms in childhood fit his sort of dysthymic pattern.

Recent MDE Episode.

Robert’s recent history includes symptoms of an MDE pushed that include: an inability to enjoy life, loss of energy, insomnia and death thoughts. Since this recent episode varies differently from the distant history of dysthymia. A dual diagnosis is warranted.

In addition to the above insights, this case study helped me understand the dual diagnosis specifics listed under Persistent Depressive Disorder What a dual diagnosis looks like in this particular situation. Morrison (2013) suggests utilizing a specifier as follows: “persistent depressive disorder (dysthymia) with intermittent major depressive episodes.” The DSM-5 includes several other specifies (as listed below). This case study can help me better understand how these dual depressive disorders present in an individual (American Psychiatric Association, 2013)

  • PDD with intermittent depressive episodes with current episode

  • PDD with persistent major depressive episode

  • PDD with intermittent major depressive episodes, without current episode

  • PDD with pure dysthymic syndrome

Diagnostic Insight

History Beats Appearance

In the analysis discussion of Robert’s case Morrison (2014) alludes to his diagnostic principles as critical to understand the logic of this dual diagnosis (p149). The following principle appears correlates with Robert’s diagnosis of Dysthymia: “A patient’s history often provides better guidance for diagnosis than does the cross-sectional MSE” (Morrison, 2014, p26). While this guideline provides insight leading us to a Dysthymia diagnosis, there are still some “leftover symptoms” in his recent history to address…

Recent Beats Ancient History – Morrison (2014) states: “A patient’s recent history often more accurately indicates diagnosis than does older history” (p27). This guideline leads us to also attending to recent symptoms indicative of an MDE episode. Finally, insights from Dr. Weigel (2015) and Morrison 2014 are helpful guidelines to making a dual diagnosis.

Reusing Symptom & Addressing Leftovers

Dr. Weigel (2015), cautions against reusing symptoms as supportive evidence of more than one diagnosis. For example, the DSM-5 cautions against reusing symptoms for bipolar disorder and ADHD in the following statement:

“High risk of misdiagnosis in children [exists] especially. Symptoms of mania…can overlap with ADHD…The ‘double counting’ of symptoms toward both ADHD and bipolar disorder [in childhood]” (American Psychiatric Association, 2013, p131

As a vital counterpoint to Weigel’s (2015) principle of “not reusing symptoms”, is Morrison’s suggestion that we “address leftover symptoms”. Some symptoms exists, that don’t reflect an MDD diagnosis, and should be diagnosed in order to ensure a client provides adequate treatment. While these principles appear basic, they are very helpful to me as a principle when sorting through symptoms and trying to ascertain a diagnosis.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Morrison, J. (2014). Diagnosis made easier: Principles and techniques for mental health clinicians, 2nd ed. New York: The Guildford Press.
Weigel, S. (April 10, 2015).  Re-using symptoms [Online Forum] Retrieved from:  https://cyberactive.bellevue.edu/webapps/discussionboard/do/message?action=list_messages&forum_id=_1439060_1&nav=discussion_board_entry&conf_id=_391549_1&course_id=_333876_1&message_id=_27847648_1#msg__27847648_1Id

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