Cyclothymia: Difference between revisions

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   ICD9  = {{ICD9|301.13}} |
   ICD9  = {{ICD9|301.13}} |
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{{SI}}
{{SI}}
{{CMG}}; {{AE}} {{KS}}, {{HW}}
{{CMG}}; {{AE}} {{I.D.}}, {{KS}}, {{HW}}


{{SK}} Cyclothymic disorder; cyclic disorder
{{SK}} Cyclothymic disorder; cyclic disorder


==Overview==
==Overview==
'''Cyclothymia''', or '''cyclothymic disorder''', is a [[mood disorder]] characterized by the co-occurrence of [[hypomanic]] and [[depressive]] symptoms over a period of at least two years, or one year in children and young adults. Symptoms must not meet the diagnostic criteria for manic/depressive episodes.<ref name=”#1”>National Institute of Mental Health (NIMH). “Bipolar Disorder.” https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml. Accessed 12 December 2016.</ref> Cyclothymia is considered a mild form of [[bipolar II disorder]].<ref name=”#2”>U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>
'''Cyclothymia''', or '''cyclothymic disorder''', is a [[mood disorder]] characterized by the co-occurrence of [[hypomanic]] and [[depressive]] symptoms over a period of at least two years, or one year in children and young adults. Symptoms must not meet the diagnostic criteria for manic/depressive episodes.<ref name="”#1”">National Institute of Mental Health (NIMH). “Bipolar Disorder.” https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml. Accessed 12 December 2016.</ref> Cyclothymia is considered a mild form of [[bipolar II disorder]].<ref name="”#2”">U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref> There is evidence that cyclothymia may be the most common form of [[bipolar disorder]].<ref name="pmid22459786">{{cite journal| author=Van Meter AR, Youngstrom EA, Findling RL| title=Cyclothymic disorder: a critical review. | journal=Clin Psychol Rev | year= 2012 | volume= 32 | issue= 4 | pages= 229-43 | pmid=22459786 | doi=10.1016/j.cpr.2012.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22459786  }} </ref>


==Historical Perspective==
==Historical Perspective==
Cyclothymia has been included in the DSM since 1980.<ref name="pmid22459786">{{cite journal| author=Van Meter AR, Youngstrom EA, Findling RL| title=Cyclothymic disorder: a critical review. | journal=Clin Psychol Rev | year= 2012 | volume= 32 | issue= 4 | pages= 229-43 | pmid=22459786 | doi=10.1016/j.cpr.2012.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22459786  }} </ref>
*In 1882, cyclothymia was characterized by recurring mood cycles. This was accomplished by Karl Ludwig Kahlbaum.
**Cyclothymia contains episodes, both of which occur in a milder form than in [[bipolar disorder]]:
***[[Melancholic episodes]]
***[[Manic episodes]]


==Classification==
*In 1980, cyclothymia was included to the [[DSM]].<ref name="pmid22459786">{{cite journal| author=Van Meter AR, Youngstrom EA, Findling RL| title=Cyclothymic disorder: a critical review. | journal=Clin Psychol Rev | year= 2012 | volume= 32 | issue= 4 | pages= 229-43 | pmid=22459786 | doi=10.1016/j.cpr.2012.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22459786 }} </ref>
Cyclothymia is classified by the DSM-V as a mild form of [[bipolar II disorder]].<ref name=”#2”>U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref><ref name=”DSM-V”>American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.</ref> There is disagreement among experts in the field of psychiatry as to whether this is an appropriate definition, or whether cyclothymia is actually better understood as a general instability of mood.<ref name="pmid26005206">{{cite journal| author=Perugi G, Hantouche E, Vannucchi G, Pinto O| title=Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder. | journal=J Affect Disord | year= 2015 | volume= 183 | issue= | pages= 119-33 | pmid=26005206 | doi=10.1016/j.jad.2015.05.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26005206 }} </ref>


