Cyclothymia : Mood and Mood Disorders ; Bipolar Mood disorder

2. ‫افغانستان‬ ‫اسالمی‬ ‫جمهوری‬
‫عامه‬ ‫صحت‬ ‫وزارت‬
‫بلخی‬ ‫سینای‬ ‫علی‬ ‫ابو‬ ‫آموزشی‬ ‫وی‬ ‫حوزه‬ ‫شفاخانه‬
‫عصبی‬ ‫و‬ ‫روانی‬ ‫سرویس‬
‫کننده‬ ‫ترتیب‬:‫فردین‬ ‫احمد‬ ‫داکتر‬
‫عالمی‬ ‫آرتین‬
‫نظر‬ ‫تحت‬:‫داکتر‬ ‫الحاج‬ ‫ورپوه‬ ُ‫رنح‬
‫عالمی‬ ‫نادر‬ ‫محمد‬
Cyclothymia or Cyclothymic Disorder
19.7.99

3. Cyclothymia
Cyclothymic Disorder

4. 1. The Mood Spectrum and Mood Swing.
2. Understanding Cyclothemia / Cyclothemic Disorder
3. Diagnosis and it’s Features
4. Etiology and prevelance
5. Differential Diagnosis of Cyclothymia & Treatment.
6. Clinical Course & Prognosis
7. Reference
Here’s what we’ll Cover :

5. The term mood describes a dominant and
sustained emotional state.
Mood
Mood :
Intensity : Not much intense or immediate
Cause : unclear or less specific
Duration : Hours of Days
+ & - mood. ( Multiple Emotions )
Expressions : not distinct

6. a mood episode refers to any period of
time when a patient feels abnormally
happy or sad.
Mood episodes are the building blocks that
mood disorders are constructed.
Mood Episode

7. The Mood Spectrum
cyclothymia
thymia A condition of the mind.(Greek thumos, state of mind)
dysthymia (Greek dus-, bad or difficult)
cyclothymia (Greek kuklos, circle)

8. Mood Swings
A mood swing is an extreme or
rapid change in mood.
+ Outcomes.
- Outcomes.
Changes in a person’s :
• energy level
• sleep patterns
• self-esteem
• Concentration
• drug or alcohol use can be signs of an oncoming
mood disorder.

9. The Mood Spectrum

10. Understanding Cyclothymia
patients have had repeated mood
swings, but none that are severe or
long enough to be called major
depressive episodes or manic
episodes.
cyclothymia
(Greek kuklos, circle)

11. Understanding Cyclothymia
patients have had repeated mood
swings, but none that are severe or
long enough to be called major
depressive episodes or manic
episodes.
cyclothymia
(Greek kuklos, circle)

12. - 2 Year *
+ Episodes of Hypomanic symptoms .
+ Episodes of Major Depressive symptoms.

13. During this Timeline :
Half of this time ; Episodes should be
Present.
Not + 2 months ; Symptom Free.

14. Not meet the Criteria for
Depressive ; Manic ; Hypomanic episode.

15. Not Better Explained by :
Schizo-spectrum ;
Delusional Disorder
Psychotic Disorder.

16. Not Due to Substance Use or
Another medical condition

17. Causes Impairment in Daily Life.

18. Cyclothymic Disorder ( Dx Criteria )
Elevated
Mood /
Depressive
Symptoms
Not Better
Explained by :
Schizo-spectrum
Delusional Disorder
Psychotic Disorder.
Not meet the
Criteria for
Depressive ; Manic
; Hypomanic
episode.
Have been
Present ½ the
time ; + 2m
Symptom Free.
Not Due to
Substance Use or
Another medical
condition
Causes
Impairment in
Daily Life.

