This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Clinical Features and Prospective Naturalistic Outcome

Maria Kovacs, PhD; Hagop S. Akiskal, MD; Constantine Gatsonis, PhD; Phoebe L. Parrone, MS

Arch Gen Psychiatry. 1994;51(5):365-374.

Abstract
Objectives
To characterize the clinical presentation, course, and outcome of childhood-onset dysthymic disorder and assess the predictive validity of this diagnosis.

Design
As part of a longitudinal prospective study, school-age, clinically referred youngsters (n=55) whose first depression was dysthymic disorder and a comparison group of youngsters (n=60) whose first affective episode was major depressive disorder (MDD) were repeatedly examined during a 3- to 12-year interval. The diagnoses were based on DSM-III criteria.

Results
Dysthymic disorder was associated with earlier age at onset than MDD, similarly frequent symptoms of affective dysregulation, but low rates of anhedonia and neurovegetative symptoms and greater overall risk of any subsequent affective disorder. The affective disorders that dysthymic children developed, including first-episode MDD (76%) and bipolar disorder (13%), far outnumbered nonaffective conditions. After the first episode of MDD, the clinical course of the initially dysthymic youths was similar to the course of the comparison patients with regard to rates of recurrent major depression, bipolar disorder, and certain nonaffective disorders.

Conclusions
Childhood-onset dysthymic disorder is an early marker of recurrent affective illness. Although on long-term follow-up, dysthymic disorder and MDD are associated with similar rates of certain outcomes, there exist sufficient differences to warrant diagnosis of each disorder. Dysthymic children who have subsequent mood disorders are most likely first to have an episode of MDD, and that episode appears to be the "gateway" to recurrent affective illness. The interval between the onset of dysthymia and the first major depression provides a window of opportunity for intervention and possible prevention of later episodes.

Author Affiliations
From the Department of Psychiatry, University of Pittsburgh (Pa) School of Medicine, and Western Psychiatric Institute and Clinic (Dr Kovacs and Ms Parrone); University of California at San Diego, La Jolla (Dr Akiskal); and Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Gatsonis).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders
Focus 2008;6:379-400.
ABSTRACT | FULL TEXT  

Forty-Year Psychiatric Outcomes Following Assessment for Internalizing Disorder in Adolescence
Colman et al.
Am. J. Psychiatry 2007;164:126-133.
ABSTRACT | FULL TEXT  

Ten-Year Prospective Follow-Up Study of the Naturalistic Course of Dysthymic Disorder and Double Depression
Klein et al.
Am. J. Psychiatry 2006;163:872-880.
ABSTRACT | FULL TEXT  

A Review of Mood Disorders Among Juvenile Offenders
Ryan and Redding
Psychiatr. Serv. 2004;55:1397-1407.
ABSTRACT | FULL TEXT  

Psychiatric Hospitalizations Among Children and Youths With Human Immunodeficiency Virus Infection
Gaughan et al.
Pediatrics 2004;113:e544-e551.
ABSTRACT | FULL TEXT  

Family Study of Chronic Depression in a Community Sample of Young Adults
Klein et al.
Am. J. Psychiatry 2004;161:646-653.
ABSTRACT | FULL TEXT  

Family Food Insufficiency, but Not Low Family Income, Is Positively Associated with Dysthymia and Suicide Symptoms in Adolescents
Alaimo et al.
J. Nutr. 2002;132:719-725.
ABSTRACT | FULL TEXT  

Outcome of Dysthymic Disorder at 5-Year Follow-Up: The Effect of Familial Psychopathology, Early Adversity, Personality, Comorbidity, and Chronic Stress
Hayden and Klein
Am. J. Psychiatry 2001;158:1864-1870.
ABSTRACT | FULL TEXT  

The Maudsley long-term follow-up of child and adolescent depression: 1. Psychiatric outcomes in adulthood
FOMBONNE et al.
Br. J. Psychiatry 2001;179:210-217.
ABSTRACT | FULL TEXT  

Affective Illness in Children and Adolescents: Patterns of Presentation in Relation to Pubertal Maturation and Family History
Schraufnagel et al.
J Child Neurol 2001;16:553-561.
ABSTRACT  

Five-Year Course and Outcome of Dysthymic Disorder: A Prospective, Naturalistic Follow-Up Study
Klein et al.
Am. J. Psychiatry 2000;157:931-939.
ABSTRACT | FULL TEXT  

Adolescent Physical Abuse: Risk for Adolescent Psychiatric Disorders
Kaplan et al.
Am. J. Psychiatry 1998;155:954-959.
ABSTRACT | FULL TEXT  

Natural History of Male Psychological Health, XIV: Relationship of Mood Disorder Vulnerability to Physical Health
Vaillant
Am. J. Psychiatry 1998;155:184-191.
ABSTRACT | FULL TEXT  

A Clinical Psychotherapy Trial for Adolescent Depression Comparing Cognitive, Family, and Supportive Therapy
Brent et al.
Arch Gen Psychiatry 1997;54:877-885.
ABSTRACT  

A Controlled Family History Study of Childhood-Onset Depressive Disorder
Kovacs et al.
Arch Gen Psychiatry 1997;54:613-623.
ABSTRACT  

Developmental Precursors of Affective Illness in a General Population Birth Cohort
van Os et al.
Arch Gen Psychiatry 1997;54:625-631.
ABSTRACT  

Nocturnal Serum Melatonin Profile in Major Depression in Children and Adolescents
Shafii et al.
Arch Gen Psychiatry 1996;53:1009-1013.
ABSTRACT  

Understanding Gender Differences in Referral of Children to Mental Health Services
Green et al.
Journal of Emotional and Behavioral Disorders 1996;4:182-190.
ABSTRACT  

Family Study of Early-Onset Dysthymia: Mood and Personality Disorders in Relatives of Outpatients With Dysthymia and Episodic Major Depression and Normal Controls
Klein et al.
Arch Gen Psychiatry 1995;52:487-496.
ABSTRACT