Cyclothymia - what is it, symptoms and signs, treatment

Fluctuations in the emotional background and frequent pathological changes in mood may turn out to be a mental disorder, which experts call cyclothymia. In this case, depression (dysthymia) alternates with excitement (hyperthymia), but both of these conditions are not pronounced. Periods of melancholy and high spirits can alternate, be doubled, and also be separated by sharply and unexpectedly emerging stability (let's call it a period of mental well-being).

Due to the identity of the symptoms, cyclothymia is often called bipolar disorder, that is, manic-depressive psychosis, but in a mild form. In Germany, psychiatrists use this term to refer to any affective mental disorder characterized by manic and depressive episodes, no matter how severe the disorder may be. Deontological ethics (moral and moral considerations) calls them to this.

Also, the concept of “cyclothymia” is used to describe a certain type of personality and its characteristic psychoses that arose for internal reasons

In the list of emotional disorders, the prevalence of the illness discussed in this article is 5%. However, there is an assumption that the number of patients with it is much larger, but they do not seek specialized help, since the manifestations of the disorder are not intense and do not “poison” life too much.

Features of manifestation and classification

Typically, cyclothymia develops in people whose ancestors suffered from bipolar disorder. Its first signs appear in adolescence, so diagnosis is difficult due to the mood swings characteristic of puberty. This is very bad, because if treatment measures are not taken in time, it can become chronic or develop into more serious mental illnesses.

The insidiousness of cyclothymia also lies in the fact that after its debut it may not manifest itself at all, or may recur after some time.

The patient's mood changes from depressed to excited, and vice versa, without any reason or pattern, unexpectedly, several times a day or even within an hour. But sometimes a change in cycles can be triggered by a psychogenic event.

The phases of depression and hypomania are short, pass in waves, the symptoms either intensify or fade. Such emotional fluctuations can be interrupted by a fairly long intermission

The frequency of exacerbations can be:

regular – mood changes after a certain period of time;
seasonal - cyclothymia manifests itself in autumn or spring;
48 hour. In this case, the alternation of states of depression and hypomania is very variable and inconsistent.

Cyclothymia is divided into forms that differ in the strength of manifestation and predominant conditions:

vital – deep depression, melancholy for no reason, mental pain. Tingling in the heart, increased blood pressure, muscle fatigue, loss of energy. Appetite and sleep disturbances;
apathetic – indifference to one’s own person and loved ones. Life activity at zero, complete indifference to everything, loss of motivation. Speech is quiet, slow, monotonous, decreased reaction speed;
anesthetic – the feeling of anxiety increases, fussiness or lethargy, indifference appears. There are no emotions or interests. The surrounding reality is boring. Such signs allow a diagnosis to be made.

Forecast

According to most authors who have studied the course of cyclothymic disorders, the prognosis depends on the typicality of symptoms and the syntony of the patient’s initial personality (internal balance and emotional responsiveness). The more typical the symptoms (cyclothymic nuclear group), the more balanced and emotionally responsive the initial personality, the more favorable the prognosis.

Cyclothymia with schizophrenia-like inclusions that appeared at a young age, or the presence of massive pathoplastic-psychogenic “layers” are unfavorable signs.

Elderly people often experience prolongation of certain phases of the disease.

Causes

As mentioned above, the main factor in the development of cyclothymia is genetic predisposition. But, in addition, some sources adhere to the psychodynamic theory. According to her, a mild form of manic-depressive psychosis can develop in childhood against the background of worries about the unfavorable atmosphere of growing up. Most likely, this again should be blamed on the parents for their different views on raising their child, the lack of an action plan in this area, as well as excessive criticism with little encouragement for the child.

There is also a biological version of the cause of this disease. In this case, the instability of the emotional sphere is explained by the hyperactivity of cortisol. This hormone in the human body is actively involved in creating an individual response to stress.

Cyclothymia - what is it?

In psychology and psychiatry, cyclothymia is sudden fluctuations in the emotional background. Typically, the root “cyclo-” indicates that the condition is recurring, wave-like, or cyclical. This is how it is: depression and depression (dysthymia) alternate with strong excitement. However, neither disorder has pronounced symptoms. They replace each other or are separated by emotional stability, which is called a period of mental well-being.

The International Classification of Diseases (ICD-10) considers cyclothymia as a separate disease. Essentially, it is an affective behavior disorder characterized by alternating periods of high and low mood.

