Cyclothymia
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: 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]
Historical Perspective
Cyclothymia has been included in the DSM since 1980.[3]
Classification
Cyclothymia is classified as a mild form of bipolar II disorder.[2]
Pathophysiology
Commonly Comorbid Conditions
Conditions that are commonly comorbid with cyclothymia include:[4]
- ADHD
- Anxiety disorders
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][5]
- Major depression
- 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.[6]
- Bipolar disorder
Epidemiology and Demographics
The prevalence of cyclothymic disorder is 400-1,000 per 100,000 (0.4%-1%) of the overall population.[7][5]
Age
Gender
- Men and women are equally likely to be affected by cyclothymia, though women may be more likely to seek treatment.[2][7]
Race
Risk Factors
Risk factors for the development of cyclothymia include:[2][5]
- Being an adolescent
- Genetic predisposition
Screening
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.[4]
- 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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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
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Treatment for cyclothymia can include a variety of cognitive behavioral therapy techniques. Additionally, mood stabilizers, such as lithium and medications for anxiety and mood stabilization such as benzodiazepines, are often prescribed in low doses to treat cyclothymia.
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 U.S. National Library of Medicine. “Cyclothymic disorder.” https://medlineplus.gov/ency/article/001550.htm. Accessed 12 December 2016.
- ↑ 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 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.
- ↑ 5.0 5.1 5.2 5.3 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.
- ↑ 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.
- ↑ 7.0 7.1 Baldessarini RJ, Vázquez G, Tondo L (2011). "Treatment of cyclothymic disorder: commentary". Psychother Psychosom. 80 (3): 131–5. doi:10.1159/000322234. PMID 21372620.