Table 2.

Proposals for the diagnosis of dysthymia and adjustment disorders in cancer patients [13]

Dysthymia

Based on the presence of depressed mood for the last 2 years (criterion A) plus at least two of the six traditional symptoms of dysthymia (Criterion B), defined in DSM5 as Persistent Depressive Disorder (i.e., poor appetite or overeating; insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness), but after having ascertained that (a) hopelessness is not demoralization or discouragement related to the reality of the medical illness; (b) low self-esteem is feeling bad about oneself, not the situation; and (c) all the somatic symptoms are not easily explained by physical illness, treatments, or hospital environment.

Adjustment disorders (with depressed mood)

In Criterion A, The development of depressed mood in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s) should include illness (e.g., cancer) or treatment, as stressor(s).

In Criterion B, the fact that there is a marked distress reaction in excess of what would be expected from exposure to the stressor should consider that rarely with medical illness is the distress considered in excess of the stressor. Also, a further item (treatment is recommended) is added.