Symptoms of cyclothymia are similar to bipolar disorder or a mild form of manic-depressive psychosis. But they don't call her that. In particular, in Germany, for moral and ethical reasons, the word “cyclothymia” refers to all disorders that have depressive or manic stages. And this does not depend on their severity.

The first signs of the disorder appear between the ages of 14 and 17, around the time of puberty. However, it is difficult to diagnose, since the behavior of adolescents is influenced by hormonal imbalance and various environmental factors.

Prevalence

According to official statistics, 0.4-4.5% of the adult population of the planet suffers from cyclothymia. But there may be more such people, because only half of the total number seeks medical help. The rest do not consider manifestations of cyclothymia and sudden mood swings to be anything serious.

Symptoms

The manifestations of cyclothymia are very similar to bipolar disorder in the presence of opposite phases, but they are more smoothed out. Their symptoms develop gradually.

The depressive stage is characterized by:

pessimism;
longing;
nighttime insomnia and daytime sleepiness;
decline in performance;
isolation from people;
decreased activity, loss of energy;
a negative assessment of what was in the past, is in the present, and will be in the future;
own underestimation;
loss of passion for life;
deterioration of memory and ability to concentrate;
creative crisis;
inability to enjoy anything.

There are also people suffering from this disorder whose depressive symptoms are aggravated: they have a feeling of hopelessness, worthlessness, guilt, and lack of perspective. However, there are no suicidal thoughts.

The hypomanic phase has the following symptoms:

the desire to communicate with as many people as possible and more actively;
familiar address to the interlocutor, special style of speech;
inflated self-esteem, delusions of grandeur;
wonderful, euphoric mood;
creative and labor activity is increased, but unorganized and produces poor results;
the past, present and future are seen as optimistic;
increased interest in members of the opposite sex, leading to promiscuity;
violation of sleep patterns, low need for it;
strong gestures and facial expressions.

During this period, the patient has a desire to travel, collect something, or join a religious cult. Irritability, aggression, and inability to compromise are quite possible. There is also a risk of starting to take alcohol or drugs, gamble, and get involved in dubious scams.

Treatment of cyclothymia

The main goal of treatment for cyclothymia is to stop prolonged emotional outbursts and restore the state to remission, as well as reduce the risk of relapse. The treatment regimen involves several measures:

Working with a qualified psychologist
Use of medications
Creating the most relaxed environment possible
Elimination of bad habits: alcohol or drug use
Normalization and stabilization of the emotional state through deprivation. During this procedure, the person stays awake for about 38 hours.
NO therapy, which uses heated nitrogen
Psychotherapy individually or together with other family members.

If cyclothymia occurs in a cyclical pattern, then light therapy may be used. If the condition worsens, treating specialists can develop drug therapy:

To reduce central nervous system excitation, lithium carbonate is used. It has a sedative and antidepressant effect. In 60% of cases, patients tolerate the effects of the drug favorably
Normotimics. Help stabilize the emotional background, reduce the likelihood of convulsive reactions, and also have an antipsychotic effect
Antidepressants. As Cyclothymia progresses, a negative emotional background often increases. For example, Fluvoxamine helps eliminate manic episodes
Neuroleptics combat excessive psychomotor agitation.

If medications provide only temporary relief, ECT (electroconvulsive therapy) may be used to relieve depression. When using psychotropic drugs, use is expected for three months. Specialists monitor the intake of pills and change the dosage if necessary. If the rules are not followed, this may negatively affect the patient's condition.

Inpatient treatment is required only for patients experiencing acute depression.

Diagnosis of cyclothymia

Diagnosis of a mental disorder involves a specialist listening to the patient’s complaints and interviewing relatives. The doctor also uses a special test. This is recommended for people who suspect they have this disorder. All questions must be answered “yes” or “no”. The cyclothymic test includes the following questions:

From time to time do you feel either active or inactive?
Do you have a grandiose plan in your head, but as you move towards its implementation, the “fuse” disappears?
Do you experience frequent mood swings for no reason?
You can't stand hunger - does it make you irritable and weak?
Do external circumstances have no effect on your mood?
Do the seasons of the year greatly affect mood swings?
During a conversation (business, friendly), does your desire to speak disappear or your activity decrease?
Does it happen that after falling asleep in a good mood, you wake up depressed?
Do you periodically lose interest in everything?
Do you have scary dreams even though you usually sleep soundly?
Do you have unstable employment: sometimes you work hard and hard, sometimes you sit back?
Do you often feel elated, in which you want to move mountains, or apathy - you don’t even want to move?

