Cyclothymic Disorder

Cyclothymic disorder consists of chronic cyclical episodes of mild depression and symptoms of mild mania.

DSM IV Diagnostic Criteria

  • Many periods of depression and hypomania, occurring for at least 2 years. Depressive episodes do not reach severity of major depression.
  • During the 2 year period, the patient has not been symptom-free for more than 2 months at a time.
  • During the 2 year period, no episodes of major depression, mania or mixed states were present.
  • Symptoms are not accounted for by schizoaffective disorder and do not coexist with schizophrenia, schizophreniform disorder, delusional disorder, or any other psychotic disorder.
  • Symptoms are not caused by substance use or general medical condition.
  • Symptoms cause significant distress or functional impairment.

Clinical Features of Cyclothymic Disorder

  • Symptoms are similar to those of bipolar I disorder, but they are of a lesser magnitude and cycles occur at a faster rate.
  • Patients frequently have coexisting substance abuse and one third of patients develop a severe mood disorder (usually bipolar II).
  • Occupational and interpersonal impairment is frequent and usually a consequence of hypomanic states.
  • Cyclothymic disorder often coexists with borderline personality disorder.

Epidemiology of Cyclothymic Disorder

  • The prevalence is 1%, but cyclothymic disorder constitutes 5-10% of psychiatric outpatients.
  • The onset occurs between age 15 and 25, and women are affected more than men by a ratio of 3:2.
  • Thirty percent of patients have a family history of bipolar disorder.

Differential Diagnosis of Cyclothymic Disorder

Bipolar II Disorder. Patients with bipolar type II disorder exhibit hypomania and episodes of major depression.
Substance-Induced Mood Disorder/Mood Disorder Due to a General Medical Condition. See under dysthymic disorder and bipolar I.
Personality Disorders (antisocial, borderline, histrionic, narcissistic) can be characterized by marked shifts in mood. Personality disorders may coexist with cyclothymic disorder.

Treatment of Cyclothymic Disorder

Mood stabilizers are the treatment of choice, and Lithium is effective in 60% of patients. The clinical use of mood stabilizers is similar to that of bipolar disorder. (Also see “Psychiatric Therapy,” page ).

Depressive episodes must be treated cautiously because of the risk of precipitating manic symptoms with antidepressants (occurs in 50% of patients). Antidepressants can also increase the rate of cycling. Patients are often treated concurrently with anti-manics and antidepressants.

Patients often require supportive therapy to improve their awareness of their illness and to deal with the functional consequences of their behavior.

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