21. The depressive symptoms of cyclothymic disorder include:
•Feeling hopeless or sad +
•Losing interest in favorite activities +
•Becoming easily tearful
•Irritability & Restlessness
•Changes in weight
•Feeling guilty and worthless
•Having sleep problems
•Feeling fatigued
•Problems with concentration
•Having thoughts of suicide or death

22. The hypomanic symptoms of cyclothymic disorder include:
•Experiencing a sense of euphoria or happiness +
•Feeling extremely optimistic
•Having an inflated self-esteem ( grandiosity )
•Talkativeness
•Making poor decision and Partaking in risky behaviors
•Having racing thoughts and easily distracted
•Excessive physical actions
•Feeing irritable or agitated +
•Not needing as much sleep as normal ( 3 hours )

23. Maj.Dep.Episode
+5 Symptoms / 2wks ( +2c )
+ Depressed Mood
+ Loss of Interest or Pleasure
Guilt or Shame
Low Self-Esteem
Anergia / Fatigue
Abnormal Sleep
Abnormal Appetite
Psychomotor Retardation or Agitation
Hypomanic Episode
4 Days ; ( 2c+ 4s)
+ Elated Mood
+ Irritability
Distractibility
Irresponsibility
Impulsivity
Reckless Risk Taking
Hyperactivity
Over-Talkativeness

24. OPD patients
in NPHs.
3-5%
Affects 1% of World Wide
Population *
10 – 20 %
+ Borderline
Personality
Disorder
M : F
2 : 3
50 – 75% in
15 -25y Age.

25. Etiology of Cyclothymic Disorder :
family history of
major depression,
bipolar disorder,
suicide, or alcohol or
drug dependence.
Idiopathic
Genetic factors
( bipolar disorder )
~ 15% to 50% risk that
people with cyclothymia
will be Dx
Bipolar Disorder
comorbidities
Triggers and Life events.

26. the most common comorbidities with cyclothymia are :
In children and adolescents :
• anxiety disorders – GAD ; PD ; OCD.
• impulse control issues
• eating disorders – Anorexia & Bulimia Nervosa ; Pica
• ADHD.
• In adults, cyclothymia also tends to be comorbid with impulse control
issues.
( gambling and compulsive sexuality in men)
( compulsive buying and binge eating in women)

27. Clinical Course
• Onset : Gradual. Early Adolescents
• Mood Swings – Mild ( Hours ; Days ; Weeks , Months )
• Mood Elation Episodes maybe more enjoyable due to
• Increased Productivity ; Activity ; Sociability.
• Reason of Visit to Doctor : Depressive Symptoms.
• May Remain undiagnosed.

28. - Life Impact -
These swings in mood often negatively impact a person's work and
social life.
Consequences often include instability with an uneven work and
schooling history, impulsive and frequent changes of residence,
repeated romantic or marital breakups, and an episodic abuse of
alcohol and drugs.

29. Differensial Daignose
Other Mood Disorders
Drug Abuse
• Cocaine
• Amphetamine
• Steroids
Personality Disorder
• Borderline
• Anti-social
• Histrionic
• ADHD ( in children & teens ) :Stimulants in ADHD + ; while worsens in –
Cyclothymic disorder.
•
- Bipolar Mood Disorder ; With Rapid Cycling ; Ultra Rapid Cycling.
Recurrent Depressive Disorder ; Drug or Alcohol Misuse ;

30. Treatment
Goals

31. Mood Stabilizer
mood stabilizer" does not describe a mechanism, but rather an effect.
 Anti-convulsant Mood Stabilizers
 Valproate
 Lamotrigine
 Carbamazepine
• Topiramate / Gabapentin ( not FDA App.)
• Anti Psychotics : Atypical.
• Olanzapine ; Quetiapine ; aripiprazole …
• Omega 3 fatty acids vs placebo !
• Lithium Carbonate
Slow Onset of Anti Manic effects ( 1 – 3w)
Avoid in the Acute Phase due to :
Unpredictable Response
Side Effects
Lab Tests.

32. Treatment
Crisis : Sedating Antipsychotics :
Chlorpromazine 50mg nocte
Risperidone 1mg nocte
Olanzapine 2.5mg nocte
Combination Therapy
monotherapy ; not sufficient.
Atypical AP + lithium or
Valproate + Benzodiazepine

33. Bases of an Effective Treatment
Psycho-Social
Support.
The Right Drugs.
Life Style Changes.
Avoid Triggers.
Strict – and
Adequate Sleep
Proper Exercise

35. RESEARCH RESOURCES
● Kaplan & Sadock's ; 2015.
● DSM – V Made Easy ; 2017.
● ICT 10 https://icd.who.int/browse10/2019/en#/F30-F39
● WebMD ;
● American Psychiatric Association Official Website
● Oxford Medical Handbook of Psychiatry 3rd Edition

36. Thank You