Cyclothymic disorder (CD), also termed cyclothymia, is a mental disorder with mild but long-lasting and severely impairing mood swings. Characteristic mood changes include periods of euphoria which are abruptly followed by depressive episodes.
CD is part of the spectrum of bipolar disorders and can progress to bipolar disorder type 1 or 2. Onset usually occurs in adolescence and affects both genders equally. Prevalence is estimated to be up to 1/100. Progression to bipolar disorder occurs in up to 50% of cases.
CD may only be diagnosed if the specific mood swings persist for two years in adults or one year in adolescents.
Presentation
Expert consensus defines cyclothymic disorder (CD) as a subclinical variant of bipolar disorder, which is characterized by chronic mood swings alternating between hypomanic and depressive periods. Due to the subclinical nature of CD, it has also been incorrectly assessed as a character trait in the past [1] [2] [3].
A cardinal feature of all types of bipolar disorders is perturbed sleeping, which also applies to CD [4] [5]. Long-term studies have shown that CD is as debilitating as other disorders of the bipolar spectrum [6] [7].
Hypomanic episodes may manifest with general euphoria, exaggerated self-esteem, logorrhea, impaired risk assessment, distractability, lack of concentration, racing thoughts, no need for sleep and marked irritability [1] [3].
CD patients have described their depressive periods with a feeling of fatigue, demoralization, persistent irritability, restlessness, guilt, low self-esteem and sleep disturbances together with weight changes and even suicidal thoughts [1] [8].
CD shows significant clinical overlap with major depressive episodes and bipolar disorders type 1 and 2 and can progress to the latter [9]. The exact etiology of CD remains unknown.
Workup
Diagnosing cyclothymic disorder requires a physical examination to check for potential causes of mood swings, a psychological evaluation to analyze the patient's mood swings with questionnaires and professional interviews. The patient's family and close friends may be included in this psychological analysis to obtain a complete picture of the mood swings and their frequency. Moreover, cases should keep track of their mood swings with a mood chart and record their sleeping hours.
Clinical criteria for CD are persistent episodes of hypomania and depression for at least one year in adolescents and two years in adults with intermittently stable mood periods shorter than two months. Characteristic findings cannot be traced back to other causes like substance abuse, and significantly affect the patient's social interactions [1].
Hypomanic CD symptoms in children are hard to distinguish from characteristic attention deficit hyperactivity disorder (ADHD) signs making CD a non-trivial diagnosis. Manic episodes never occur in CD [3] [10].
Progression of CD to bipolar disorder type 1 and 2 can be prevented with professional treatment. A late onset of CD hints towards substance abuse.
Treatment
Treatment often takes the form of individual psychotherapy, although group treatment can also be helpful for this disorder. Get more on Cyclothymia treatment through Psychotherapy. [depression-guide.com]
This review will include historical concepts, clinical phenomenology, family history, biological studies, and treatment of cyclothymia. [ncbi.nlm.nih.gov]
Dual Diagnosis Treatment Can Help with Addiction and Cyclothymic Disorder Dual diagnosis treatment (or integrative addiction treatment) has been show to help so many people with co-occurring disorders. [northpointwashington.com]
Early recognition means avoiding unnecessary complications and establishing specific treatments and clinical management since the beginning. [doi.org]
Prognosis
Find information on the symptoms causes, diagnosis and prognosis of this disorder. Read about help in the community and treatments available. [selfcounseling.com]
Prognosis Prognosis is good when the proper combination of medication and therapy are received. [allpsych.com]
The early detection and treatment of cyclothymia can guarantee a significant change in the long-term prognosis, when appropriate mood-stabilizing pharmacotherapy and specific psychological approaches and psychoeducation are adopted. [ncbi.nlm.nih.gov]
