Cyclothymia

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Cyclothymia
ICD-10 F34.0
ICD-9 301.13

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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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