Her extremely sedentary lifestyle would benefit from exercise and diet, which could help stabilize mood. Due to Dolores’ inability to relate well with others, cognitive behavioral therapy should be used. Consider bipolar illnesses in patients with any disruptive disorder that does not respond to treatment. At the age of 13, Dolores is raped by her grandmother’s upstairs tenant. Cerebrovascular insults or head injury resulting in brain damage may produce an organic mood disorder characterized by a change in mood or affect, usually accompanied by a change in the overall level of activity. The only coping skill she really has is eating, and it causes her just as much pain as the issue she aims to avoid. The lifetime prevalence of bipolar I disorder is as high as 1.6%, and that of bipolar II disorder is 0.5%. Unfortunately, those who suffer from cyclothymia and do not carry out adequate medical treatment, can develop Bipolar Disorder. Symptoms of cyclothymia include mood swings that alternate between mild to moderate “highs” and “lows.” A “high” is defined as a distinct period of time in which a person experiences abnormal and persistently elevated or irritable mood along with an abnormal increase in activity or energy. Cyclothymic disorder closely relates to Bipolar disorder, yet is less severe. While decreased sleep continuity and slow-wave sleep may be associated with numerous conditions, the REM sleep changes in major depression are relatively specific. Remember that depressed patients often have bipolar disorders. While she experiments with alcohol and marijuana, she has no history of substance abuse or dependence. Dolores’ times of “power” contain within them hypomanic symptoms such as excessive involvement in pleasurable, yet possibly dangerous, activities. Dolores Price begins as a young girl growing up in New England. In college, she works tirelessly to please her roommate and the other girls she is around. Patients diagnosed as cyclothymic experienced brief hypomanic periods (lasting fewer than four days) and brief mild depressive periods (lasting fewer than two weeks). A number of recreational drugs can cause affective and behavioural disturbance, which may mimic mania. Selected patients, especially those reporting seasonal affective disorder symptoms, may benefit from therapeutic bright light exposure. Case Studies of Fictional Characters. In her marriage, she is depressed when Dante is not happy. She enjoys leaving her therapist upon her release from therapy. Assess for drug and/or alcohol use as substances may induce bipolar disorder, and substance use is frequently a comorbid condition. The book follows Dolores through childhood, adolescence, and young adulthood. These mood switches often emerge during adolescence and typically occur rapidly and unpredictably, leading to significant instability and psychological distress (Akiskal, 2001; Brieger & Marneros, 1998). After she moves back to Easterly, her jobs are menial and she only works when she is experiencing hypomania. These REM sleep changes tend to correlate with the severity of the depression. Following the implementation of exercise, cognitive therapy should be used. Research. Name: Dolores Price Killgore, in Encyclopedia of Sleep, 2013. Patients may also complain of nightmares. Depressive episodes sometimes occur in the course of dysthymia and the combination of dysthymia and recurrent depressive disorder is sometimes referred to as ‘double depression’. She tries once to cut herself but is taken aback by the blood. Cyclothymia refers to the presence of numerous hypomanic symptoms that do not meet full criteria for a hypomanic episode and depressive symptoms that do not meet criteria for a major depressive episode, occurring for at least half the time for 2 years with no more than 2 months of remission of symptoms. The length of each cycle tends to decrease, although the number of cycles increases with age (Figure 29-3). Substance-induced mood disorders must also be considered, particularly those associated with cocaine, tricyclic antidepressants and selective serotonin reuptake inhibitors. In any case, the emotional episodes can influence day by day life, and cause issues with individual and work connections. Cyclothymia disorder, its symptoms, and treatment . Speech often is loud, rapid, and difficult to interpret, and behavior may be intrusive and demanding. Additional strategies that independently target the sleep disruption may improve sleep as well as mood symptoms. A previous history of depression or (hypo)mania, or a family history of bipolar disorder may assist in making the diagnosis. Because the condition is often undiagnosed in parents, the questions should be directed toward the presence of the symptoms for bipolar disorders. She attempts to go to college, but ends up leaving and goes to Cape Cod to attempt suicide. 