Abstract Dysthymia is a psychopathological construct historically described and often reconsidered through the centuries. Its first description is dated back to 400 b.C., when Hippocrates proposed his theory about the ‘black bile’ and the melancholic temperament. The concept of dysthymia (dys-, ‘ill’, thymia-, ‘emotions’) has been largely elaborated in the XIX and XX centuries by Burton, Cullen, Schneider, Kretschmer, Akiskal and other authors, and recently re-formulated in the various editions of the modern Diagnostic and Statistical Manual of Mental Disorders under different diagnostic labels: neurotic depression, dysthymic disorder, persistent depressive disorder. Beyond the nosology, dysthymia issues some other challenges, including the need for further research to characterise the peculiar pathophysiological framework of this syndrome (compared with major depressive disorder) and to better define evidences about tailored-treatment options and their effectiveness.

中文翻译：

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从心境恶劣到难治性抑郁症：精神病理学结构的演变

摘要 心境恶劣是历史上描述的一种精神病理学结构，几个世纪以来经常被重新考虑。它的第一个描述可以追溯到公元前 400 年，当时希波克拉底提出了他关于“黑胆汁”和忧郁气质的理论。Burton、Cullen、Schneider、Kretschmer、Akiskal 和其他作者在 19 世纪和 20 世纪大量阐述了心境恶劣（dys-、“病态”、thymia-、“情绪”）的概念，最近在现代精神疾病诊断和统计手册的各种版本，具有不同的诊断标签：神经质抑郁症、心境恶劣障碍、持续性抑郁障碍。除了疾病分类学，心境恶劣还会带来一些其他挑战，