Cyclothymic Disorder

 Cyclothymic Disorder is a chronic bipolar disorder consisting of short periods of mild depression and short periods of hypomania. These symptoms may last a few days to a a number of weeks. The onset is separated by short periods of normal mood. Individuals with cyclothymia are never totally free of symptoms of either depression or hypomania for more than a number of months at a time. Diagnostic criteria is as follows:

Symptoms present fro at least 2 years, the patient has had periods of hypomanic symptoms and periods of low mood that don't fulfill the criteria for Major Depressive Disorder.

The longest period the patient has been free of mood swings is 2 months.

During the first 2 years of this disorder, the patient has not fulfilled criteria for Manic, Mixed, or Major Depressive Episode.

Schizoaffective disorder doesn't explain the disorder better, and it isn't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.

The symptoms are not directly caused by a general medical condition or the use of any substances, including prescription medications.

These symptoms cause the patient clinically important distress or impair work, social or personal functioning.

Associated Features:

Euphoric Mood
Depressed Mood
Somatic or Sexual Dysfunction
Hyperactivity
Addiction
Odd or Eccentric or Suspicious Personality
Dramatic or Erratic or Antisocial Personality

Differential Diagnosis:

Some disorders have similar or even the same symptom. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which he needs to rule out to establish a precise diagnosis.

Psychiatric:

Mood Disorder Due to a General Medical Condition; Substance-Induced Mood Disorder; Bipolar I Disorder, With Rapid Cycling; Bipolar II Disorder, With Rapid Cycling; Borderline Personality Disorder.

Medical:

Organic Mood Syndromes caused by: Acquired Immune Deficiency Syndrome (AIDS), Cushing's Disease, Epilepsy, Fahr's Syndrome, Huntington's Disease, Hyperthyroidism, Premenstrual Syndrome, Migraines, Multiple Sclerosis, Neoplasm, Postpartum, Stroke, Systemic Lupus Erythematosus, Trauma, Uremia, Vitamin Deficiency, Wilson's Disease.

Drugs:

Amphetamines, Antidepressants (treatment or withdrawal), Baclofen, Bromide, Bromocriptine, Captopril, Cimetidine, Cocaine, Corticosteroids (including ACTH), Cyclosporin, Disulfiram, Hallucinogens (intoxication and flashbacks), Hydralazine, Isoniazid, Levodopa, Methylphenidate, Metrizamide (following myelography), Opiates, Procarbazine, Procyclidine, Yohimbine.

Mood Disorder Episodes:    |  Major  |  Manic |  Mixed |  Hypomanic  |

Cause:

Genetic factors appear to be causative in Cyclothymia as they do in the Bipolar Disorders. Many of those affected have a family history of major depression, bipolar disorder, suicide or alcohol/drug dependence.

Treatment:

In some cases individuals may prefer no treatment or supportive psychotherapy alone. Lithium, a mood stabilizer used commonly in the treatment of Bipolar Disorder, has been proven to help a substantial number of people with Cyclothymia.

Counseling and Psychotherapy [ See Therapy Section ]:

Couples or Family therapy is often sought to help with the problems in relationships brought on by the disorder.

Pharmacotherapy [ See Psychopharmacology Section ] :

Biomedical treatment of cyclothymic disorder should be empirically derived and should be offered only if the individual's functioning is significantly adversely affected.

Antimanic Drugs.
Lithium Carbonate.
Carbamazepine (Tegretol).
Valproic Acid (Depakene, Depakote).
Verapamil (Calan).