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. It usually develops in early adult life and tends to run a chronic course. Bipolar I disorder consists of recurrences of mania and major depression or mixed states that occur at different times in the patient, or a mixture of symptoms that occur at the same time (see Figure 29-2, B). She blogs about her journey with this condition, runs a mental health support group on Facebook, and has begun organizing fundraising events for mental health research and treatment. It also demonstrates the impacts a mood disorder can have on every aspect of one’s life. Current epidemiological and clinical research has demonstrated the high prevalence and the validity of cyclothymia as a distinct form of bipolarity. She has no friends in high school and her only friend in college was the dorm’s maid. Co-morbid substance misuse is a significant problem for many individuals with established bipolar disorder, and continued use often destabilizes the illness and either prolongs recovery or precipitates relapse. In many cases, cyclothymia is also subject to seasonal changes, with more prominent depressive episodes during winter (Akiskal, 2001). She is grandiose and believes that she will succeed in imagining her life with Dante, who is clearly abusive and unfaithful. The book demonstrates the difficulty that may be faced by others who have relationships with cyclothymic individuals. Her treatment is also only slightly effective and she still experiences cycles as she gets older. E. The symptoms are not due to the direct physiological effects of a substance (e.g. She feels useless, especially when she angers him. Patient Story: Somatic Symptom Disorder. As unstable mood is an integral part of BD, patients may have fluctuating perceptions of their body image. It is accurate in its depiction of the feelings that accompany cyclothymia, describing hypomania as “power” and depression as “oppressive.” Dolores’ mother may also have bipolar disorder, reflecting the possibility that bipolar disorder may be more common in first degree relatives. Bipolar II disorder is characterized by the presence of major depression episodes and hypomania. Source: She’s Come Undone, (book by Wally Lamb, 1992). Physical exam. Cyclothymia is a condition in which there is a persistent instability of mood, involving numerous periods of mild depression and mild elation that fall short of meeting diagnostic criteria for depressive and manic episodes. A. There is never a time in Dolores’ life where she does not experience any of these symptoms. Dolores also exhibits depressive symptoms at many times. Poor judgment may lead to financial and legal problems. Indeed, it is difficult to find research on cyclothymic disorder, as patients with this rather stable condition rarely present for treatment. Search for: Cyclothymic Disorder. It continues to be included in the latest version, the fifth edition of the DSM (DSM-5) under the category of bipolar and related disorders. She only manages to succeed at a job when she is in control, or in power. The essential feature of bipolar I disorder is a clinical course that includes the occurrence of one or more manic episodes or mixed episodes. After her father leaves her and her mother, they move in with her uptight grandmother. The following principles should guide the evaluation of patients with symptoms of depression or mania: Recognize the symptoms mania and hypomania. Space-occupying lesions may cause significant mood disturbance, as well as worsening the course of an already established bipolar illness. Risk factors for borderline personality disorder include a history of abuse, neglect, or early parental loss. A physical exam and lab tests may be done to help identify any medical problems that could be causing your symptoms. Sleep may be characterized as either significant insomnia, with problems initiating and maintaining sleep, or, conversely, hypersomnia, with excessive sleep. Let's take a look at eight signs of cyclothymic disorder below — and if they sound a little too familiar, it may be an indication to seek help. The symptoms of a hypomanic episode are the same, though are present for a shorter duration (i.e., 4 days or fewer), are not associated with psychotic symptoms of delusions or hallucination, and are not severe enough to cause major social or academic dysfunction. The differential diagnosis of depressive disorders is considered elsewhere in this volume, and the following account highlights the important conditions from which manic disorders must be distinguished. Paul Mackin, Allan Young, in Core Psychiatry (Third Edition), 2012. Unstable self-esteem, in combination with unrealistic standards of success, may predispose individuals with BD toward extreme shifts in self-evaluation, which may include appraisal of one’s physical attributes (i.e., body image). These mood variations are not readily attributable to external circumstances. Cyclothymic disorder is a mental disorder. some cases full-blown impulse control disorders may emerge such as pathological gambling and compulsive sexuality in men, or compulsive buying and binge eating in women [15, 17-19]. Diagnosing Cyclothymia The American Psychiatric Association states that in order for an accurate cyclothymia diagnosis to be made, an individual must meet all of the following: 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. Although specific sleep abnormalities are not present in all patients