==Pathophysiology==
*Cyclothymia has been conceptualized in a variety of ways:<ref name="pmid9298424">{{cite journal| author=Brieger P, Marneros A| title=Dysthymia and cyclothymia: historical origins and contemporary development. | journal=J Affect Disord | year= 1997 | volume= 45 | issue= 3 | pages= 117-26 | pmid=9298424 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9298424  }} </ref>
**As a subtype of [[bipolar disorder]]
**As a [[temperament]]
**As a [[personality trait]]
**As a [[personality disorder]]


===Commonly Comorbid Conditions===
*The two defining features of the disorder, according to [[DSM-5]], are:
Conditions that are commonly comorbid with cyclothymia include:<ref name="pmid21396717">{{cite journal| author=Van Meter A, Youngstrom EA, Youngstrom JK, Feeny NC, Findling RL| title=Examining the validity of cyclothymic disorder in a youth sample. | journal=J Affect Disord | year= 2011 | volume= 132 | issue= 1-2 | pages= 55-63 | pmid=21396717 | doi=10.1016/j.jad.2011.02.004 | pmc=3109127 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21396717  }} </ref>
**The presence of depressive episodes
*ADHD
**The presence of hypomania
*Anxiety disorders


==Causes==
==Classification==
*Cyclothymia is classified by the [[DSM-V]] as a mild form of [[bipolar II disorder]].<ref name="”#2”">U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref><ref name="”DSM-V”">American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.</ref>
*There is disagreement among experts in the field of [[psychiatry]] as to whether this is an appropriate definition, or whether cyclothymia is actually better understood as a general instability of [[mood]].<ref name="pmid26005206">{{cite journal| author=Perugi G, Hantouche E, Vannucchi G, Pinto O| title=Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder. | journal=J Affect Disord | year= 2015 | volume= 183 | issue=  | pages= 119-33 | pmid=26005206 | doi=10.1016/j.jad.2015.05.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26005206  }} </ref>
*Cyclothymia has been conceptualized to include other characteristics such as:<ref name="pmid26005206.">{{cite journal| author=Perugi G, Hantouche E, Vannucchi G, Pinto O| title=Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder. | journal=J Affect Disord | year= 2015 | volume= 183 | issue=  | pages= 119-33 | pmid=26005206. | doi=10.1016/j.jad.2015.05.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26005206  }} </ref>
**[[Mood reactivity]]
**[[Impulsivity]]
**[[Anxiety]]


The cause of cyclothymic disorder is unknown. Genetics may play a role, as indicated by a range of twin studies involving dizygotic (fraternal) and monozygotic (identical) [[twins]] and the high likelihood that a patient with cyclothymia will have a family history of mood disorders.<ref name=”#2”>U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>
===Commonly Comorbid Conditions===
*Conditions that are commonly comorbid with cyclothymia include:<ref name="pmid21396717">{{cite journal| author=Van Meter A, Youngstrom EA, Youngstrom JK, Feeny NC, Findling RL| title=Examining the validity of cyclothymic disorder in a youth sample. | journal=J Affect Disord | year= 2011 | volume= 132 | issue= 1-2 | pages= 55-63 | pmid=21396717 | doi=10.1016/j.jad.2011.02.004 | pmc=3109127 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21396717  }} </ref>
**[[ADHD]]
**[[Anxiety disorders]]


==Differentiating Cyclothymia from other disorders==
==Differentiating Cyclothymia from other disorders==
Cyclothymia must be differentiated from other disorders that present with similar symptomatology, including:<ref name=”#2”>U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref><ref name=”DSM-V”>American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.</ref>
 
