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Synonyms and Keywords: Cyclothymic disorder; cyclic disorder
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. Cyclothymia is considered a mild form of bipolar II disorder. There is evidence that cyclothymia may be the most common form of bipolar disorder.
- In 1882, cyclothymia was characterized by recurring mood cycles. This was accomplished by Karl Ludwig Kahlbaum.
- Cyclothymia has been conceptualized in a variety of ways:
- The two defining features of the disorder, according to DSM-5, are:
- The presence of depressive episodes
- The presence of hypomania
- Cyclothymia is classified by the DSM-V as a mild form of bipolar II disorder.
- 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.
- Cyclothymia has been conceptualized to include other characteristics such as:
Commonly Comorbid Conditions
Differentiating Cyclothymia from other disorders
- Cyclothymia must be differentiated from other disorders that present with similar symptomatology, including:
- Major depression
- Bipolar disorder
Epidemiology and Demographics
- The prevalence of cyclothymic disorder is 400-1,000 per 100,000 (0.4%-1%) of the overall population.
- 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%.
- Cyclothymia is most common in young adults.
- Men and women are equally likely to be affected by cyclothymia, though women may be more likely to seek treatment.
- No racial predilection of cyclothymia has been observed.
- Risk factors for the development of cyclothymia include:
- 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.
Natural History, Complications, and Prognosis
- Cyclothymia usually manifests early in a patient’s life.
- Possible complications include a progression to bipolar disorder, though this occurs in less than half of cyclothymic patients.
- Cyclothymia may remain a chronic condition or disappear over the course of a patient’s life.
DSM-V Diagnostic Criteria for Cyclothymic Disorder
History and Symptoms
- Symptoms of cyclothymia include:
- 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)
- One prominent barrier to a diagnosis is a lack of consensus among clinicians about the precise distinction between syndromal and subsyndromal depression and mania.
- 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.
- No imaging findings are diagnostic of cyclothymia, though limited evidence suggests that cyclothymia may be associated with activity in the left lingual gyrus.
The treatment of cyclothymia may involve medications.
- Medication may involve:
- Commonly prescribed mood-stabilizers are:
- Clinical evidence also supports the use of such antipsychotic drugs as quetiapine.
- Talk therapy is another source of treatment for cyclothymia.
- National Institute of Mental Health (NIMH). “Bipolar Disorder.” https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml. Accessed 12 December 2016.
- 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.
- Brieger P, Marneros A (1997). "Dysthymia and cyclothymia: historical origins and contemporary development". J Affect Disord. 45 (3): 117–26. PMID 9298424.
- 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.
- 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
- 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.
- 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.
- 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.