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Am J Psychiatry 1994; 151:1592-1599
Copyright © 1994 by American Psychiatric Association
Is dysthymia a different disorder in the elderly?
DP Devanand, MS Nobler, T Singer, JE Kiersky, N Turret, SP Roose and HA Sackeim
Late Life Depression Clinic, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York 10032.
OBJECTIVE: This study evaluated elderly dysthymic patients in a late life
depression clinic and compared their clinical features to previous findings
in young adult dysthymic patients. METHOD: Of 224 consecutive elderly
outpatients, 40 (17.9%) met criteria for dysthymic disorder. A
semistructured interview was used to obtain history, the Structured
Clinical Interview for DSM-III-R--Patient Version and the Structured
Clinical Interview for DSM-III-R Personality Disorders were used to make
DSM-III-R diagnoses, and standard rating instruments for depression were
administered. RESULTS: The gender distribution was equal and major
stressors were common. The mean age at onset of dysthymia was 55.2 years
(SD = 15.4), with an average illness duration of 12.5 years (SD = 14.2).
Early onset (before 21 years of age) and secondary dysthymia were rare. A
history of major depression earlier during the course of dysthymic illness,
comorbid anxiety disorders, and personality disorders were relatively
uncommon. Cross-sectionally, cognitive and functional symptoms were more
prominent than vegetative symptoms. CONCLUSIONS: Dysthymia is not uncommon
among depressed elderly outpatients who present for treatment. Elderly
dysthymic patients differ from young adult dysthymic patients, who are
mostly female with an early onset and who frequently have comorbid axis I
and axis II disorders. Most elderly dysthymic patients do not appear to be
young dysthymic patients who simply grew older, and the DSM-III-R subtyping
of dysthymia into early/late onset and primary/secondary may not apply to
the elderly. Further clinical studies of "pure" dysthymic disorder appear
feasible in the elderly, and these are clearly needed.
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