*[[Major depression]]
*Cyclothymia must be differentiated from other disorders that present with similar symptomatology, including:<ref name="”#2”">U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref><ref name="”DSM-V”">American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.</ref>
**Patients with cyclothymia can be distinguished from patients with major depression based on an earlier age of onset and a higher likelihood of having a family history of bipolar disorder.<ref name="pmid19556009">{{cite journal| author=Maina G, Salvi V, Rosso G, Bogetto F| title=Cyclothymic temperament and major depressive disorder: a study on Italian patients. | journal=J Affect Disord | year= 2010 | volume= 121 | issue= 3 | pages= 199-203 | pmid=19556009 | doi=10.1016/j.jad.2009.05.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19556009  }} </ref>
**[[Major depression]]
*[[Bipolar disorder]]
***Patients with cyclothymia can be distinguished from patients with major [[depression]] based on an earlier age of onset, a higher likelihood of having a family history of [[bipolar disorder]], and a higher incidence of [[sleep disturbances]].<ref name="pmid19556009">{{cite journal| author=Maina G, Salvi V, Rosso G, Bogetto F| title=Cyclothymic temperament and major depressive disorder: a study on Italian patients. | journal=J Affect Disord | year= 2010 | volume= 121 | issue= 3 | pages= 199-203 | pmid=19556009 | doi=10.1016/j.jad.2009.05.031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19556009 }} </ref><ref name="pmid22968491">{{cite journal| author=Van Meter A, Youngstrom EA, Demeter C, Findling RL| title=Examining the validity of cyclothymic disorder in a youth sample: replication and extension. | journal=J Abnorm Child Psychol | year= 2013 | volume= 41 | issue= 3 | pages= 367-78 | pmid=22968491 | doi=10.1007/s10802-012-9680-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22968491 }} </ref>
**Cyclothymia can be distinguished from bipolar disorder by the relatively minimized intensity of the mood-altering episodes patients experience.<ref name=”DSM-V”>American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.</ref>
**[[Bipolar disorder]]
***Cyclothymia can be distinguished from [[bipolar disorder]] by the relatively minimized intensity of the mood-altering episodes patients experience and a younger age of onset.<ref name="”DSM-V”">American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.</ref><ref name="pmid22968491">{{cite journal| author=Van Meter A, Youngstrom EA, Demeter C, Findling RL| title=Examining the validity of cyclothymic disorder in a youth sample: replication and extension. | journal=J Abnorm Child Psychol | year= 2013 | volume= 41 | issue= 3 | pages= 367-78 | pmid=22968491 | doi=10.1007/s10802-012-9680-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22968491  }} </ref>


==Epidemiology and Demographics==
==Epidemiology and Demographics==


The prevalence of cyclothymic disorder is 400-1,000 per 100,000 (0.4%-1%) of the overall population.<ref name="pmid21372620">{{cite journal| author=Baldessarini RJ, Vázquez G, Tondo L| title=Treatment of cyclothymic disorder: commentary. | journal=Psychother Psychosom | year= 2011 | volume= 80 | issue= 3 | pages= 131-5 | pmid=21372620 | doi=10.1159/000322234 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21372620  }} </ref><ref name=”DSM-V”>American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.</ref>
*The prevalence of cyclothymic disorder is 400-1,000 per 100,000 (0.4%-1%) of the overall population.<ref name="pmid22459786">{{cite journal| author=Van Meter AR, Youngstrom EA, Findling RL| title=Cyclothymic disorder: a critical review. | journal=Clin Psychol Rev | year= 2012 | volume= 32 | issue= 4 | pages= 229-43 | pmid=22459786 | doi=10.1016/j.cpr.2012.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22459786  }} </ref><ref name="pmid21372620">{{cite journal| author=Baldessarini RJ, Vázquez G, Tondo L| title=Treatment of cyclothymic disorder: commentary. | journal=Psychother Psychosom | year= 2011 | volume= 80 | issue= 3 | pages= 131-5 | pmid=21372620 | doi=10.1159/000322234 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21372620  }} </ref><ref name="”DSM-V”">American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.</ref>
 
*There is evidence that suggests cyclothymia may be the most common form of [[bipolar disorder]].
*The estimated lifetime prevalence rate was found to be between 5%-8%, whereas other studies suggest a much lower rate ranging from 0.4%-2.5%.<ref name="pmid26005206">{{cite journal| author=Perugi G, Hantouche E, Vannucchi G, Pinto O| title=Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder. | journal=J Affect Disord | year= 2015 | volume= 183 | issue=  | pages= 119-33 | pmid=26005206 | doi=10.1016/j.jad.2015.05.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26005206  }} </ref>
===Age===
===Age===
*Cyclothymia is most common in young adults.<ref name=”DSM-V”>American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.</ref>
*Cyclothymia is most common in young adults.<ref name="”DSM-V”">American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.</ref>


