Internet Mental Health
 
CYCLOTHYMIC DISORDER
 


Prediction: Episodic and Chronic

      Occupational-Economic:
  • Work impairment (may be unpredictable, inconsistent, or unreliable if having prolonged mood swings)
      Wisdom vs Irrationality: N/A
      Courage vs Negative Emotion:
  • Episodic depressed mood alternating with elated mood (insufficient to qualify as a major depressive episode or manic episode)
  • When depressed: low self-confidence, pessimism, loneliness and hypersensitivity to rejection
      Community vs Detachment: N/A
      Moderation vs Disinhibition: N/A
      Justice vs Antagonism: N/A
      Medical:N/A


SYNOPSIS

Cyclothymia F34.0 - ICD10 Description, World Health Organization
A persistent instability of mood involving numerous periods of depression and mild elation, none of which is sufficiently severe or prolonged to justify a diagnosis of bipolar affective disorder (F31.-) or recurrent depressive disorder (F33.-). This disorder is frequently found in the relatives of patients with bipolar affective disorder. Some patients with cyclothymia eventually develop bipolar affective disorder.
Cyclothymic Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with cyclothymic disorder needs to meet all of the following criteria:

  • 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.

  • 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.

  • Criteria for a major depressive, manic, or hypomanic episode have never been met.

  • The hypomanic and depressive symptoms are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

  • The symptoms are not attributable to the physiological effects of a substance (a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

This disorder, for at least 2 years, has numerous periods with mild elation, and numerous periods with mild depression. The elation never becomes severe enough to meet the diagnostic criteria for a manic, mixed, or hypomanic episodes, and the depression never becomes severe enough to meet the diagnostic criteria for a major depressive episode. The duration of this disorder only needs to be 1 year in children and adolescents. To be diagnosed, this disorder must cause significant impairment in an individual's life. This disorder is frequently found in the relatives of patients with bipolar disorder. Some patients with cyclothymic disorder eventually develop bipolar disorder.

Effective Therapies

There are only a few research studies on the effectiveness of treatment for this disorder. This research has shown that medication (mood-stabilizers used in combinatiion with antidepressants) is highly effective. In addition, cognitive behavioral therapy (CBT), and well-being therapy have been shown to be effective. Informing patients and their families about this illness significantly improves patient compliance and family cooperation.

Ineffective Therapies

Vitamins, dietary supplements, and acupuncture are all ineffective for mood disorders.


Prevalence

Lifetime prevalence for this disorder in the general population is 0.4% to 1%. This disorder is more common in women and men.

Course

This disorder usually has an insidious onset in adolescence or early adult life. It often develops with prolonged periods of cyclical, often unpredictable mood changes. This disorder usually has a chronic course, and has a 15%-50% risk that the person will eventually develop bipolar I or II disorder.

Familial Pattern

First-degree biological relatives of individuals with cyclothymic disorder have elevated rates of bipolar I or II disorder, major depressive disorder, and substance-related disorders compared with the general population. Cyclothymic disorder is more common in the first-degree biological relatives of individuals with bipolar I disorder.

Complications

By definition, there must clinically significant distress or impairment in social, occupational, or other important functioning as result of this mood disturbance.

Comorbidity

This disorder is associated with an increased risk of having substance-related disorders, sleep disorders and bipolar I or II disorder. Children with this disorder have an increased risk of having attention-deficit/hyperactivity disorder.

Associated Laboratory Findings

No laboratory test has been found to be diagnostic of this disorder.

Treatment

The most important first step in the treatment of this disorder is to prevent alcohol or illicit drug abuse. Medication often is ineffective when the individual is still abusing alcohol or illicit drugs.

There is little research on the treatment of cyclothymic disorder. Generally, research is showing that the medications that are effective in treating bipolar I disorder are also effective in cyclothymic disorder.

Mood stabilizers (e.g., lithium, carbamazepine and valproate) in combination with antidepressant medication (buproprion, SSRI or MAOI antidepressant medication) has been shown to be effective in the treatment of this disorder. Thyroid augmentation of antidepressant medication can be helpful.

Cognitive behavioral therapy (CBT), and well-being therapy have been shown to be effective. Psychoeducation (teaching patients and their families about this illness) significantly improves patient compliance and family cooperation.

Description

Stories

Free Diagnosis Of This Disorder

Treatment

Research

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Internet Mental Health 1995-2011 Phillip W. Long, M.D.