Dysthymia: an atypical protracted depression. A preliminary report.

Abstract

The author reports on 86 cases of protracted disorders - without significant changed consciousness - which he named dysthymia. The clinical manifestations were characterized by peculiar emotional disorders, polymorphous autonomic and vascular shifts. These states occurred in the majority of cases after some somatic diseases in conjunction with other physical or psychological stresses in individuals with anxiety traits and 'neurocirculatory asthenia'. The first phase of the disease was accompanied by anxiety, restlessness, autonomic and vascular paroxysms, anorexia, insomnia and disturbances of other physiological functions. Subsequently dysphoric mood, somatic concerns, pseudoneurotic and neurotic syndromes appeared. The outcome of the disorders was either with slow practical recovery or with a relatively stable personality change in the form of weakened volition, a reduction of energy, and a narrowing of the 'zone of comfort' due to the impairment of homeostatic functions. Often hypochondriasis could develop on the background of such features. Dysthymia is viewed as a special entity which must not be included either in the group of neuroses or in the group of typical organic brain syndromes, or in the group of endogenous psychoses.