Persistent Depressive Disorder Test

What is a persistent depressive disorder?

Persistent depressive disorder (PDD), also known as dysthymic disorder or chronic depression, is a long-lasting form of depression characterized by a depressed mood that persists for most of the day, more days than not, for at least two years (1 year for children and adolescents) (American Psychiatric Association, 2013). Unlike major depressive disorder, which involves severe and distinct episodes of mild or moderate depression, PDD is a chronic, ongoing condition with milder but more persistent symptoms.

Early diagnosis and treatment of PDD are crucial, as the condition can have a significant impact on an individual's well-being and can increase the risk of developing other mental health conditions, such as anxiety disorders or substance abuse disorders.

Symptoms

PDD or dysthymia symptoms can include the following:

• low self-esteem
• poor appetite or overeating is also manifested in weight gain
• trouble sleeping characterized by insomnia or hypersomnia
• low energy or fatigue
• trouble concentrating or difficulty making decisions
• feelings of hopelessness

These symptoms, while not as severe as those of major depressive disorder, can significantly impair an individual's ability to function in daily life and can lead to difficulties in personal relationships, work, and overall quality of life.

How does it differ from major depressive disorder?

Persistent depressive disorder (PDD) and major depressive disorder (MDD) are both forms of depression, but they differ in several key ways:

• Duration: PDD involves chronic, persistent depressed mood lasting at least two years (1 year for children/adolescents), while MDD involves distinct episodes of severe depression.
• Severity: Symptoms in PDD are milder but more persistent, while symptoms in MDD are more severe and disabling.
• Course: PDD is a chronic condition without remission periods, while MDD has episodic periods of remission.
• Symptom presentation: PDD may involve "double depression" with episodes of major depression, while MDD involves distinct episodes.
• Treatment: Both may involve psychotherapy and antidepressants, but treatment plans may differ based on severity and duration.

Diagnosing persistent depressive disorder

To diagnose depression and a potential PDD condition, a healthcare professional must take a comprehensive evaluation, typically a mental health professional, such as a psychiatrist, psychologist, or licensed clinical social worker. This process commonly involves the following measures:

Clinical interviews

The initial step in diagnosing PDD often involves a detailed clinical interview, during which the healthcare practitioner gathers information on the patient's medical and psychiatric history and the duration and impact of depression symptoms and physical symptoms.

Differential diagnosis

Differential diagnosis is crucial in distinguishing PDD from other mood disorders and mental health conditions with similar presentations. For instance, PDD must be differentiated from MDD in terms of the duration and severity of symptoms. Distinguishing PDD from bipolar disorder is essential due to the presence of hypomanic or manic episodes in the latter.

Attention must also be given to ruling out another mood disorder, such as seasonal affective disorder or mood disorder due to substances or medical conditions that might mimic depressive symptoms.

Diagnostic and statistical manual of mental disorders (DSM-5)

The DSM-5 provides specific criteria for diagnosing major depressive disorders, including PDD, which healthcare practitioners rely on:

1. A depressed mood for most of the day, more days than not, as indicated by either subjective account or observation by others, for at least two years.
2. Presence of two (or more) of the following symptoms when feeling depressed:some text
   • Poor appetite or overeating
   • Insomnia or hypersomnia
   • Low energy or fatigue
   • Low self-esteem
   • Poor concentration or difficulty making decisions
   • Feelings of hopelessness
3. During the two-year period (one year for children and adolescents), the person has never been without the symptoms for more than two months at a time.
4. Criteria for a major depressive episode may be continuously present for two years.
5. There has never been a manic episode or a hypomanic episode, and the criteria for cyclothymia have never been met.
6. The disturbance is not better explained by another mental disorder, substance use, or a medical condition.
7. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Assessment tools

Healthcare professionals may use various assessment tools to diagnose PDD, such as structured clinical interviews, self-report questionnaires, and rating scales. These tools can help identify the presence and severity of depressive symptoms and assess their impact on daily functioning.

Longitudinal observation

Given the chronic nature of PDD, healthcare professionals may need to observe and monitor the individual's symptoms over an extended period to ensure that the diagnostic criteria are met consistently.

How to use this template

Here's a step-by-step guide on how to use the Persistent Depressive Disorder (PDD) test:

Step 1: Introduction and instructions

Before administering the test, briefly introduce the patient, explaining that the test is designed to evaluate the presence and severity of persistent depressive symptoms. Communicate the test's purpose and ensure the patient understands the process.

