Sansone R A, Sansone L A
Department of Psychiatry, University of Oklahoma College of Medicine, Tulsa 74129, USA.
Postgrad Med. 1996 Jun;99(6):233-4, 237-44, 249.
Dysthymic disorder, an insidious and chronic depressive mood disorder that waxes and wanes in intensity over several years, is fairly prevalent in healthcare settings. Although the explicit etiology is unknown, serotonergic dysfunction may be involved. Dysthymia appears to have a high rate of comorbidity, including both psychiatric and medical disorders. The primary care physician should maintain an awareness of this mood disorder, be able to screen efficiently for signs and symptoms, and be able to differentiate major depression from dysthymia. The foundation of treatment is pharmacotherapy, in particular with serotonergic antidepressants, although response is moderate at best. Antidepressants are initiated at low doses and drug trials are conducted for 3-month periods if not precluded by side effects. When reasonably effective, antidepressants should be continued for 2 to 3 years or more. Adjunctive interventions in the treatment of dysthymia are based on comorbid psychiatric or medical conditions. Although dysthymia is an insidious, difficult-to-treat disorder, intervention is worthwhile. Further research may elucidate more effective interventions for this challenging disorder.
恶劣心境障碍是一种隐匿性慢性抑郁情绪障碍，其强度在数年中呈起伏变化，在医疗环境中相当普遍。尽管确切病因不明，但可能涉及血清素功能障碍。恶劣心境障碍似乎有很高的共病率，包括精神疾病和躯体疾病。初级保健医生应了解这种情绪障碍，能够有效地筛查其体征和症状，并能够区分重度抑郁症和恶劣心境障碍。治疗的基础是药物治疗，特别是使用血清素能抗抑郁药，尽管疗效充其量只是中等。抗抑郁药从低剂量开始使用，如果没有副作用，进行为期3个月的药物试验。当有一定疗效时，抗抑郁药应持续使用2至3年或更长时间。恶劣心境障碍治疗中的辅助干预措施基于共病的精神或躯体状况。尽管恶劣心境障碍是一种隐匿性、难以治疗的疾病，但干预是值得的。进一步的研究可能会阐明针对这种具有挑战性疾病的更有效干预措施。
