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Am J Psychiatry 1983; 140:11-20
Copyright © 1983 by American Psychiatric Association
Dysthymic disorder: psychopathology of proposed chronic depressive subtypes
HS Akiskal
The author develops a nosologic framework for understanding the
psychopathology of low-grade chronic depressions: 1) late-onset primary
depressions with residual chronicity, 2) chronic secondary dysphorias,
having a variable onset age and considered part of the symptomatic picture
of nonaffective "neurotic" disorders or reactions to longstanding
incapacitating medical diseases, and 3) early-onset characterologic
depressions, which include a) character-spectrum disorders developing in
the setting of tempestuous early object relationships and b) subaffective
dysthymic disorders, conceptualized as genetically attenuated forms of
primary affective illnesses. Differences in family history, REM latency,
and pharmacologic responsiveness are presented in support of these
distinctions. The author also proposes operational criteria to identify a
thymoleptic- responsive subaffective dysthymic group.
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