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Answer 3
  1. Dysthymic disorder. Dysthymic disorder (DD) consists of a persistent, long-term change in mood that generally is less intense but more chronic than occurs in MDD. Although the symptoms of DD are not as severe as in MDD, they cause as much, or more, psychosocial impairment. The DSM-IV-TR criteria for early-onset and adult DD are identical, except that a diagnosis of early-onset DD requires a 1-year duration of symptoms and a diagnosis of adult DD requires a 2-year duration of symptoms.1 Children may have only irritable mood instead of depressed mood. Besides having a depressed mood or irritability consistently for a period of 1 year, children and adolescents must have a minimum of 2 other symptoms to receive a diagnosis of DD: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration, difficulty making decisions, or feelings of hopelessness. In early-onset DD, no major depressive episode is present during the 1-year duration of the disturbance. Other symptoms such as feelings of being unloved, anger, self-deprecation, somatic complaints, anxiety, and disobedience have been reported in early-onset DD.1

    1. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed., text revision. Washington (DC): American Psychiatric Association; 2000.

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