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Cyclothymic Disorder

Affective Personality

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.

Loss of Hair
  • In the depressive state, people with cyclothymia also experience physical complaints including frequent headaches, tightness in the head and chest, an empty sensation in the head, weakness, weight loss, and hair loss.The distinguishing factor between[en.wikipedia.org]
Hysteria
  • Although 66% of the cyclothymic outpatients had previously received the diagnosis of hysteria or sociopathy, their pedigrees were similar to those seen in classical bipolar manic-depressive illness; furthermore, 44% of the cyclothymic group experienced[ncbi.nlm.nih.gov]
Neglect
  • Neglect has contributed to confusion about the diagnosis and clinical presentation of cyclothymic disorder. Its status as a mood disorder is also ambiguous due to overlap in terminology and symptoms with temperament and personality disorders.[ncbi.nlm.nih.gov]
  • "This is a neglected disorder since there is no approved drug treatment for it. It is attributed to temperament, something you cannot do anything about it. But we discovered something else".[news-medical.net]
  • , problems with concentration, lack of recall, guilt, self-criticism, low self-esteem, pessimism, self-destructive thinking, apathy, hopelessness, helplessness, irritability, quick temper, lack of motivation, social withdrawal, appetite change, self-neglect[bestchristianboardingschools.com]
  • Erratic and neglectful parenting: failure to inculcate a discipline of emotional self-regulation. Overbearing, inconsistent parenting: "the combination of swift, harsh, and often arbitrary punishment with loving overindulgence" (Spilka, pg. 22).[ptypes.com]

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

  • BACKGROUND: There is a lack of controlled studies of psychological treatment of cyclothymic disorder.[ncbi.nlm.nih.gov]
  • This review will include historical concepts, clinical phenomenology, family history, biological studies, and treatment of cyclothymia.[ncbi.nlm.nih.gov]
  • Read about help in the community and treatments available.[selfcounseling.com]
  • 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]
  • Treatments for this disorder include mood-stabilizing medicine, antidepressants, talk therapy, or some combination of these three treatments. Some of the more commonly used mood stabilizers are lithium and antiseizure medicines.[nlm.nih.gov]

Prognosis

  • Find information on the symptoms causes, diagnosis and prognosis of this disorder. Read about help in the community and treatments available.[selfcounseling.com]
  • 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]
  • Outlook (Prognosis) Less than half of people with cyclothymic disorder go on to develop bipolar disorder. In other people, cyclothymia continues as a chronic condition or disappears with time.[baptistjax.com]
  • Outlook (Prognosis) Less than one half of people with cyclothymic disorder go on to develop bipolar disorder. In other people, cyclothymia continues as a chronic condition or disappears with time.[pennstatehershey.adam.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]

Etiology

  • The exact etiology of CD remains unknown.[symptoma.com]
  • […] or if there is no etiological relationship between the mood symptoms and the general medical condition.[mental-health-today.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

  • 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]
  • 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]
  • 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 called "personality[ncbi.nlm.nih.gov]
  • Epidemiological and clinical research have shown the high prevalence of cyclothymia and the validity of the concept that it should be seen as a distinct form of bipolarity, not simply as a softer form.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • 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]
  • […] and related mental health disorders Pharmacological treatment to stabilize disruptive mental health symptoms Medical care during detox from the drug of choice, if necessary Psychotherapeutic assistance to address drug-related issues, including relapse prevention[dualdiagnosis.org]

References

Article

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington DC: American Psychiatric Association; 2001.
  2. Akiskal H, Khani M, Scott-Strauss A. Cyclothymic temperamental disorders. Psychiatr Clin North Am. 1979;2:527–554.
  3. 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.
  4. 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.
  5. Harvey A, Mullin B, Hinshaw S. Sleep and circadian rhythms in children and adolescents with bipolar disorder. Dev Psychopathol. 2006;18(4):1147–1168.
  6. 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.
  7. Kessler R, Avenevoli S, Merikangas K. Mood disorders in children and adolescents: an epidemiologic perspective. Biol Psychiatry. 2001;49(12):1002–1014.
  8. Tomba E, Rafanelli C, Grandi S, Guidi J, Fava GA. Clinical configuration of cyclothymic disturbances. J Affect Dis. 2012; 139(3):244-249.
  9. Vieta E, Reinares M, Rosa AR. Staging bipolar disorder. Neurotox Res. 2011;19(2):279–285.
  10. Van Meter AR, Youngstrom EA, Findling RL. Cyclothymic disorder: A critical review. Clin Psych Rev. 2012; 32(4):229-243.

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Last updated: 2019-07-11 21:05