Cyclothymia

Depression & Anxiety Links

Cyclothymia

Cyclothymia is a chronic bipolar disorder that consists of short periods of mild depression alternating with short periods of hypomania. It is considered to be a chronic, low level form of bipolar disorder. The onset of each phase is separated by short periods of normal mood. Cyclothymic disorder is a recurrent, chronic, mild form of bipolar disorder in which mood typically oscillates between hypomania and dysthymia. It is not diagnosed if a person has had either a manic episode or a major depressive episode.

History and Mental Status Examination

This disorder is a milder form of bipolar disorder consisting of recurrent mood disturbances between hypomania and dysthymic mood. A single episode of hypomania is sufficient to diagnose cyclothymic disorder; however, most individuals also have dysthymic periods. The diagnosis of cyclothymic disorder is never made when there is a history of mania or major depressive episode or mixed episode.(as told in "Blueprints in Psychiatry"-"mood disorders")

Diagnostic Criteria

    * The lifetime prevalence of cyclothymic disorder is 0.4-1%. The rate appears equal in men or women, though women more often seek treatment.
    * Symptoms are present for at least two years: periods of hypomanic symptoms and periods of low mood that do not fulfill the criteria for major depressive disorder.
    * The longest period the patient has been free of symptoms is two months.
    * During the first two years of the disorder, the patient has not fulfilled the criteria for either bipolar disorder or major depressive disorder.
    * The disorder cannot be better explained as schizoaffective disorder, and it is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder or psychotic disorder not otherwise specified.
    * Symptoms are not directly caused by a general medical condition or the use of any substances such as prescription medicines.
    * The symptoms cause the patient clinically significant distress or impair work, social or personal functioning.

ICD-10 Diagnostic Criteria

F34.0 Cyclothymia

A persistent instability of mood, involving numerous periods of mild depression and mild elation. This instability usually develops early in adult life and pursues a chronic course, although at times the mood may be normal and stable for months at a time. The mood swings are usually perceived by the individual as being unrelated to life events. The diagnosis is difficult to establish without a prolonged period of observation or an unusually good account of the individual's past behaviour. Because the mood swings are relatively mild and the periods of mood elevation may be enjoyable, cyclothymia frequently fails to come to medical attention. In some cases this may be because the mood change, although present, is less prominent than cyclical changes in activity, self-confidence, sociability, or appetitive behaviour. If required, age of onset may be specified as early (in late teenage or the twenties) or late.

The essential feature is a persistent instability of mood, involving numerous periods of mild depression and mild elation, none of which has been sufficiently severe or prolonged to fulfill the criteria for bipolar affective disorder or recurrent depressive disorder. This implies that individual episodes of mood swings do not fulfill the criteria for any of the categories described under manic episode or depressive episode.

Includes:

    * affective personality disorder
    * cycloid personality
    * cyclothymic personality

Differential Diagnosis

This disorder is common in the relatives of patients with bipolar affective disorder and some individuals with cyclothymia eventually develop bipolar affective disorder themselves. It may persist throughout adult life, cease temporarily or permanently, or develop into more severe mood swings meeting the criteria for bipolar affective disorder or recurrent depressive disorder.

Causes

Cyclothymia appears to have a significant genetic contribution, which has been shown by a range of twin studies involving dizygotic and monozygotic twins. Brain changes in cyclothymia include a variety of changes in the receptor mechanisms.

Treatment

Treatment for cyclothymia can range from a variety of cognitive and behavioural techniques to the administration of mood stabilizing drugs. Mood stabilisers are frequently prescribed to treat cyclothymia, although sufferers may choose to remain untreated, or to undergo supportive psychotherapy alone. Lithium and valium are commonly prescribed, and has been proven to help a substantial number of people.