Step 2: Administer the test

Our PDD Test consists of a series of questions or rating scales that assess the presence and severity of depressive symptoms over an extended period, usually two years or more. During this step, ask the patient to respond to each question or item honestly and to the best of their ability.

Step 3: Scoring and interpretation

Once the test is completed, follow the scoring instructions provided by the test manual or the specific assessment tool you use. This may involve assigning numerical values to the patient's responses, calculating a total score, or determining the presence of particular symptom clusters.

Interpret the test results based on the provided guidelines or cut-off scores. The interpretation should consider the duration and severity of the depressive symptoms and their impact on the patient's daily functioning.

Step 4: Plan the next steps

Based on the test results and your clinical judgment, develop a treatment plan or make appropriate recommendations for the patient. This may involve referral to a primary healthcare provider or a mental health provider, initiation of proper treatment, and monitoring and follow-up.

Results and interpretation

The 16-item Quick Inventory of Depressive Symptomatology (QIDS), modified with a screening question for PDD, is a valuable tool for assessing the presence and severity of depressive symptoms, as well as identifying individuals who may meet the criteria for PDD.

The 16-item QIDS assesses the severity of depressive symptoms, with each item scored on a scale from 0 to 3. The total score ranges from 0 to 27, with higher scores indicating more severe depressive symptoms (Rush et al., 2003).

The PDD screening question, added by Brinkman et al. (2019), asks: "In the past two years, have you suffered from depressed mood most days, even if you felt okay sometimes?" A positive response to this question, combined with a QIDS score of 6 or higher, suggests the potential presence of PDD.

The interpretation of the QIDS scores is as follows:

• Scores of 0-5: No depression
• Scores of 6-10: Mild depression
• Scores of 11-15: Moderate depression
• Scores of 16-20: Severe depression
• Scores of 21 or higher: Very severe depression

Suppose the patient scores 6 or higher on the QIDS and responds positively to the PDD screening question. In that case, further evaluation is recommended to determine if the individual meets the full diagnostic criteria for PDD, as outlined in the DSM-5.

Next steps

After administering the Persistent Depressive Disorder (PDD) test and interpreting the results, it's essential to take the appropriate next steps to ensure proper care and help clients overcome depression.

If the test results indicate the presence of PDD or persistent depressive symptoms, it's crucial to develop a comprehensive treatment plan. This plan may involve a combination of the following:

Psychotherapy

Talk therapy, including cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), are practical psychotherapeutic approaches for treating PDD. CBT identifies and modifies negative thought patterns and behaviors, while IPT aims to improve interpersonal relationships and social functioning.

Pharmacotherapy

Antidepressant medication, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), may be prescribed to alleviate depressive symptoms. However, it's important to note that medication alone may not be sufficient for managing PDD, and it is often used in conjunction with psychotherapy.

Lifestyle modifications

Encouraging patients to adopt healthy lifestyle habits, such as regular exercise, a balanced diet, stress management techniques, and adequate sleep, can be beneficial in managing symptoms and improving overall well-being.

Psychoeducation

Educating patients and their families about PDD, its symptoms, and available treatment options can empower them to understand better and manage the condition.

Follow-up and monitoring

Regular follow-up appointments are essential to monitor the patient's progress, adjust the treatment plan, and address any emerging concerns or side effects.

Referrals and collaborative care

In some cases, referrals to other healthcare professionals, such as psychiatrists, counselors, or support groups, may be necessary for comprehensive care. Coordination among healthcare providers is crucial for ensuring continuity of care.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.

Brinkmann, E., Glanert, S., Hüppe, M., Moncada Garay, A. S., Tschepe, S., Schweiger, U., & Klein, J. P. (2019). Psychometric evaluation of a screening question for persistent depressive disorder. BMC Psychiatry, 19(1). https://doi.org/10.1186/s12888-019-2100-0

Rush, A. John., Trivedi, M. H., Ibrahim, H. M., Carmody, T. J., Arnow, B., Klein, D. N., Markowitz, J. C., Ninan, P. T., Kornstein, S., Manber, R., Thase, M. E., Kocsis, J. H., & Keller, M. B. (2003). The 16-Item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological Psychiatry, 54(5), 573–583. https://doi.org/10.1016/s0006-3223(02)01866-8