title: Cyclothymic disorder in youth: why is it overlooked, what do we know and where is the field headed?
abstract: Cyclothymic disorder is a chronic and impairing subtype of bipolar disorder, largely neglected in pediatric research. Consequently, it is rarely diagnosed clinically despite potentially being the most prevalent form of bipolar disorder. Lack of attention has added to confusion about the diagnosis and clinical presentation of cyclothymic disorder. In pediatric studies, cyclothymic disorder is commonly grouped with 'subthreshold' presentations of bipolar disorder under the undifferentiated label 'bipolar disorder not otherwise specified'. However, research indicates that cyclothymic disorder can be reliably distinguished from the other forms of bipolar disorder and from other childhood disorders. Importantly, cyclothymic disorder may be a diathesis for more acute presentations of bipolar disorder, warranting a prominent role in dimensional models of mood and psychopathology. Current evidence suggests that cyclothymic disorder has the potential to make unique contributions to our understanding of the risk factors and outcomes associated with bipolar disorder. This potential has yet to be fully realized, limiting our knowledge and ability to intervene in a meaningful way with youth who are exhibiting symptoms of a major mood disorder. Including cyclothymic disorder in future research studies of children - particularly longitudinal outcome studies - is essential for understanding the developmental trajectory of bipolar spectrum disorders and learning how to accurately diagnosis and treat the full spectrum of bipolar disorders.
authors.affiliation: University of North Carolina at Chapel Hill, NC 27514, USA.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Van Meter
authors.forename: Eric A
authors.initials: EA
authors.lastname: Youngstrom
references.citation: J Am Acad Child Adolesc Psychiatry. 2005 Mar;44(3):213-35
references.pmid: 15725966
references.citation: J Affect Disord. 1997 Sep;45(3):117-26
references.pmid: 9298424
references.citation: World Psychiatry. 2011 Feb;10(1):45-51
references.pmid: 21379356
references.citation: J Am Acad Child Adolesc Psychiatry. 2000 Apr;39(4):453-60
references.pmid: 10761347
references.citation: Bipolar Disord. 2000 Sep;2(3 Pt 2):281-93
references.pmid: 11249806
references.citation: CNS Spectr. 2006 Jun;11(6):465-71
references.pmid: 16816785
references.citation: Arch Gen Psychiatry. 1985 Oct;42(10):996-1003
references.pmid: 4037989
references.citation: Bipolar Disord. 2001 Dec;3(6):325-34
references.pmid: 11843782
references.citation: J Affect Disord. 2008 Mar;106(3):229-40
references.pmid: 17692389
references.citation: J Affect Disord. 1994 Aug;31(4):281-94
references.pmid: 7989643
references.citation: J Am Acad Child Adolesc Psychiatry. 1995 Apr;34(4):454-63
references.pmid: 7751259
references.citation: J Clin Psychiatry. 2011 Sep;72(9):1250-6
references.pmid: 21672501
references.citation: J Affect Disord. 2000 Sep;59 Suppl 1:S5-S30
references.pmid: 11121824
references.citation: Child Abuse Negl. 1996 Aug;20(8):709-23
references.pmid: 8866117
references.citation: J Am Acad Child Adolesc Psychiatry. 1997 Aug;36(8):1046-55
references.pmid: 9256584
references.citation: Twin Res Hum Genet. 2005 Oct;8(5):459-66
references.pmid: 16212835
references.citation: J Nerv Ment Dis. 1993 Aug;181(8):485-93
references.pmid: 8360639
references.citation: Am J Psychiatry. 1997 Jan;154(1):44-9
references.pmid: 8988957
references.citation: J Affect Disord. 2011 Jul;132(1-2):55-63
references.pmid: 21396717
references.citation: Arch Gen Psychiatry. 2007 Apr;64(4):419-26
references.pmid: 17404119
references.citation: J Am Acad Child Adolesc Psychiatry. 2003 Mar;42(3):269-78
references.pmid: 12595779
references.citation: J Child Psychol Psychiatry. 2009 Dec;50(12):1485-94
references.pmid: 19573034
references.citation: Compr Psychiatry. 1982 Mar-Apr;23(2):186-9
references.pmid: 7067433
references.citation: Bipolar Disord. 2008 Feb;10(1 Pt 2):194-214
references.pmid: 18199237
references.citation: J Affect Disord. 2006 Dec;96(3):207-13
references.pmid: 16647762
references.citation: Am J Med Genet B Neuropsychiatr Genet. 2008 Apr 5;147(3):326-32
references.pmid: 18081158
references.citation: J Clin Psychiatry. 2011 Sep;72(9):1257-62
references.pmid: 21672494
references.citation: J Clin Psychiatry. 2007 May;68(5):781-8
references.pmid: 17503990
references.citation: Psychother Psychosom. 2011;80(3):136-43
references.pmid: 21372621
references.citation: J Affect Disord. 2003 Jan;73(1-2):87-98
references.pmid: 12507741