===Gender===
===Gender===
*Men and women are equally likely to be affected by cyclothymia, though women may be more likely to seek treatment.<ref name=”#2”>U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref><ref name="pmid21372620">{{cite journal| author=Baldessarini RJ, Vázquez G, Tondo L| title=Treatment of cyclothymic disorder: commentary. | journal=Psychother Psychosom | year= 2011 | volume= 80 | issue= 3 | pages= 131-5 | pmid=21372620 | doi=10.1159/000322234 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21372620  }} </ref>
*Men and women are equally likely to be affected by cyclothymia, though women may be more likely to seek treatment.<ref name="”#2”">U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref><ref name="pmid21372620">{{cite journal| author=Baldessarini RJ, Vázquez G, Tondo L| title=Treatment of cyclothymic disorder: commentary. | journal=Psychother Psychosom | year= 2011 | volume= 80 | issue= 3 | pages= 131-5 | pmid=21372620 | doi=10.1159/000322234 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21372620  }} </ref>


===Race===
===Race===
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==Risk Factors==
==Risk Factors==


Risk factors for the development of cyclothymia include:<ref name=”#2”>U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref><ref name=”DSM-V”>American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.</ref><ref name="pmid23544035">{{cite journal| author=Van Meter AR, Youngstrom EA| title=Cyclothymic disorder in youth: why is it overlooked, what do we know and where is the field headed? | journal=Neuropsychiatry (London) | year= 2012 | volume= 2 | issue= 6 | pages= 509-519 | pmid=23544035 | doi=10.2217/npy.12.64 | pmc=3609426 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23544035  }} </ref>
*Risk factors for the development of cyclothymia include:<ref name="”#2”">U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref><ref name="”DSM-V”">American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.</ref><ref name="pmid23544035">{{cite journal| author=Van Meter AR, Youngstrom EA| title=Cyclothymic disorder in youth: why is it overlooked, what do we know and where is the field headed? | journal=Neuropsychiatry (London) | year= 2012 | volume= 2 | issue= 6 | pages= 509-519 | pmid=23544035 | doi=10.2217/npy.12.64 | pmc=3609426 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23544035  }} </ref>
*Being an adolescent
**Being an adolescent
*Childhood abuse
**Childhood abuse
*Having a mentally ill parent
**Having a mentally ill parent
*Having problems at school
**Having problems at school
*Genetic predisposition
**[[Genetic predisposition]]


==Screening==
*The cause of cyclothymic disorder is unknown.
*No formal screening guidelines have been established for cyclothymia.
*Genetics may play a role, as indicated by a range of twin studies involving [[dizygotic]] (fraternal) and [[monozygotic]] (identical) [[twins]].
*There is a high likelihood that a patient with cyclothymia will have a [[family history]] of [[mood disorders]].<ref name="”#2”">U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
*Cyclothymia usually manifests early in a patient’s life.<ref name=”#2”>U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>
*Cyclothymia usually manifests early in a patient’s life.<ref name="”#2”">U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>
*Possible complications include a progression to bipolar disorder, though this occurs in less than half of cyclothymic patients.<ref name=”#2”>U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>
*Possible complications include a progression to [[bipolar disorder]], though this occurs in less than half of cyclothymic patients.<ref name="”#2”">U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>
**Early intervention may allow patients to circumvent some of the complications associated with bipolar disorder.<ref name="pmid21396717">{{cite journal| author=Van Meter A, Youngstrom EA, Youngstrom JK, Feeny NC, Findling RL| title=Examining the validity of cyclothymic disorder in a youth sample. | journal=J Affect Disord | year= 2011 | volume= 132 | issue= 1-2 | pages= 55-63 | pmid=21396717 | doi=10.1016/j.jad.2011.02.004 | pmc=3109127 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21396717  }} </ref>
**Early intervention may allow patients to circumvent some of the complications associated with [[bipolar disorder]].<ref name="pmid21396717">{{cite journal| author=Van Meter A, Youngstrom EA, Youngstrom JK, Feeny NC, Findling RL| title=Examining the validity of cyclothymic disorder in a youth sample. | journal=J Affect Disord | year= 2011 | volume= 132 | issue= 1-2 | pages= 55-63 | pmid=21396717 | doi=10.1016/j.jad.2011.02.004 | pmc=3109127 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21396717  }} </ref>
*Cyclothymia may remain a chronic condition or disappear over the course of a patient’s life.<ref name=”#2”>U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>
*Cyclothymia may remain a [[chronic]] condition or disappear over the course of a patient’s life.<ref name="”#2”">U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>


