Cyclothymic Disorder (301.13)

Bill Pelz, Herkimer Community College

289 Cyclothymic Disorder (301.13)

DSM-IV-TR criteria

A. For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode. Note; in children and adolescents, the duration must be at least 1 year..
B. During the above 2 year period (1 year in children and adolescents), the person has not been without the symptoms in Criteria A for more than 2 months at a time
C. No Major Depressive Episode, Manic Episode, or Mixed Episode has been present during the first 2 years of the disturbance.
- Note; After the initial 2 years ( 1 year in children and adolescents) of Cyclothymic Disorder, there may be superimposed Manic or Mixed Episodes in which case both Bipolar 1 Disorder and Cyclothymic Disorder may be diagnosed) or major Depressive Episode (in which case both Bipolar 2 Disorder and Cyclothymic Disorder, Delusional Disorder may be diagnosed).
D. The symptoms in Criteria A are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
E. The symptoms are not due to the direct physiological effects of a substance (e.g. a drug abuse, a medication) or a general medical conditioned (e.g. hyperthyroidism).
F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Associated features

This is a chronic but a less severe case of Bipolar disorder. The individual experiences numerous hypomanic episodes and many periods of depression over a two year period. Some periods of moods may last as long as two months in some individuals. There will also be “normal” periods of time lasting up to two months. In the first two years, there cannot be any evidence of a Manic Episode or any history of major depressive episodes
Cyclothymic Disorder is a chronic, fluctuating mood disturbance with numerous periods of hypomanic symptoms and depressive symptoms. These symptoms do not qualify for either a diagnosis of a full Manic Episode or Major Depressive Episode.
Substance Related Disorders and Sleep Disorders can be comorbid with Cyclothymic Disorder.
There is a 15 to 50 percent risk that an individual with Cyclothymic Disorder will later develop one of the Bipolar II disorders.

Child vs. adult presentation

Presence of Cyclothymic Disorder early in life may increase the likelihood of developing other Mood Disorders later in life (especially the Bipolar Disorders.)
In children and/or adolescents, symptoms only need to be present for one year as opposed to two years in adults.

Gender and cultural differences in presentation

Cyclothymic Disorder seems to be equally common in both men and women. However in clinical settings women are more likely to present for treatment.

Epidemiology

General lifetime prevalence rates are from 0.4% to 1%. Prevalence rates for mood disorder clinics can range between 3% to 5%.

Etiology

Major Depressive Disorder and Bipolar I or II seem to be more common in the First-degree biological relatives of people with Cyclothymic Disorder then in the normal population. Also, Cyclothymic Disorder may be more common in first-degree biological relatives of those with Bipolar I.

Empirically supported treatments

There are various treatment options available for those patients with Cyclothymia Disorder. A simple change in lifestyle could be a key component. An example would be getting plenty of exercise. Exercise has been known to regulate mood and also help with emotional stability. This will not cure Cyclothymia of course, but it may offer the patient some relief.

Medication is another option. Some possible medicaations that could be prescribed are lithium, anti-seizure medication, antipsychotics, and antianxiety medication. Some alternate medications are magnesium, hypericum perforatum, SAMe, and Omega-3 fatty acids.

There are also therapy options if the patient does not want a medication. These are also a little safer than medication. Some examples are cognitive behavioral therapy, interpersonal therapy, and group therapy.