What is Cyclothymia?
Cyclothymia is a state of chronic mood instability with multiple episodes of mild depression and mild elation. The prevalence of cyclothymia in the population is 3-6%.
What provokes / Causes of Cyclothymia
The reason for the development of cyclothymia is primarily determined by genetic factors, since this disorder is common in relatives of patients with bipolar affective disorder, although it can also be due to a special affective background in the family. Additional external influences may play a role in the pathokinesis and pathoplasty of the disease.
Pathogenesis (what happens?) during Cyclothymia
Cyclothymia usually develops at a young age with early (adolescent) or late onset. The course of cyclothymia can be undulating, with more or less uniform changes (increase and decrease) in the severity of phase fluctuations, or periodic (with intervals between phases). Cyclothymia may persist throughout adulthood, stop temporarily or permanently, or develop into a more severe mood disorder, fitting the description of bipolar affective disorder or recurrent depressive disorder.
Symptoms of Cyclothymia
The clinic is endogenously perceived only as a period of inspiration, thoughtless actions or blues.
The period of depressed mood grows gradually and is perceived as a decrease in energy or activity, the disappearance of the usual inspiration and creativity. This in turn leads to a decrease in self-confidence and feelings of inferiority, as well as social isolation, isolation is also manifested in reduced talkativeness. Insomnia appears, pessimism is a stable property of character. The past and the future are evaluated negatively or ambivalently. Patients sometimes complain of increased drowsiness and impaired attention, which prevents them from absorbing new information. An important symptom is anhedonia (loss of feeling of joy, pleasure) in relation to previously pleasant types of discharge of the instinct (food, sex, travel) or pleasant activities. A decrease in activity is especially noticeable if it followed an elevated mood. However, there are no suicidal thoughts. The episode can be perceived as a period of idleness, existential emptiness, and when it is long, it is evaluated as a character trait.
The opposite state can be stimulated by endogenous and external events and also be tied to the season. With an elevated mood, energy and activity increase, and the need for sleep decreases. Creative thinking increases or sharpens, this leads to an increase in self-esteem. Interest in sex increases and sexual activity increases, interest in other types of instinctive activities increases (food, travel, there is an over-involvement in the interests of one’s own children, relatives, an increased interest in outfits and jewelry). The future is perceived optimistically, past achievements are overestimated. Cyclic mood rhythms clearly depend on the length of daylight hours, the latitude of the area, this is intuitively captured by patients in their desire for migration and travel.
Diagnosis of Cyclothymia
The main feature at diagnosis is persistent, chronic mood instability, including alternating periods of mild depression and mild elation, with or without intervening periods of normal mood. Observed affective episodes are lower in level than mild ones, and moderate and severe manifestations of affective episodes are absent.
In depression, at least three of the following symptoms must be present:
- decreased energy or activity;
- decreased self-confidence or feelings of inferiority;
- difficulty concentrating;
- social isolation;
- decreased interest or pleasure in sex or pleasurable activities;
- decrease in talkativeness;
- pessimistic attitude towards the future and negative assessment of the past.
An increase in mood is accompanied by at least three of the following symptoms:
- increased energy or activity;
- reduced need for sleep;
- increased self-esteem;
- heightened or unusual creative thinking;
- increased sociability;
- increased talkativeness or demonstration of the mind;
- increased interest in sex and increased sexual relations, other pleasurable activities;
- over-optimism and overestimation of past achievements.
Individual anti-disciplinary actions are possible, usually in a state of intoxication, which are rated as “excessive fun”.
Seasonal mood swings can often be observed from childhood or adolescence, but the diagnosis of cyclothymia is considered adequate only in post-puberty, when unstable mood with periods of subdepression and hypomania lasts at least two years.
Differential diagnosis. It should be differentiated from mild depressive and manic episodes, bipolar affective disorders occurring with moderate and mild affective attacks, hypomanic states should also be distinguished from the onset of Pick’s disease.
In relation to mild depressive and manic episodes, this can usually be done on the basis of anamnesis data, since unstable mood in cyclothymia should be determined for up to two years, suicidal thoughts are also not characteristic of cyclothymics, and periods of elevated mood are socially more harmonious. Cyclothymic episodes do not reach the psychotic level, which distinguishes them from affective bipolar disorders, in addition, cyclothymics have a unique anamnestic history, episodes of mood disturbances are noted very early in puberty.
Mood changes in Pick’s disease occur late in life and are associated with more severe impairments to social functioning.
Treatment of Cyclothymia
Prevention of episodes of disturbed mood in cyclothymia is carried out with lithium, carbamazepine or sodium valproate. These same drugs can be used in the treatment of elevated mood, although in cases where it is accompanied by increased productivity, this is hardly advisable. For depressed mood, Prozac, sleep deprivation therapy, and NO therapy are indicated. Sometimes the effect is given by 2-3 sessions of nitrous oxide, amytal-caffeine disinhibition and intravenous administration of novocaine.