==Diagnosis==
==Diagnosis==
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===Diagnostic Criteria===
===Diagnostic Criteria===


DSM-V Diagnostic Criteria for Cyclothymic Disorder<ref name=”DSM-V”>American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.</ref>
DSM-V Diagnostic Criteria for Cyclothymic Disorder<ref name="”DSM-V”">American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.</ref>
{{cquote|
{{cquote|


*A. For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with [[hypomanic]] symptoms that do not meet criteria for a [[hypomanic]]
*A. For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with [[hypomanic]] symptoms that do not meet criteria for a [[hypomanic]] episode and numerous periods with depressive symptoms that do not meet criteria for a [[major depressive episode]].
episode and numerous periods with depressive symptoms that do not meet criteria for a [[major depressive episode]].


'''''AND'''''
'''''AND'''''


*B. During the above 2-year period (1 year in children and adolescents), the [[hypomanic]] and depressive periods have been present for at least half the time and the individual
*B. During the above 2-year period (1 year in children and adolescents), the [[hypomanic]] and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.
has not been without the symptoms for more than 2 months at a time.


'''''AND'''''
'''''AND'''''


*C. Criteria for a major depressive, [[manic]], or [[hypomanic]] episode have never been met.
*C. Criteria for a major [[depressive]], [[manic]], or [[hypomanic]] episode have never been met.


'''''AND'''''
'''''AND'''''


D. The symptoms in criterion A are not better explained by [[schizoaffective disorder]], [[schizophrenia]], [[schizophreniform disorder]], [[delusional disorder]], or other specified or unspecified [[schizophrenia]] spectrum and other psychotic disorder.
*D. The symptoms in criterion A are not better explained by [[schizoaffective disorder]], [[schizophrenia]], [[schizophreniform disorder]], [[delusional disorder]], or other specified or unspecified [[schizophrenia]] spectrum and other [[psychotic disorder]].


'''''AND'''''
'''''AND'''''


E. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., [[hyperthyroidism]]).
*E. The symptoms are not attributable to the [[physiological]] effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., [[hyperthyroidism]]).


'''''AND'''''
'''''AND'''''


F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
*F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.




Specify if:
Specify if:


:*With anxious distress
:*With [[anxious distress]]
}}
}}


===Symptoms===
===History and Symptoms===
Symptoms of cyclothymia include:<ref name=”#2”>U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>
*Periods of both mania (extreme mood elevation and energy) and depression (low mood and energy level) for at least two years, or one in children and young adults
*Mood swings that are not as severe as those observed in bipolar disorder
*Continuity of manic/depressive episodes (i.e., no more than 2 consecutive months without symptoms)


===Physical Examination===
*Symptoms of cyclothymia include:<ref name="”#2”">U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>
*A diagnosis of cyclothymia is made based on a patient’s mood history.<ref name=”#2”>U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>
**Periods of both [[mania]] (extreme mood elevation and energy) and [[depression]] (low mood and energy level) for at least two years, or one in children and young adults
*One prominent barrier to diagnosis is a lack of consensus among clinicians about the precise distinction between syndromal and subsyndromal depression and mania.<ref name="pmid21372620">{{cite journal| author=Baldessarini RJ, Vázquez G, Tondo L| title=Treatment of cyclothymic disorder: commentary. | journal=Psychother Psychosom | year= 2011 | volume= 80 | issue= 3 | pages= 131-5 | pmid=21372620 | doi=10.1159/000322234 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21372620  }} </ref>
**[[Mood swings]] that are not as severe as those observed in [[bipolar disorder]]
**Continuity of manic/depressive episodes (i.e., no more than 2 consecutive months without symptoms)
 
