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

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

Anonymous — Fri, 19 Jun 2009 22:41:49 -0800

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!

By: taff

taff — Fri, 19 Jun 2009 22:57:27 -0800

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.

By: taff

taff — Fri, 19 Jun 2009 22:58:58 -0800

And versus is not a psych term. It's an english language... idiom.

By: archofatlas

archofatlas — Fri, 19 Jun 2009 22:58:59 -0800

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.

By: amyms

amyms — Fri, 19 Jun 2009 23:02:50 -0800

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).

By: dogrose

dogrose — Fri, 19 Jun 2009 23:03:02 -0800

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.

By: Dasein

Dasein — Fri, 19 Jun 2009 23:04:21 -0800

I think archofatlas is right.

By: archofatlas

archofatlas — Fri, 19 Jun 2009 23:10:30 -0800

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.

By: amyms

amyms — Fri, 19 Jun 2009 23:14:09 -0800

FWIW, after review, if the psychiatrist actually did say "versus" then I think archofatlas is probably correct too.

By: drpynchon

drpynchon — Fri, 19 Jun 2009 23:35:19 -0800

As someone who spouts off that sort of jargon all day long, I'd say it's very likely what archofatlas said.

By: so_gracefully

so_gracefully — Sat, 20 Jun 2009 00:16:19 -0800

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).

By: 6:1

6:1 — Sat, 20 Jun 2009 03:53:28 -0800

I agree with archofatias. IANAD, but work with them all day long. He needs more data, more time to diagnose.

By: jasper411

jasper411 — Sat, 20 Jun 2009 08:25:40 -0800

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.)

By: jamjam

jamjam — Sat, 20 Jun 2009 10:07:24 -0800

Differential diagnosis: The process of weighing the probability of one disease versus that of other diseases possibly accounting for a patient's illness.

By: davidnc

davidnc — Sat, 20 Jun 2009 12:16:16 -0800

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.

By: peggynature

peggynature — Sat, 20 Jun 2009 13:36:35 -0800

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.)