Cyclothymic Disorder - Anatomy of Psych

What is cyclothymic disorder?

Cyclothymic disorder is a disorder characterized by chronic, fluctuating mood disturbances that consist of hypomanic symptoms that do not qualify as a hypomanic episode, as well as depressive symptoms that do not qualify as a depressive episode. These groups of symptoms occur independently from each other. Cyclothymic disorder has a lifetime prevalence of 0.4-1%, and presents equally between men and women. However, women are more likely to seek clinical attention, leading to higher diagnosis rate in women than men (3:2 ratio).

Cyclothymic disorder can be looked at as a milder version of bipolar II disorder.

What does cyclothymic disorder look like?

Signs & Symptoms

Hypomanic-type symptoms:

An exaggerated feeling of happiness or well-being (euphoria)
Extreme optimism
Inflated self-esteem
Talking more than usual
Poor judgment that can result in risky behavior or unwise choices
Racing thoughts
Irritable or agitated behavior
Excessive physical activity
Increased drive to perform or achieve goals (sexual, work related or social)
Decreased need for sleep
Tendency to be easily distracted
Inability to concentrate

Depression-type symptoms:

Feeling sad, hopeless or empty
Tearfulness
Irritability, especially in children and teenagers
Loss of interest in activities once considered enjoyable
Changes in weight
Feelings of worthlessness or guilt
Sleep problems
Restlessness
Fatigue or feeling slowed down
Problems concentrating
Thinking of death or suicide

DSM-5 Criteria

Criterion A. For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for hypomanic episode and numerous periods with depressive symptoms that do not meet the criteria for a major depressive episode.

Criterion B. During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.

Criterion C. Criteria for a major depressive, manic, or hypomanic episode have never been met.

Criterion D. The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

Criterion E. The symptoms are not attributable to the physiological effects of a substance (e.g. a drug of abuse, a medication) or another medical condition (e.g. hyperthyroidism).

Criterion F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Subtypes & Specifiers

Risk Factors

About 30% of individuals with cyclothymic disorder have a family history of bipolar I disorder

Prognosis

15-50% chance of subsequently developing bipolar I or bipolar II disorder

Risk Factors

Bipolar and related disorder due to another medical condition
Depressive disorder due to another medical condition
Substance/medication-induced depressive or bipolar and related disorder
Bipolar I/II disorder with rapid cycling
Borderline personality disorder
Other specified bipolar and related disorders

How is cyclothymic disorder investigated?

There is no screening tool for cyclothymic disorder.

How is cyclothymic disorder treated?

There is limited research on treatments for cyclothymic disorder.

Mood stabilizers

Nursing Management

See nursing management for bipolar I disorder.

References

[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.

[2] Boyd, M. A. (2019). Psychiatric & mental health nursing for Canadian practice. Wolters Kluwer.

[3] Townsend, M. C. (2015). Psychiatric mental health nursing. F.A. Davis.