Cyclothymia
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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 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:
- Cyclothymia has been conceptualized in a variety of ways:[4]
- As a subtype of bipolar disorder
- As a temperament
- As a personality trait
- As a personality disorder
- The two defining features of the disorder, according to DSM-5, are:
- The presence of depressive episodes
- The presence of hypomania.
Classification
- Cyclothymia is classified by the DSM-V as a mild form of bipolar II disorder.[2][5]
- 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.[6]
- Cyclothymia has been conceptualized to include other characteristics such as:[7]
Commonly Comorbid Conditions
- Conditions that are commonly comorbid with cyclothymia include:[8]
Differentiating Cyclothymia from other disorders
- Cyclothymia must be differentiated from other disorders that present with similar symptomatology, including:[2][5]
- 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.[9][10]
- 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.[5][10]
- Major depression
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]
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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)
Physical Examination
- 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:[2]
- Medication
- Medication may involve:[2]
- Commonly prescribed mood-stabilizers are:
- [Llithium (medication)|lithium]]
- Anti-seizure drugs
- Clinical evidence also supports the use of such antipsychotic drugs as quetiapine.[11]
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.
- ↑ Brieger P, Marneros A (1997). "Dysthymia and cyclothymia: historical origins and contemporary development". J Affect Disord. 45 (3): 117–26. PMID 9298424.
- ↑ 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.
- ↑ 6.0 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.
- ↑ 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). - ↑ 8.0 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.
- ↑ 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.
- ↑ 10.0 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.
- ↑ 11.0 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.
- ↑ 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.