===Clinical Examination===
 
*A diagnosis of cyclothymia is made based on a patient’s [[mood]] history.<ref name="”#2”">U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>
 
*One prominent barrier to a diagnosis is a lack of consensus among clinicians about the precise distinction between syndromal and subsyndromal depression and [[mania]].<ref name="pmid21372620">{{cite journal| author=Baldessarini RJ, Vázquez G, Tondo L| title=Treatment of cyclothymic disorder: commentary. | journal=Psychother Psychosom | year= 2011 | volume= 80 | issue= 3 | pages= 131-5 | pmid=21372620 | doi=10.1159/000322234 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21372620  }} </ref>


===Laboratory Findings===
===Laboratory Findings===
*Although no laboratory findings are diagnostic of cyclothymia, a healthcare provider may wish to order blood tests and/or urine tests in order to rule out other possible causes of mood swings.<ref name=”#2”>U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>
 
*Although no laboratory findings are diagnostic of cyclothymia, a healthcare provider may wish to order [[blood tests]] and/or [[urine tests]] in order to rule out other possible causes of mood swings.<ref name="”#2”">U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>


===Imaging Findings===
===Imaging Findings===
*No imaging findings are diagnostic of cyclothymia, though limited evidence suggests that cyclothymia may be associated with activity in the left lingual gyrus.<ref name="pmid25151190">{{cite journal| author=Mizokami Y, Terao T, Hatano K, Kodama K, Kohno K, Makino M et al.| title=Identification of the neural correlates of cyclothymic temperament using an esthetic judgment for paintings task in fMRI. | journal=J Affect Disord | year= 2014 | volume= 169 | issue=  | pages= 47-50 | pmid=25151190 | doi=10.1016/j.jad.2014.07.037 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25151190  }} </ref>


===Other Diagnostic Studies===
*No imaging findings are diagnostic of cyclothymia, though limited evidence suggests that cyclothymia may be associated with activity in the left [[lingual gyrus]].<ref name="pmid25151190">{{cite journal| author=Mizokami Y, Terao T, Hatano K, Kodama K, Kohno K, Makino M et al.| title=Identification of the neural correlates of cyclothymic temperament using an esthetic judgment for paintings task in fMRI. | journal=J Affect Disord | year= 2014 | volume= 169 | issue=  | pages= 47-50 | pmid=25151190 | doi=10.1016/j.jad.2014.07.037 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25151190  }} </ref>
*No other diagnostic modalities are in use for cyclothymia.


==Treatment==
==Treatment==


===Medical Therapy===
===Medical Therapy===
*The treatment of cyclothymia may involve medication, talk therapy, or some combination of the two.<ref name=”#2”>U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>
The treatment of cyclothymia may involve medications.<ref name="”#2”">U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>
*'''Medication'''
*'''Medication'''
**Medication may involve mood-stabilizing drugs, antidepressants, or both.<ref name=”#2”>U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>
**Medication may involve:<ref name="”#2”">U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref>  
***Commonly prescribed mood-stabilizers are lithium and anti-seizure drugs.
***[[Mood stabilizers|Mood-stabilizing drugs]]
**Clinical evidence also supports the use of such antipsychotic drugs as quetiapine.<ref name="pmid21372620">{{cite journal| author=Baldessarini RJ, Vázquez G, Tondo L| title=Treatment of cyclothymic disorder: commentary. | journal=Psychother Psychosom | year= 2011 | volume= 80 | issue= 3 | pages= 131-5 | pmid=21372620 | doi=10.1159/000322234 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21372620  }} </ref>
***[[Antidepressants]]
*'''Talk Therapy'''
**Commonly prescribed [[mood-stabilizers]] are:
**Support groups may be helpful for patients suffering from cyclothymia.<ref name=”#2”>U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref><ref name="pmid21372620">{{cite journal| author=Baldessarini RJ, Vázquez G, Tondo L| title=Treatment of cyclothymic disorder: commentary. | journal=Psychother Psychosom | year= 2011 | volume= 80 | issue= 3 | pages= 131-5 | pmid=21372620 | doi=10.1159/000322234 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21372620  }} </ref>
***[[Lithium]]
 
