Cyclothymia

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Overview
Cyclothymia is a mood disorder. This disorder is a milder form of bipolar II 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").

The lifetime prevalence of cyclothymic disorder is 0.4-1%. The rate appears equal in men or women, though women more often seek treatment.

Diagnostic Criteria (DSM-IV-TR)

 * During the first two years of the disorder, the patient has not fulfilled enough criteria to qualify as having either bipolar disorder or major depressive disorder.
 * 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.
 * 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 do not cause the patient clinically significant distress or impair work, social or personal functioning.


 * A person with this disorder may experience euphoric highs, boosts of energy and require less sleep in one phase, followed by a severe mood swings into a depressive state coupled with negativity & sadness for no particular reason.
 * These mood swings are not as severe as bipolar I disorder or bipolar II disorder.
 * Cyclothymia is to bipolar disorder as Dysthymia (a mild form of clinical depression) is to major depressive disorder.

Diagnostic Criteria (ICD-10)
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 later.

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 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 major depressive episode.

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

Causes
Cyclothymia appears to have a genetic contribution, which has been shown by a range of twin studies involving dizygotic (fraternal) and monozygotic (identical) twins.

Psychosocial factors have also been implicated, for example stressful life events or living conditions, and interpersonal difficulties. In addition, some unsupported theories posit that the hypomanic episodes have meaning in the context of a person seeking to achieve goals or to avoid depression.

Treatment
Treatment for cyclothymia can include a variety of cognitive behavioral therapy techniques. Additionally, mood stabilizers, such as lithium and medications for anxiety and mood stabilization such as benzodiazepines, are often prescribed in low doses to treat Cyclothymia.