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.
Entire Body System
- Problems at School
Problems at school and involvement in the court system, in addition to other factors that may be associated with having a child with mental illness, such as doctors’ appointments and turmoil at home, take a toll on the family as well as the child [ 58 [ncbi.nlm.nih.gov]
Psychiatrical
- 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]
- Fidgeting
You Feel Like You're Moving Through Molasses In the same way that manic episodes are characterized by fidgeting and restlessness, depression may cause "psychomotor retardation," aka physically moving slower. 8. [bustle.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.
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.