Next, summing up the positive answers, we interpret them:

10-12 “yes” - you have pronounced cyclothymia;
5-9 – there is a tendency towards disorder;
less than 4 – there is no predisposition at all.

Naturally, this result does not provide a direct answer to the question, but it does give reason to think about contacting a specialist.

Diagnosis and treatment

The diagnostic picture of cyclothymia is formed based on complaints received from the patient himself, an examination by a neurologist and observations recorded by a psychotherapist. The diagnosis is made on the basis of cyclical changes in mood, in which there may be no period of normalcy.

For at least two years, a patient with cyclothymia should steadily clear up hypomanic states intersected with depressive mood. Adolescents and children, when diagnosed with the disease, are subject to cyclical fluctuations throughout the year.

An additional diagnosis is usually bipolar disorder, since against the background of cyclothymia, attacks of a manic or severe depressive nature can develop.

When choosing the optimal treatment tactics, the observing physician relies on the development of a particular episode currently occurring. This is explained by the fact that the therapeutic effect should concern the suspension of the current ailment and the prevention of relapse in the future.

In the case when the doctor does not observe the critical condition of the patient, treatment of cyclotomy can be carried out on an outpatient basis, and suitable antidepressants are prescribed.

Intensive therapy combines the use of psychotropic drugs and psychotherapy. Psychotropic medications, as a rule, have a positive effect on the patient’s mood, and psychotherapeutic techniques can bring greater confidence to the patient’s life, and will also allow him to cope with his own thoughts and feelings.

In most cases, cyclothymia is treated at home, because there is such a factor as inaction and it worsens within the hospital, which negatively affects the patient’s well-being. When hospitalization is mandatory, then stay in a medical facility will be limited.

Undoubtedly, the recovery process is influenced by such factors as the patient’s desire for a speedy restoration of a normal state.

Accordingly, in this situation, a positive attitude, combined with the support of loved ones, plays a big role. During this period, difficulties may arise with taking psychotropic medications, because already in the first month of treatment the patient may have the feeling that antidepressants are causing irreparable harm to his consciousness.

This can be directly influenced by those around you, approving all incentives to restore health.

Development and prevalence of the disease

Cyclothymia, as a rule, develops at a young age and then takes a chronic course, although long-term intermissions are also possible. Changes in mood in patients are usually not associated with external circumstances, although individual episodes can be provoked psychogenically. Cyclothymia often occurs in relatives of patients with bipolar psychosis and can subsequently also develop into bipolar disorder (or into cyclical depression, as its variety).

The prevalence of cyclothymia is significantly higher than that of psychotic level affective disorders (BD, major depressive disorder). According to formal DSM-IV criteria, in different age groups it varies from 0.4 to 4.5%. However, it should be borne in mind that only 30-50% of patients consult a doctor for depression, while 60-80% of them are treated by general practitioners, and almost half (43%) try to hide the symptoms of depression for various reasons. Hyperthymia, on the other hand, is often not perceived by patients as a painful condition (and often is not even an objective pathology). Thus, a significant proportion of patients do not receive a psychiatric diagnosis. Consequently, the actual prevalence of cyclothymia (and, similarly, dysthymia) is significantly higher than these figures.

Causes of cyclothymia

In most cases, the causes of cyclothymia are considered to be genetically determined. At the same time, the predisposition to affective disorders, which include cyclothymia, is inherited polygenically - the likelihood of the disease depends on the combination of genes. The X chromosome contains pathological genes, so women suffer from this mental disorder twice as often.

Diagnosis of cyclothymia

To diagnose the disease, specialists rely on the following aspects:

The patient's story about his own health
Visit to a neurologist
Taking diagnostic measures from a psychotherapist.

To install Cyclothymia, experts note periodic and sudden changes in mood that are not typical for a person’s normal state. The emotional range ranges from deep depression to unreasonable euphoria. In the most advanced situations, stability in condition can be diagnosed. It is important to take into account that in order to approve Cyclothymia as a present disease, specialists must establish at least three characteristic signs.

Depending on the stage of development, those suffering from cyclothymia may not have all the obvious signs of the disease or manic depression. In cases where the patient has a depressive mood without significant manifestations, he is monitored by specialists for at least two years. It is advisable to carry out differential diagnostic procedures:

Excluding the assumption of primary damage to the central nervous system and the development of Cyclothymia as a secondary affective state
Elimination of other assumptions, for example, the possible development of schizophrenia.

If a patient has a depressive-manic disorder, a specialist can determine the development of bipolar disorder.