references.citation: J Abnorm Psychol. 2012 Feb;121(1):16-27
references.pmid: 21668080
references.citation: Am J Psychiatry. 2009 Jul;166(7):795-804
references.pmid: 19448190
references.citation: Dev Psychopathol. 2006 Fall;18(4):1147-68
references.pmid: 17064432
references.citation: J Affect Disord. 2009 Jan;112(1-3):144-50
references.pmid: 18538857
references.citation: Bipolar Disord. 2005 Dec;7(6):525-35
references.pmid: 16403178
references.citation: Am J Public Health. 2001 May;91(5):753-60
references.pmid: 11344883
references.citation: J Clin Psychiatry. 1993 Aug;54(8):300-4
references.pmid: 8253697
references.citation: Arch Gen Psychiatry. 1986 May;43(5):441-5
references.pmid: 3964023
references.citation: Am J Public Health. 1998 Jan;88(1):75-80
references.pmid: 9584037
references.citation: J Child Psychol Psychiatry. 2005 Mar;46(3):235-45
references.pmid: 15755300
references.citation: J Child Neurol. 2001 Aug;16(8):553-61
references.pmid: 11510924
references.citation: Biol Psychiatry. 2001 Jun 15;49(12):1002-14
references.pmid: 11430842
references.citation: Am J Psychiatry. 2010 Oct;167(10):1194-201
references.pmid: 20713498
references.citation: Neurotox Res. 2011 Feb;19(2):279-85
references.pmid: 20461491
references.citation: Psychother Psychosom. 2011;80(3):131-5
references.pmid: 21372620
references.citation: J Affect Disord. 2005 Mar;85(1-2):181-9
references.pmid: 15780688
references.citation: J Psychiatr Res. 2010 Apr;44(6):405-8
references.pmid: 19889426
references.citation: JAMA. 2003 Sep 17;290(11):1517-9
references.pmid: 13129995
references.citation: J Affect Disord. 2008 May;108(1-2):25-32
references.pmid: 18006072
references.citation: J Psychiatr Res. 2005 Nov;39(6):611-22
references.pmid: 16009376
references.citation: Am J Psychiatry. 2003 Jun;160(6):1093-9
references.pmid: 12777267
references.citation: Psychol Med. 2011 Aug;41(8):1567-77
references.pmid: 20836910
references.citation: Biol Psychiatry. 2003 Jun 1;53(11):970-7
references.pmid: 12788242
references.citation: Bipolar Disord. 2005 Dec;7(6):623-34
references.pmid: 16403188
references.citation: J Pers Disord. 1997 Spring;11(1):19-33
references.pmid: 9113820
references.citation: Am J Psychiatry. 1977 Nov;134(11):1227-33
references.pmid: 910973
references.citation: J Child Adolesc Psychopharmacol. 2000 Fall;10(3):185-92
references.pmid: 11052408
references.citation: J Am Acad Child Adolesc Psychiatry. 2006 Mar;45(3):298-304
references.pmid: 16540814
references.citation: J Affect Disord. 2003 Jan;73(1-2):123-31
references.pmid: 12507745
references.citation: Arch Gen Psychiatry. 2006 Feb;63(2):175-83
references.pmid: 16461861
references.citation: Am J Psychiatry. 2000 Mar;157(3):466-8
references.pmid: 10698829
references.citation: J Clin Psychopharmacol. 1996 Apr;16(2 Suppl 1):56S-66S
references.pmid: 8708001
references.citation: Arch Gen Psychiatry. 1988 Jun;45(6):581-8
references.pmid: 3377645
references.citation: J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-9
references.pmid: 20855043
references.citation: J Clin Psychol. 2008 Apr;64(4):501-18
references.pmid: 18324665
references.citation: J Affect Disord. 2006 Apr;91(2-3):125-31
references.pmid: 16464506
references.citation: J Affect Disord. 2003 Jan;73(1-2):133-46
references.pmid: 12507746
references.citation: J Affect Disord. 2003 Jan;73(1-2):75-85
references.pmid: 12507740
references.citation: Pediatrics. 2009 Mar;123(3):e446-52
references.pmid: 19254981
references.citation: Dev Psychopathol. 2008 Summer;20(3):881-97
references.pmid: 18606036
references.citation: Am J Psychiatry. 2000 Dec;157(12):1925-32
references.pmid: 11097952
references.citation: Compr Psychiatry. 1977 Jul-Aug;18(4):327-32
references.pmid: 326475
references.citation: Am J Psychiatry. 1970 Jan;126(7):983-7
references.pmid: 5409569
references.citation: J Am Acad Child Adolesc Psychiatry. 2009 Apr;48(4):386-399
references.pmid: 19252450
references.citation: J Abnorm Psychol. 2009 Aug;118(3):431-47
references.pmid: 19685942
references.citation: J Abnorm Child Psychol. 2013 Apr;41(3):367-78
references.pmid: 22968491
references.citation: Eur Psychiatry. 2007 Mar;22(2):92-8
references.pmid: 17142013
references.citation: J Affect Disord. 2006 Dec;96(3):197-205
references.pmid: 16824616
references.citation: J Affect Disord. 2005 Mar;85(1-2):153-68
references.pmid: 15780686
references.citation: J Child Adolesc Psychopharmacol. 2002 Spring;12(1):3-9
references.pmid: 12014593
references.citation: Br J Psychiatry. 2006 Aug;189:118-23
references.pmid: 16880480
references.citation: J Psychopharmacol. 2009 Jun;23(4):346-88
references.pmid: 19329543