experiencing major depressive episodes, there is a strong tendency that there may exist a disturbance in sleep continuity, decreased percentage and total amount of slow-wave sleep, and particular abnormalities in REM sleep. Sleep disturbances are highly prevalent in mood disorder patients and sleep-related symptoms are incorporated into the DSM-IV diagnostic criteria of these disorders. After a lesbian encounter in college, she kills the woman’s goldfish to prove she has control. This mood pattern is persistent for two years or more. Maya Northen is a mental health awareness enthusiast who was born with rapid-cycling cyclothymia, and finally diagnosed at the age of 29. These changes consist of manic episodes, which are periods of feeling extraordinarily up, and depressive episodes, which are periods of feeling hopeless and sad. The bipolar disorders include bipolar I disorder, bipolar II disorder, and cyclothymic disorder. Thus, the relationship may be cyclical. She then goes through periods of what she describes as “power.” She spews vicious sarcasm at those around her and is, at times, cruel. Cyclothymia -- or cyclothymic disorder -- is a relatively mild mood disorder. This δ-sleep ratio also tends to correlate with a patient's clinical state. The book does not do much to describe any sort of mental disorder. She waves the fact that a psychic has given her more help in front of his face in order to anger him. To receive a diagnosis is to be recognised as having something outside the psychiatrically-defined band of ‘normal’ but it’s a diagnosis of subjective symptoms – not the nice clear cut objective presentation of psychosis for example, or suicidality, or catatonia of major depression. Most patients who become manic will eventually experience depression. People with cyclothymic disorder have milder symptoms than occur in full-blown bipolar disorder. M.R. Abundant epidemiologic evidence shows that a history of insomnia or persistent insomnia increases the risk of the future development of major depressive disorder. Schneider's first rank symptoms occur in 10–20% of individuals with mania, and their presence should not necessarily point to a diagnosis of schizophrenia. She exhibits weight gain, not only in adolescence but later in her adult life after she moves back into her old house. Now, as an adult, she marries an abusive and manipulative man. Following the rape, Dolores’ mother constantly gives her food. Both genetic and psychosocial factors are believed to be causative. If Dante is unhappy, Dolores is unhappy. Typically, the symptoms associated with drug misuse subside when the substance is withdrawn, unlike manic symptoms which persist. Borderline personality disorder is a chronic personality disorder characterized by intense mood lability, impulsivity, identity disturbances, and unstable relationships. Cyclothymia is defined as not that bad. Style of dress often is colorful and strange, and long periods without sleep are common. She becomes highly distracted during her stay in the halfway house with an etch-a-sketch. There are four basic types of bipolar disorder, (1) and while each type has a somewhat different set of symptoms, all of them are characterized by noticeable changes in mood, energy, thinking, concentration, and behavior. Periods of elation may be marked by ambition, warmth, enthusiasm, optimism, and high energy. She goes through periods of depression, believing she has harmed everyone around her. Longitudinal studies suggest that insomnia often begins prior to other depressive symptoms and that insomnia is a robust predictor of recurrence in people with previous depressive episodes. Her therapist even goes as far as to pretend to be her mother. Berkson, in Encyclopedia of Body Image and Human Appearance, 2012. Her parents’ divorce is one section, the rape is another section, her adolescence is one section, her college life is a section, her therapy is a section, and her adult life is a section. See also Disorder and 10 signs to identify a … Cyclothymic disorder is a chronic, cyclic illness of hypomania and depressive symptoms without episodes of major depression. One study found that awareness of stigmatization was correlated with lower self-esteem in remitted BD patients. Throughout adolescence, Dolores continually gains weight until she weighs 257 pounds at age 18. A careful history of illicit substance use together with urine drug-screening may be helpful in reaching a diagnosis. Towards the end of the story, she simply wants a child, after obsessing over her abortion. The essential feature of a manic episode is a distinct period during which the affected person's mood is elevated and expansive or irritable (Table 29-2). She strives to be loved but gives up on it easily when it fails her. She has no real goals. Symptoms must last for more than one year in children … The EEG signal abnormalities observed in mood-disordered patients do not necessarily normalize with the resolution of depressive or manic episodes. Insomnia complaints commonly include the full spectrum of difficulty initiating and maintaining sleep with reported frequent awakenings and trouble returning to sleep. 