***[[Anti-epileptic drugs]]
===Surgery===
**Clinical evidence also supports the use of such [[antipsychotic drugs]] as [[quetiapine]].<ref name="pmid21372620">{{cite journal| author=Baldessarini RJ, Vázquez G, Tondo L| title=Treatment of cyclothymic disorder: commentary. | journal=Psychother Psychosom | year= 2011 | volume= 80 | issue= 3 | pages= 131-5 | pmid=21372620 | doi=10.1159/000322234 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21372620  }} </ref>
*Surgery is not recommended for the management of cyclothymia.
**Talk therapy is another source of treatment for cyclothymia.
 
***Support groups may be helpful for patients suffering from cyclothymia.<ref name="”#2”">U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.</ref><ref name="pmid21372620">{{cite journal| author=Baldessarini RJ, Vázquez G, Tondo L| title=Treatment of cyclothymic disorder: commentary. | journal=Psychother Psychosom | year= 2011 | volume= 80 | issue= 3 | pages= 131-5 | pmid=21372620 | doi=10.1159/000322234 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21372620  }} </ref>
===Prevention===
*No established measures exist for the primary prevention of cyclothymia.
*Measures for the secondary prevention of cyclothymia include early diagnosis and treatment interventions.


==References==
==References==

Latest revision as of 20:54, 9 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Irfan Dotani, Kiran Singh, M.D. [2], Haleigh Williams, B.S.

Synonyms and keywords: Cyclothymic disorder; cyclic disorder

Overview

Cyclothymia, or cyclothymic disorder, is a mood disorder characterized by the co-occurrence of hypomanic and depressive symptoms over a period of at least two years, or one year in children and young adults. Symptoms must not meet the diagnostic criteria for manic/depressive episodes.[1] Cyclothymia is considered a mild form of bipolar II disorder.[2] There is evidence that cyclothymia may be the most common form of bipolar disorder.[3]

Historical Perspective

  • In 1980, cyclothymia was included to the DSM.[3]
  • The two defining features of the disorder, according to DSM-5, are:
    • The presence of depressive episodes
    • The presence of hypomania

Classification

Commonly Comorbid Conditions

Differentiating Cyclothymia from other disorders

  • Cyclothymia must be differentiated from other disorders that present with similar symptomatology, including:[2][5]

Epidemiology and Demographics

  • The prevalence of cyclothymic disorder is 400-1,000 per 100,000 (0.4%-1%) of the overall population.[3][11][5]
  • There is evidence that suggests cyclothymia may be the most common form of bipolar disorder.
  • The estimated lifetime prevalence rate was found to be between 5%-8%, whereas other studies suggest a much lower rate ranging from 0.4%-2.5%.[6]

Age

  • Cyclothymia is most common in young adults.[5]

Gender

  • Men and women are equally likely to be affected by cyclothymia, though women may be more likely to seek treatment.[2][11]

Race

  • No racial predilection of cyclothymia has been observed.

Risk Factors

  • Risk factors for the development of cyclothymia include:[2][5][12]
    • Being an adolescent
    • Childhood abuse
    • Having a mentally ill parent
    • Having problems at school
    • Genetic predisposition
  • The cause of cyclothymic disorder is unknown.
  • Genetics may play a role, as indicated by a range of twin studies involving dizygotic (fraternal) and monozygotic (identical) twins.
  • There is a high likelihood that a patient with cyclothymia will have a family history of mood disorders.[2]

Natural History, Complications, and Prognosis

  • Cyclothymia usually manifests early in a patient’s life.[2]
  • Possible complications include a progression to bipolar disorder, though this occurs in less than half of cyclothymic patients.[2]
    • Early intervention may allow patients to circumvent some of the complications associated with bipolar disorder.[8]
  • Cyclothymia may remain a chronic condition or disappear over the course of a patient’s life.[2]

Diagnosis

Diagnostic Criteria

DSM-V Diagnostic Criteria for Cyclothymic Disorder[5]

“
  • A. For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.

AND

  • B. During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.

