Cyclothymia
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. Cyclothymia is considered a mild form of bipolar II disorder. There is evidence that cyclothymia may be the most common form of bipolar disorder.

# Historical Perspective
- In 1882, cyclothymia was characterized by recurring mood cycles. This was accomplished by Karl Ludwig Kahlbaum.
Cyclothymia contains episodes, both of which occur in a milder form than in bipolar disorder:
Melancholic episodes
Manic episodes
- Cyclothymia contains episodes, both of which occur in a milder form than in bipolar disorder:
Melancholic episodes
Manic episodes
- Melancholic episodes
- Manic episodes
- In 1980, cyclothymia was included to the DSM.
- Cyclothymia has been conceptualized in a variety of ways:
As a subtype of bipolar disorder
As a temperament
As a personality trait
As a personality disorder
- As a subtype of bipolar disorder
- As a temperament
- As a personality trait
- As a personality disorder
- The two defining features of the disorder, according to DSM-5, are:
The presence of depressive episodes
The presence of hypomania
- The presence of depressive episodes
- The presence of hypomania

# Classification
- 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:
Mood reactivity
Impulsivity
Anxiety
- Mood reactivity
- Impulsivity
- Anxiety

## Commonly Comorbid Conditions
- Conditions that are commonly comorbid with cyclothymia include:
ADHD
Anxiety disorders
- ADHD
- Anxiety disorders

# Differentiating Cyclothymia from other disorders
- Cyclothymia must be differentiated from other disorders that present with similar symptomatology, including:
Major depression
Patients with cyclothymia can be distinguished from patients with major depression based on an earlier age of onset, a higher likelihood of having a family history of bipolar disorder, and a higher incidence of sleep disturbances.
Bipolar disorder
Cyclothymia can be distinguished from bipolar disorder by the relatively minimized intensity of the mood-altering episodes patients experience and a younger age of onset.
- Major depression
Patients with cyclothymia can be distinguished from patients with major depression based on an earlier age of onset, a higher likelihood of having a family history of bipolar disorder, and a higher incidence of sleep disturbances.
- Patients with cyclothymia can be distinguished from patients with major depression based on an earlier age of onset, a higher likelihood of having a family history of bipolar disorder, and a higher incidence of sleep disturbances.
- Bipolar disorder
Cyclothymia can be distinguished from bipolar disorder by the relatively minimized intensity of the mood-altering episodes patients experience and a younger age of onset.
- Cyclothymia can be distinguished from bipolar disorder by the relatively minimized intensity of the mood-altering episodes patients experience and a younger age of onset.

# 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%.

## Age
- Cyclothymia is most common in young adults.

## Gender
- Men and women are equally likely to be affected by cyclothymia, though women may be more likely to seek treatment.

## Race
- No racial predilection of cyclothymia has been observed.

# Risk Factors
- Risk factors for the development of cyclothymia include:
Being an adolescent
Childhood abuse
Having a mentally ill parent
Having problems at school
Genetic predisposition
- 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 patients life.
- Possible complications include a progression to bipolar disorder, though this occurs in less than half of cyclothymic patients.
Early intervention may allow patients to circumvent some of the complications associated with bipolar disorder.
- Early intervention may allow patients to circumvent some of the complications associated with bipolar disorder.
- Cyclothymia may remain a chronic condition or disappear over the course of a patients life.

# Diagnosis

## Diagnostic Criteria
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)
- 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 patients mood history.
- One prominent barrier to a diagnosis is a lack of consensus among clinicians about the precise distinction between syndromal and subsyndromal depression and mania.

## 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.

## 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.

# Treatment

## Medical Therapy
The treatment of cyclothymia may involve medications.
- Medication
Medication may involve:
Mood-stabilizing drugs
Antidepressants
Commonly prescribed mood-stabilizers are:
Lithium
Anti-epileptic drugs
Clinical evidence also supports the use of such antipsychotic drugs as quetiapine.
Talk therapy is another source of treatment for cyclothymia.
Support groups may be helpful for patients suffering from cyclothymia.
- Medication may involve:
Mood-stabilizing drugs
Antidepressants
- Mood-stabilizing drugs
- Antidepressants
- Commonly prescribed mood-stabilizers are:
Lithium
Anti-epileptic drugs
- Lithium
- Anti-epileptic drugs
- Clinical evidence also supports the use of such antipsychotic drugs as quetiapine.
- Talk therapy is another source of treatment for cyclothymia.
Support groups may be helpful for patients suffering from cyclothymia.
- Support groups may be helpful for patients suffering from cyclothymia.