title: Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder.
abstract: Data emerging from both academic centers and from public and private outpatient facilities indicate that from 20% to 50% of all subjects that seek help for mood, anxiety, impulsive and addictive disorders turn out, after careful screening, to be affected by cyclothymia. The proportion of patients who can be classified as cyclothymic rises significantly if the diagnostic rules proposed by the DSM-5 are reconsidered and a broader approach is adopted. Unlike the DSM-5 definition based on the recurrence of low-grade hypomanic and depressive symptoms, cyclothymia is best identified as an exaggeration of cyclothymic temperament (basic mood and emotional instability) with early onset and extreme mood reactivity linked with interpersonal and separation sensitivity, frequent mixed features during depressive states, the dark side of hypomanic symptoms, multiple comorbidities, and a high risk of impulsive and suicidal behavior. Epidemiological and clinical research have shown the high prevalence of cyclothymia and the validity of the concept that it should be seen as a distinct form of bipolarity, not simply as a softer form. Misdiagnosis and consequent mistreatment are associated with a high risk of transforming cyclothymia into severe complex borderline-like bipolarity, especially with chronic and repetitive exposure to antidepressants and sedatives. The early detection and treatment of cyclothymia can guarantee a significant change in the long-term prognosis, when appropriate mood-stabilizing pharmacotherapy and specific psychological approaches and psychoeducation are adopted. The authors present and discuss clinical research in the field and their own expertise in the understanding and medical management of cyclothymia and its complex comorbidities.
authors.affiliation: Deparment of Clinical and Experimental Medicine, University of Pisa, Italy; Institute of Behavioural Science "G. De Lisio", Pisa, Italy. Electronic address: giulio.perugi@med.unipi.it.
authors.forename: Giulio
authors.initials: G
authors.lastname: Perugi
authors.affiliation: Centre des Troubles Anxieux et de l'Humeur - Anxiety & Mood Center, 117, Rue de Rennes, Paris 75006, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Hantouche
authors.affiliation: Deparment of Clinical and Experimental Medicine, University of Pisa, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Vannucchi
authors.affiliation: International Mood Clinic, Rio de Janeiro, Brazil.
authors.forename: Olavo
authors.initials: O
authors.lastname: Pinto
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000175:diagnosis; D001008:Anxiety Disorders / Q000175:diagnosis; D001883:Borderline Personality Disorder / Q000175:diagnosis; D015897:Comorbidity; D003527:Cyclothymic Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D003863:Depression / Q000175:diagnosis; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors
keywords: Bipolar spectrum; Cyclothymia; Cyclothymic disorder; Cyclothymic temperament