In the red corner, a bad mood. In the blue corner, an even worse mood. FIGHT!

June 19, 2009 10:41 PM

I just got back from a psychiatric evaluation. The diagnostic impression is "chronic major depressive disorder versus dysthymia." What does "versus" mean in this context?

You are not a/my psychiatrist. I know I should have asked him when I had the chance, but I was kind of thinking “hmm, I’ll Google that later.” Google didn’t really turn up anything. I could ask him again at my follow-up appointment in a couple of weeks, or I could call the office next week, but I admit I’m curious now.

I have a passing familiarity with the DSM-IV, but I’ve never heard “versus” used like this. My best guess is that, at this point, I seem to fit the criteria for both depression and dysthymia, and my psychiatrist has yet to determine which is a more appropriate diagnosis.

I was diagnosed with dysthymia a few years ago, so I suppose it’s also likely that “versus” means a revision of my previous diagnosis.

Or did I hear him wrong and he said something else?

Is this use of “versus” common in psychology/psychiatry/medicine in general?

If you have any ideas let me know. It’s not a huge deal, but it’s got me wondering. Thanks!

posted by anonymous to health & fitness (15 comments total)

He's trying to tell you that you don't currently fit the criteria for a diagnosis of dysthymia and that you have a depressive disorder- which is more severe....currently.

That said, you should not worry about seeming silly... you should ask him to clarify anything he said. He'd want to know that didn't fully understand so he could discuss it with you better.
posted by taff at 10:57 PM on June 19

And versus is not a psych term. It's an english language... idiom.
posted by taff at 10:58 PM on June 19

He is considering a couple different diagnosis in mind, but doesn't have enough data to know which one it is, so has listed both and uses the "versus" to indicate that uncertainty.
posted by archofatlas at 10:58 PM on June 19

Maybe instead of "versus" the psychiatrist said "vis a vis" which literally means "face to face" but idiomatically means "serving the same function as"... Maybe he was fine-tuning your diagnosis by saying that your new diagnosis serves the same function as your previous diagnosis (meaning it has the same symptoms and manifestations).
posted by amyms at 11:02 PM on June 19

Here, "versus" means "not," "as distinguished from"—Basically, your psychiatrist feels that your earlier diagnosis of dysthymia is no longer accurate and he/she feels that you now have a major depressive disorder.

Yes, it's common for "versus" to be used in this sense, not only in psychiatric/medical contexts but also when the writer wants to distinguish between two things that are similar but not identical. "I love sweaters but only if they're knit in silk versus wool."

On preview: As taff says, diagnoses are snapshots, not indelible labels.
posted by dogrose at 11:03 PM on June 19

I think archofatlas is right.
posted by Dasein at 11:04 PM on June 19

Thanks Dasein - I'm actually pretty certain I'm right.

In medicine, if you have, say, a patient with tachycardia (elevated heart rate) after a surgery, but don't know why, you could write: "pain vs. hypovolemia vs. internal bleed" to indicate the diagnosis you are working up at the moment.
posted by archofatlas at 11:10 PM on June 19

FWIW, after review, if the psychiatrist actually did say "versus" then I think archofatlas is probably correct too.
posted by amyms at 11:14 PM on June 19

As someone who spouts off that sort of jargon all day long, I'd say it's very likely what archofatlas said.
posted by drpynchon at 11:35 PM on June 19

FWIW, not all professionals who diagnose psychological disorders use the term 'versus' to indicate differential diagnosis, so my guess is it's more idiomatic to this particular psychiatrist (or maybe to psychiatrists on a more general level, although I don't recall hearing it from any psychiatrist I've collaborated with before, personally).
posted by so_gracefully at 12:16 AM on June 20

I agree with archofatias. IANAD, but work with them all day long. He needs more data, more time to diagnose.
posted by 6:1 at 3:53 AM on June 20

Usually I've heard this kind of thing labeled "rule out," as in depression, rule out dysthymia. If this is correct, it means what people upthread are saying. It's a difficult differential diagnosis to make, with many overlapping symptoms, and that the actual diagnosis will hinge on some distinguishing criteria (e.g., how long you've had the symptoms, course of the symptoms, etc.)
posted by jasper411 at 8:25 AM on June 20

Differential diagnosis: The process of weighing the probability of one disease versus that of other diseases possibly accounting for a patient's illness.
posted by jamjam at 10:07 AM on June 20

In medical notes, "versus" is used to simply indicate that there are a few possibilities, and as someone pointed out above, usually means there's some uncertainty about it.

"Chronic MDD versus dysthymia" means your practitioner has not made one firm diagnosis but has established that you have one of the two conditions and might further distinguish between the two with further evaluation.
posted by davidnc at 12:16 PM on June 20

It's also possible to have both dysthymia and major depressive disorder, aka "double depression."

(Not that that's what he's saying with "vs.", just noting that it could eventually turn out to be both instead of just one or the other.)
posted by peggynature at 1:36 PM on June 20