A. The prevalence is 1%, but cyclothymic disorder constitutes 5-10% of psychiatric outpatients.
B. The onset occurs between age 15 and 25, and women are affected more than men by a ratio of 3:2.
C. Thirty percent of patients have a family history of bipolar disorder.
IV.Differential Diagnosis of Cyclothymic Disorder
A. Bipolar II Disorder. Patients with bipolar type II disorder exhibit hypomania and episodes of major depression.
B. Substance-Induced Mood Disorder/Mood Disorder Due to a General Medical Condition. See under dysthymic disorder and bipolar I.
C. Personality Disorders (antisocial, borderline, histrionic, narcissistic) can be characterized by marked shifts in mood. Personality disorders may coexist with cyclothymic disorder.
A. Mood stabilizers are the treatment of choice, and Lithium is effective in 60% of patients. The clinical use of mood stabilizers is similar to that of bipolar disorder. (Also see Mood Stabilizers, page 112).
B. Depressive episodes must be treated cautiously because of the risk of precipitating manic symptoms with antidepressants (occurs in 50% of patients). Antidepressants can also increase the rate of cycling. Patients are often treated concurrently with anti-manics and antidepressants.
C. Patients often require supportive therapy to improve awareness of their illness and to deal with the functional consequences of their behavior.
References, see page 122.
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