AND

AND

AND

  • E. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

AND

  • F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.


Specify if:

”

History and Symptoms

  • Symptoms of cyclothymia include:[2]
    • Periods of both mania (extreme mood elevation and energy) and depression (low mood and energy level) for at least two years, or one in children and young adults
    • Mood swings that are not as severe as those observed in bipolar disorder
    • Continuity of manic/depressive episodes (i.e., no more than 2 consecutive months without symptoms)

Clinical Examination

  • A diagnosis of cyclothymia is made based on a patient’s mood history.[2]
  • One prominent barrier to a diagnosis is a lack of consensus among clinicians about the precise distinction between syndromal and subsyndromal depression and mania.[11]

Laboratory Findings

  • Although no laboratory findings are diagnostic of cyclothymia, a healthcare provider may wish to order blood tests and/or urine tests in order to rule out other possible causes of mood swings.[2]

Imaging Findings

  • No imaging findings are diagnostic of cyclothymia, though limited evidence suggests that cyclothymia may be associated with activity in the left lingual gyrus.[13]

Treatment

Medical Therapy

The treatment of cyclothymia may involve medications.[2]

References

  1. ↑ National Institute of Mental Health (NIMH). “Bipolar Disorder.” https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml. Accessed 12 December 2016.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.
  3. ↑ 3.0 3.1 3.2 Van Meter AR, Youngstrom EA, Findling RL (2012). "Cyclothymic disorder: a critical review". Clin Psychol Rev. 32 (4): 229–43. doi:10.1016/j.cpr.2012.02.001. PMID 22459786.
  4. ↑ Brieger P, Marneros A (1997). "Dysthymia and cyclothymia: historical origins and contemporary development". J Affect Disord. 45 (3): 117–26. PMID 9298424.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.
  6. ↑ 6.0 6.1 Perugi G, Hantouche E, Vannucchi G, Pinto O (2015). "Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder". J Affect Disord. 183: 119–33. doi:10.1016/j.jad.2015.05.004. PMID 26005206.
  7. ↑ Perugi G, Hantouche E, Vannucchi G, Pinto O (2015). "Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder". J Affect Disord. 183: 119–33. doi:10.1016/j.jad.2015.05.004. PMID 26005206. Check |pmid= value (help).
  8. ↑ 8.0 8.1 Van Meter A, Youngstrom EA, Youngstrom JK, Feeny NC, Findling RL (2011). "Examining the validity of cyclothymic disorder in a youth sample". J Affect Disord. 132 (1–2): 55–63. doi:10.1016/j.jad.2011.02.004. PMC 3109127. PMID 21396717.
  9. ↑ Maina G, Salvi V, Rosso G, Bogetto F (2010). "Cyclothymic temperament and major depressive disorder: a study on Italian patients". J Affect Disord. 121 (3): 199–203. doi:10.1016/j.jad.2009.05.031. PMID 19556009.
  10. ↑ 10.0 10.1 Van Meter A, Youngstrom EA, Demeter C, Findling RL (2013). "Examining the validity of cyclothymic disorder in a youth sample: replication and extension". J Abnorm Child Psychol. 41 (3): 367–78. doi:10.1007/s10802-012-9680-1. PMID 22968491.
  11. ↑ 11.0 11.1 11.2 11.3 11.4 Baldessarini RJ, Vázquez G, Tondo L (2011). "Treatment of cyclothymic disorder: commentary". Psychother Psychosom. 80 (3): 131–5. doi:10.1159/000322234. PMID 21372620.
  12. ↑ Van Meter AR, Youngstrom EA (2012). "Cyclothymic disorder in youth: why is it overlooked, what do we know and where is the field headed?". Neuropsychiatry (London). 2 (6): 509–519. doi:10.2217/npy.12.64. PMC 3609426. PMID 23544035.
  13. ↑ Mizokami Y, Terao T, Hatano K, Kodama K, Kohno K, Makino M; et al. (2014). "Identification of the neural correlates of cyclothymic temperament using an esthetic judgment for paintings task in fMRI". J Affect Disord. 169: 47–50. doi:10.1016/j.jad.2014.07.037. PMID 25151190.

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