Expectations (prognosis) Less than half of people with cyclothymic disorder will eventually develop bipolar disorder. In other people, cyclothymia will continue as a chronic condition or disappear with time. [coordinatedhealth.com]
Etiology
[…] or if there is no etiological relationship between the mood symptoms and the general medical condition. [mental-health-today.com]
The exact etiology of CD remains unknown. [symptoma.com]
Learn about the etiology, symptoms, treatment and prognosis. Behave Net - Cyclothymic disorder - Learn about the diagnostic criteria of Cyclothymic disorder. [selfcounseling.com]
Etiology Research on this disorder is not nearly as well documented as its counterparts. It is assumed that both biological and environmental factors play a role. [allpsych.com]
Epidemiology
Results: Current epidemiological and clinical research showed the high prevalence and the validity of cyclothymia as a distinct form of bipolarity, frequently associated with multiple comorbidities with anxiety, impulse control, substance use, and so [doi.org]
OBJECTIVES: Epidemiological studies suggest that cyclothymic disorder is the most prevalent subtype of bipolar disorder (BD). However, it is rarely diagnosed, especially in youth. [ncbi.nlm.nih.gov]
According to him, as the complexity and subtyping of mood disorders continue to grow, there is increased challenge to support the concepts epidemiologically and clinically, with a particular need to improve matching of phenotypes with genetic and other [news-medical.net]
Pathophysiology
Paediatrics, Neonatology (347) Internal Medicine (337) Physiology and Pathophysiology (334) Pathology and Forensic Medicine (268) Medical Chemistry and Biochemistry (252) Neurology (246) Genetics (163) Psychiatry, Psychology, Sexology (160) Surgery, Traumatology [portal.mefanet.cz]
Eur Neuropsychopharmacol 15:75–84 PubMed CrossRef Google Scholar Soares J (2003) Contributions from brain imaging to the elucidation of pathophysiology of bipolar disorder. [link.springer.com]
Prevention
Close attention after childbirth is warranted to alleviate and prevent these episodes in such women. [ncbi.nlm.nih.gov]
There's no sure way to prevent cyclothymia. [mayoclinic.org]
Although preventive treatment hasn’t been identified yet, there is some hope among researchers that early treatment for cyclothymia may prevent full-blown bipolar disorder from developing. [everydayhealth.com]
Progression of CD to bipolar disorder type 1 and 2 can be prevented with professional treatment. A late onset of CD hints towards substance abuse. [symptoma.com]
References
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington DC: American Psychiatric Association; 2001.
- Akiskal H, Khani M, Scott-Strauss A. Cyclothymic temperamental disorders. Psychiatr Clin North Am. 1979;2:527–554.
- Van Meter AR, Youngstrom EA. Cyclothymic disorder in youth: why is it overlooked, what do we know and where is the field headed?. Neuropsychiatry (London). 2012; 2(6): 509–519.
- Geller B, Zimmerman B, Williams M, DelBello M, Frazier J, Beringer L. Phenomenology of prepubertal and early adolescent bipolar disorder: examples of elated mood, grandiose behaviors, decreased need for sleep, racing thoughts and hypersexuality. J Child Adolesc Psychopharmacol. 2002;12(1):3–9.
- Harvey A, Mullin B, Hinshaw S. Sleep and circadian rhythms in children and adolescents with bipolar disorder. Dev Psychopathol. 2006;18(4):1147–1168.
- Birmaher B, Axelson D, Goldstein B, et al. Four-year longitudinal course of children and adolescents with bipolar spectrum disorders: the course and outcome of bipolar youth (COBY) study. Am J Psychiatry. 2009;166(7):795–804.
- Kessler R, Avenevoli S, Merikangas K. Mood disorders in children and adolescents: an epidemiologic perspective. Biol Psychiatry. 2001;49(12):1002–1014.
- Tomba E, Rafanelli C, Grandi S, Guidi J, Fava GA. Clinical configuration of cyclothymic disturbances. J Affect Dis. 2012; 139(3):244-249.
- Vieta E, Reinares M, Rosa AR. Staging bipolar disorder. Neurotox Res. 2011;19(2):279–285.
- Van Meter AR, Youngstrom EA, Findling RL. Cyclothymic disorder: A critical review. Clin Psych Rev. 2012; 32(4):229-243.