Childhood-Onset Dysthymic Disorder: Clinical Features and Prospective Naturalistic Outcome

doi:10.1001/archpsyc.1994.03950050025003

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Vol. 51 No. 5, May 1994

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Childhood-Onset Dysthymic Disorder

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 outcomeof childhood-onset dysthymic disorder and assess the predictivevalidity of this diagnosis.

Design
As part of a longitudinal prospective study, school-age, clinicallyreferred youngsters (n=55) whose first depression was dysthymicdisorder and a comparison group of youngsters (n=60) whose firstaffective episode was major depressive disorder (MDD) were repeatedlyexamined during a 3- to 12-year interval. The diagnoses werebased on DSM-III criteria.

Results
Dysthymic disorder was associated with earlier age at onsetthan MDD, similarly frequent symptoms of affective dysregulation,but low rates of anhedonia and neurovegetative symptoms andgreater overall risk of any subsequent affective disorder. Theaffective disorders that dysthymic children developed, includingfirst-episode MDD (76%) and bipolar disorder (13%), far outnumberednonaffective conditions. After the first episode of MDD, theclinical course of the initially dysthymic youths was similarto the course of the comparison patients with regard to ratesof recurrent major depression, bipolar disorder, and certainnonaffective disorders.

Conclusions
Childhood-onset dysthymic disorder is an early marker of recurrentaffective illness. Although on long-term follow-up, dysthymicdisorder and MDD are associated with similar rates of certainoutcomes, there exist sufficient differences to warrant diagnosisof each disorder. Dysthymic children who have subsequent mooddisorders are most likely first to have an episode of MDD, andthat episode appears to be the "gateway" to recurrent affectiveillness. The interval between the onset of dysthymia and thefirst major depression provides a window of opportunity forintervention 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).

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