Cyclothymia: Difference between revisions
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Revision as of 19:38, 1 August 2018
Template:DiseaseDisorder infobox
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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
Cyclothymia has been included in the DSM since 1980.[3]
Classification
Cyclothymia is classified by the DSM-V as a mild form of bipolar II disorder.[2][4] 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.[5]
Pathophysiology
Commonly Comorbid Conditions
Conditions that are commonly comorbid with cyclothymia include:[6]
Causes
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.[2]
Differentiating Cyclothymia from other disorders
Cyclothymia must be differentiated from other disorders that present with similar symptomatology, including:[2][4]
- Major depression
- 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.[7][8]
- Bipolar disorder
Epidemiology and Demographics
The prevalence of cyclothymic disorder is 400-1,000 per 100,000 (0.4%-1%) of the overall population.[9][4] There is evidence that cyclothymia may be the most common form of bipolar disorder.[3]
Age
- Cyclothymia is most common in young adults.[4]
Gender
- Men and women are equally likely to be affected by cyclothymia, though women may be more likely to seek treatment.[2][9]
Race
- No racial predilection of cyclothymia has been observed.
Risk Factors
Risk factors for the development of cyclothymia include:[2][4][10]
- Being an adolescent
- Childhood abuse
- Having a mentally ill parent
- Having problems at school
- Genetic predisposition
Screening
- No formal screening guidelines have been established for cyclothymia.
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.[6]
- 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[4]
| “ |
episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode. AND
has not been without the symptoms for more than 2 months at a time. 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. 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.
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” |
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)
Physical Examination
- A diagnosis of cyclothymia is made based on a patient’s mood history.[2]
- One prominent barrier to diagnosis is a lack of consensus among clinicians about the precise distinction between syndromal and subsyndromal depression and mania.[9]
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.[11]
Other Diagnostic Studies
- No other diagnostic modalities are in use for cyclothymia.
Treatment
Medical Therapy
- The treatment of cyclothymia may involve medication, talk therapy, or some combination of the two.[2]
- Medication
- Medication may involve mood-stabilizing drugs, antidepressants, or both.[2]
- Commonly prescribed mood-stabilizers are lithium and anti-seizure drugs.
- Clinical evidence also supports the use of such antipsychotic drugs as quetiapine.[9]
- Medication may involve mood-stabilizing drugs, antidepressants, or both.[2]
- Talk Therapy
Surgery
- Surgery is not recommended for the management of cyclothymia.
Prevention
- No established measures exist for the primary prevention of cyclothymia.
- Measures for the secondary prevention of cyclothymia include early diagnosis and treatment.
References
- ↑ National Institute of Mental Health (NIMH). “Bipolar Disorder.” https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml. Accessed 12 December 2016.
- ↑ 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.
- ↑ 3.0 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.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.
- ↑ 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.
- ↑ 6.0 6.1 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.
- ↑ 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.
- ↑ 8.0 8.1 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.
- ↑ 9.0 9.1 9.2 9.3 9.4 Baldessarini RJ, Vázquez G, Tondo L (2011). "Treatment of cyclothymic disorder: commentary". Psychother Psychosom. 80 (3): 131–5. doi:10.1159/000322234. PMID 21372620.
- ↑ 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.
- ↑ 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.