2. In Maine, she feels accomplished often. Cyclothymia Articles Case Reports Symptoms Treatment, India. During a manic episode, the mood often is described as euphoric, cheerful, or “high.” The expansive quality of the mood is characterized by unceasing and unselective enthusiasm for interacting with people. This would have to be highly regulated in order for her to follow it and actually make the changes. Both depressive and manic disorders include schizophrenic illnesses and organic brain syndromes as possible differential diagnoses. Corticosteroids, especially in high doses can produce elated mood states as well as depression. All are characterized by the presence of either mania or hypomania. She is unsympathetic, hard to relate to, and it is almost impossible to feel bad for her. During these times, her job performance improves, her sexual life increases, and she cleans and cooks every day for her husband. The differential diagnosis of manic disorders (Box 21.3) includes: As referred to above, cyclothymia shares many of the characteristics of manic-depressive illness, but the severity and duration of symptoms are not sufficient to make a diagnosis of mania or recurrent depressive disorder. The rise in the incidence of HIV infection should prompt careful investigation, particularly in younger individuals who present with atypical features. Similarly, the personality traits of sociotropy (high need for approval) and neuroticism (excessive reactivity to stress) have been strongly associated with both major depression and bipolar disorder, and current evidence suggests that at least part of the genetic risk for mood disorders takes the form of inheritance of these “depressogenic” character traits and cognitive styles. Diagnosis requires 5 or more of the following: Significant efforts to avoid real or imagined abandonment, Unstable and intense relationships with extremes of idolization and devaluation, Marked identity disturbances with unstable sense of self, Significant impulsivity in at least 2 areas that are potentially self-damaging: spending, sexual activity, substance abuse, reckless driving, or binge eating, Recurrent suicidal or self-mutilating behavior, Intense dysphoria, irritability, or anxiety, Transient, stress-related paranoia or dissociation. Research points to a specific BAS-related cognitive style in BD characterized by performance evaluation, autonomy, self-criticism, and an emphasis on goal attainment. Her main goal is to please others around her to achieve approval. Both cyclothymia and bipolar disorder … Females are more frequently diagnosed than males, at a ratio of 3 : 1. Experts on cyclothymic disorder have stressed the importance of psychoeducation—which should be different from psychoeducation for bipolar disorder. Even after therapy she still experiences hypomania and depression. It is caused by biological changes in the nervous system, but there are treatments to reduce their symptoms and help the patient to have a stable mood. The DSM-IV mood disorders include major depressive disorder, bipolar disorder, cyclothymic disorder, and dysthymic disorder. Problematic behaviors during a manic episode include recklessness (e.g., excessive participation in social activities, high-risk sexual activity, buying sprees), agitation, decreased sleep, and excessive talkativeness. Patients evaluated for mood disorders should be assessed for possible sleep difficulties and patients reporting insomnia or hypersomnia should be examined for possible mood disorders. Generally, it seems that the higher the degree of fluctuation in self-esteem, the worse the prognosis in patients with BD. The BDs include bipolar I disorder, bipolar II disorder, Sleep Related Movement Disorders (SRMD) and Parasomnias, Assessment, Methodology, Training, and Policies of Sleep, Little and Falace's Dental Management of the Medically Compromised Patient (Eighth Edition), Journal of the American Academy of Child & Adolescent Psychiatry. Patients may also have prior or subsequent episodes of hypomania or major depression, though these are not required. She does nothing to anger him until her grandmother’s death. She has elevated mood and feels control over others around her. However, about 10% of patients in whom bipolar disorder is diagnosed appear to have only manic episodes.14, Men tend to have a greater number of manic episodes and women, more numerous depressive episodes. Dolores’ weight gain stemmed from her traumatic rape. This is manifested through her increased sex drive and sexual activity with Dante the first night they met, her increased interest in sex throughout certain times in her life, and her lesbian experience with her dorm’s maid. If possible, the diagnosis should specify whether the mood is characteristically depress… The correlation of cyclothymia reaches significance (.37) only with the latter facet. Bipolar I disorder is characterized by the presence of manic episodes. At times, she hates her therapist and wishes she could leave. She also never reaches full mania. Dolores is not a likable character by any means. Dolores Price begins as a young girl growing up in New England. Her weight gain stems from her own belief in herself, not a medical condition. This may be related to the relatively high incidence of childhood traumas (e.g., sexual or physical abuse) reported by BD patients (one study found more than a 50% incidence of traumatic events in youth with diagnosed BD). After a failed attempt at drowning, she ends up in a private mental institution where she undergoes immense amounts of psychoanalytic therapy. The differential diagnosis of the bipolar disorders includes schizophrenia and medical conditions that cause changes in mental status, particularly thyroid disorders, Cushing disease, and multiple sclerosis (see Table 27.3). ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Van Meter, Youngstrom, Youngstrom, Feeny, & Findling, 2011, International Encyclopedia of the Social & Behavioral Sciences, There is a great deal of support for the proposition that, Body Image in Mood and Psychotic Disorders, Encyclopedia of Body Image and Human Appearance. The first treatment that should be implemented for Dolores is a lifestyle change. Some of the criteria for a manic episode listed in the DSM-IV-TR may include body image aberrations such as inflated self-esteem or hypersexual behavior. Psychological evaluation. Cyclothymia is characterized by pronounced but not debilitating shifts of moods often lasting approximately two to nine weeks. What is cyclothymia? Similarly, studies have found that cyclothymic temperament, which entails continuous shifts in mood and perception as well as variations in self-esteem, is more severe in BD patients than in MDD patients or controls. A common symptom of depressive disorders, including major depressive disorder and bipolar disorder or cyclothymia is disruption of sleep. By continuing you agree to the use of cookies. She spends hours recreating artistic masterpieces on multiple etch-a-sketches and tunes out the rest of the world. Since low self-esteem seems to fit thematically into such a cognitive style, it may be part of the cognitive manifestation of BAS dysregulation and may underlie a cognitive deficit in how patients feel about their bodies. A recent case study of a middle-age cyclothymic female noted a combination of higher “energetic mood” toward the end of the day and sleep duration of about 3hours (Totterdell & Kellett, 2008). Your doctor or other health care provider must determine if you have cyclothymia, bipolar I or II disorder, depression, or another condition that may be causing your symptoms. Obtain a thorough family history to look for symptoms of mood disorders. Frontal lobe pathology, such as fronto-temporal dementia or Pick's disease, may manifest as a coarsening of social skills or marked disinhibition that may mimic a manic syndrome. Her therapy is very psychoanalytic in nature, focusing on her mentally unstable mother and sex. It has been speculated that these features may represent trait characteristics of individuals with greater vulnerability to mood disorders. Within a day, mood alterations from feeling high to feeling low are common. If therapy is ineffective, medication could be used, but only as a last result due to the health problems Dolores already has due to her weight. A large-scale web-based survey indicated that “cyclothymic temperament” has been associated with prolonged sleep latency, later sleep schedule, frequent nighttime awakenings, poor sleep quality, and high rates of daily and occasional use of sleep medications (Ottoni, Lorenzi, & Lara, 2011). For a mixed episode, criteria for a manic episode and for a major depressive episode (except duration) are met nearly every day for at least 1 week. Dopamine agonists and L-dopa may also cause pathological mood changes which may be difficult to distinguish from mania. The research on evidence-based psychotherapy for cyclothymia is virtually nonexistent. Cyclothymic disorder, or cyclothymia, is a form of bipolar disorder characterized by distinct episodes of hypomanic symptoms (elevated mood and euphoria) and depressive symptoms over a … These symptoms, however, are not sufficient to be a major depressive episode or a hypomanic episode. Dunner, in International Encyclopedia of the Social & Behavioral Sciences, 2001. In other words, cyclothymia is a type of bipolar disorder. Cognitive behavioral therapy, interpersonal therapy, or group therapy could be utilized. Cyclothymia is a “Bipolar-like” illness. Cyclothymia, also known as cyclothymic disorder, is a mental illness that has been defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) since 1980. She possesses no firmly held delusions. The low and high mood swings never reach the severity of major depression or mania. Dolores fails at almost all of her relationships. Careful examination of the mental state, including thorough cognitive assessment may indicate organic pathology. Both conditions share similar clinical features such as psychomotor disturbance, thought disorder and psychotic phenomena. Notwithstanding, a proportion of individuals with cyclothymia will go on to develop frank bipolar disorder (see below). Bipolar disorder NOS refers to partial syndromes, such as recurrent hypomania without depression.