DSM-IV-TR Diagnostic Criteria for Cyclothymic DSM-IV-TR Diagnostic Criteria for Cyclothymic Disorder Disorder

 For at least 2 years, the presence of numerous periods For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a depressive symptoms that do not meet criteria for a major depressive episode. major depressive episode. Note: Note: In children and In children and adolescents, the duration must be at least 1 year. adolescents, the duration must be at least 1 year.

 During the above 2-year period (1 year in children and During the above 2-year period (1 year in children and adolescents), the person has not been without the adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a symptoms in Criterion A for more than 2 months at a ttime. ime.

 No major depressive episode, manic episode, or mixed No major depressive episode, manic episode, or mixed episode has been present during the first 2 years of the episode has been present during the first 2 years of the disturbance. disturbance.

Note: Note: After the initial 2 years (1 year in children and After the initial 2 years (1 year in children and adolescents) of cyclothymic disorder, there may be adolescents) of cyclothymic disorder, there may be superimposed manic or mixed episodes (in which case superimposed manic or mixed episodes (in which case both bipolar I disorder and cyclothymic disorder may be both bipolar I disorder and cyclothymic disorder may be diagnosed) or major depressive episodes (in which case diagnosed) or major depressive episodes (in which case

 The symptoms in Criterion A are not better The symptoms in Criterion A are not better accounted for by schizoaffective disorder accounted for by schizoaffective disorder and are not superimposed on and are not superimposed on schizophrenia, schizophreniform disorder, schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder delusional disorder, or psychotic disorder not otherwise specified. not otherwise specified.

 The symptoms are not due to the direct The symptoms are not due to the direct physiological effects of a substance (e.g., physiological effects of a substance (e.g., a drug of abuse, a medication) or a a drug of abuse, a medication) or a general medical condition (e.g., general medical condition (e.g., hyperthyroidism). hyperthyroidism).

 The symptoms cause clinically significant The symptoms cause clinically significant distress or impairment in social, distress or impairment in social, occupational, or other important areas of occupational, or other important areas of ffunctioning. unctioning.

Signs and Symptoms

Signs and Symptoms

 The symptoms of cyclothymic disorder are identical to the The symptoms of cyclothymic disorder are identical to the symptoms of bipolar II disorder, except that they are generally less symptoms of bipolar II disorder, except that they are generally less severe. On occasion, however, the symptoms may be equally severe. On occasion, however, the symptoms may be equally severe, but of shorter duration than those seen in bipolar II severe, but of shorter duration than those seen in bipolar II disorder. About half of all patients with cyclothymic disorder have disorder. About half of all patients with cyclothymic disorder have depression as their major symptom, and these patients are most depression as their major symptom, and these patients are most likely to seek psychiatric help while depressed. Some patients with likely to seek psychiatric help while depressed. Some patients with cyclothymic disorder have primarily hypomanic symptoms and are cyclothymic disorder have primarily hypomanic symptoms and are less likely to consult a psychiatrist than are primarily depressed less likely to consult a psychiatrist than are primarily depressed patients. Almost all patients with cyclothymic disorder have patients. Almost all patients with cyclothymic disorder have periods of mixed symptoms with marked irritability. periods of mixed symptoms with marked irritability.

 Most patients with cyclothymic disorder seen by psychiatrists have Most patients with cyclothymic disorder seen by psychiatrists have not succeeded in their professional and social lives as a result of not succeeded in their professional and social lives as a result of their disorder, but a few have become high achievers who have their disorder, but a few have become high achievers who have worked especially long hours and have required little sleep. Some worked especially long hours and have required little sleep. Some persons' ability to control the symptoms of the disorder persons' ability to control the symptoms of the disorder successfully depends on multiple individual, social, and cultural successfully depends on multiple individual, social, and cultural attributes. attributes.

 The lives of most patients with cyclothymic disorder are difficult. The lives of most patients with cyclothymic disorder are difficult. The cycles of the disorder tend to be much shorter than those in The cycles of the disorder tend to be much shorter than those in bipolar I disorder. In cyclothymic disorder, the changes in mood bipolar I disorder. In cyclothymic disorder, the changes in mood are irregular and abrupt and sometimes occur within hours. The are irregular and abrupt and sometimes occur within hours. The unpredictable nature of the mood changes produces great stress. unpredictable nature of the mood changes produces great stress. Patients often feel that their moods are out of control. In irritable, Patients often feel that their moods are out of control. In irritable, mixed periods, they may become involved in unprovoked mixed periods, they may become involved in unprovoked

A 29-year-old car salesman was referred by his girlfriend, a A 29-year-old car salesman was referred by his girlfriend, a psychiatric nurse, who suspected he had a mood disorder, even psychiatric nurse, who suspected he had a mood disorder, even though the patient was reluctant to admit that he might be a though the patient was reluctant to admit that he might be a moody person. According to him, since age 14 he has experienced moody person. According to him, since age 14 he has experienced repeated alternating cycles that he terms good times and bad repeated alternating cycles that he terms good times and bad times.During a bad period, usually lasting 4 to 7 days, he times.During a bad period, usually lasting 4 to 7 days, he oversleeps 10 to 14 hours daily, lacks energy, confidence, and oversleeps 10 to 14 hours daily, lacks energy, confidence, and motivation just vegetating, as he puts it. Often he abruptly shifts, motivation just vegetating, as he puts it. Often he abruptly shifts, characteristically upon waking up in the morning, to a 3-day to 4- characteristically upon waking up in the morning, to a 3-day to 4day stretch of overconfidence, heightened social awareness, day stretch of overconfidence, heightened social awareness, promiscuity, and sharpened thinking Things would flash in my promiscuity, and sharpened thinking Things would flash in my mind. At such times he indulges in alcohol to enhance the mind. At such times he indulges in alcohol to enhance the experience, but also to help him sleep. Occasionally the good experience, but also to help him sleep. Occasionally the good periods last 7 to 10 days, but culminate in irritable and hostile periods last 7 to 10 days, but culminate in irritable and hostile outbursts, which often herald the transition back to another period outbursts, which often herald the transition back to another period of baddays. He admits to frequent use of marijuana, which he of baddays. He admits to frequent use of marijuana, which he claims helps him adjust to daily routines. claims helps him adjust to daily routines.

 In school, As and Bs alternated with Cs and Ds, with the result that In school, As and Bs alternated with Cs and Ds, with the result that the patient was considered a bright student whose performance the patient was considered a bright student whose performance was mediocre overall because of unstable motivation. As a car was mediocre overall because of unstable motivation. As a car salesman his performance has also been uneven, with good days salesman his performance has also been uneven, with good days canceling out the “bad days; yet even during his good days, he canceling out the “bad days; yet even during his good days, he is sometimes argumentative with customers and loses sales that is sometimes argumentative with customers and loses sales that appeared sure. Although considered a charming man in many appeared sure. Although considered a charming man in many social circles, he alienates friends when he is hostile and irritable. social circles, he alienates friends when he is hostile and irritable. He typically accumulates social obligations during the bad days He typically accumulates social obligations during the bad days and takes care of them all at once on the first day of a goodperiod. and takes care of them all at once on the first day of a goodperiod.