Introduction
Cyclothymic disorder is an affective mood disorder primarily characterized by severe changes in emotion. Hypomanic episodes come in place of periods of depression. The condition is similar to bipolar disorder; however, there are a number of key clinical differences between the two. The main thesis of this paper is that cyclothymic disorder is a less severe version of bipolar disorder, one that is both difficult to recognize and treat. A better system for diagnosing and medicating cyclothymic disorder is necessary to assist individuals on their journey to self-fulfillment.
Prevalence and Neurobiology
It is first important to establish the basics of cyclothymic disorder. The condition is relatively rare, usually found in 0.4% to 1% of people (Bielecki & Gupta, 2022). The distribution rate is equal for males and females, although the prevalence can change depending on location. According to existing data, some hospitals presented rates of cyclothymic disorder diagnosis as high as 5-10% (Sanches & Soares, 2020) among the high-risk populations. On a neurobiological level, scientists currently struggle to fully understand the causes and mechanisms of cyclothymic disorder.
When comparing the condition with major depression, a difference in brain activity was discovered. Notably, the amygdala appears to function differently in people with either disorder. Despite an inability to pinpoint the lead causes of cyclothymic disorder, researchers are able to determine its effects on brain function (“Cyclothymic disorder,” 2022). A drop in cognitive ability, memory, processing speed, and executive functioning could be noted.
Differences Compared to Bipolar I
The cyclothymic disorder can be compared to bipolar I. Both conditions are characterized by constant changes in mood and shifts between mania and depression. However, a difference in severity can be noted. In particular, cyclothymic disorder is explicitly diagnosed when a patient’s cyclic episodes are persistent but do not meet the criteria needed to diagnose bipolar I. At least three symptoms must be exhibited, including an inflated sense of self, a lack of desire to sleep, distractibility, and talkativeness (American Psychiatric Association, 2022). These issues must be severe enough to impede a person’s daily life, negatively affecting their mental health, social interaction, and work.
Similarly, a major depressive episode is one characterized by its negative influence on one’s life. The difference comes in the form of symptoms, which now constitute a continuous depressed mood, diminished interest in activities of most kinds, fatigue, abnormal sleep patterns, and diminished cognitive ability (American Psychiatric Association, 2022). Symptoms during a major depressive episode must be experienced for at least two weeks.
In the case of cyclothymic disorder, the symptoms for both manic and depressive episodes may present less frequently or less severely. This disallows a person from being diagnosed with bipolar I. However, the individual must exhibit changes in mood indicative of cyclothymic disorder for at least a year (American Psychiatric Association, 2022). They must not be induced by medication use, drugs, or other mental health disorders. In this way, cyclothymic disorder can be seen as a diagnosis that requires a much larger period of observation.
Special Populations
Certain populations may find themselves disproportionately affected by cyclothymic disorder. This may come as a result of their unique vulnerability or gaps in medical care systems that are present today. As shown by research, children appear to be most vulnerable when discussing concerns of cyclothymic disorder, as they are often underdiagnosed due to the disorder duration requirements (Malhi & Bell, 2019). This trend exists because many criteria that are necessary to diagnose the disorder are difficult to observe in children, along with the fact that parents, caretakers, and doctors may disregard symptoms of both mania and depression.
Legal Considerations
Legal considerations of cyclothymic disorder diagnosis and treatment come from specific regulations put in place in order to protect people from potential harm. Restrictions determine how individuals get access to medication, what types of medication are available to them, and what information is necessary to make a prescription legitimate. In the case of cyclothymic disorder, the most common prescription is for mood-stabilizing medication, one also used for bipolar I. This type of medication must be prescribed by a healthcare provider (doctor or psychiatrist). Therefore, legal issues may arise if individuals without proper accreditation give patients prescriptions for mood-stabilizing medication (Bipeta, 2019). Furthermore, patients themselves can come under legal scrutiny for trying to acquire mood stabilizers without a prescription.
Ethical Considerations
In terms of ethics, usual ethical issues concerning patient diagnosis and treatment arise. First, such an issue touches on informed consent, the need to provide individuals with all the information they need to make choices regarding their treatment process. Healthcare providers and mental health professionals must utilize their knowledge in order to keep the patient up-to-speed with the course of their care, the severity of their condition, its potential symptoms, and the treatment options that become available to them (Bipeta, 2019). This type of patient-centered care is vital in the process of increasing mental health awareness within communities and helping individuals live with dignity, agency, and autonomy.
Another large consideration is patient information confidentiality. Data regarding one’s healthcare journey must only be disclosed when necessary, with trusted professionals and people the patient approves of. All data must be stored safely and securely by the healthcare provider. Moreover, when discussing mental disorder diagnosis, it is possible to identify another concern additionally. Namely, the existence of specific diagnostic criteria as contrasted by the real-life issues faced by the individual. Individuals who experience symptoms of cyclothymic disorder or bipolar disorder may struggle to maintain their normal lives, keep relationships, or secure a stable income.
Cultural Considerations
Culture plays a large role in diagnosing mental health disorders and how symptoms of mental health disorders may manifest. Depending on a person’s identity, their place of birth, or their community, the way they approach mental health care will differ. As outlined by researchers, for example, feelings of shame still permeate mental health discussions in Asian countries (Gopalkrishnan, 2018). Because of this, Asian people may be more reluctant to seek professional help. Similarly, the approaches to mental health support and therapy will change depending on the location. The use of specific therapy methods and even underlying philosophies that justify the use of certain techniques will differ from country to country.
Social Determinants of Health
While society of today strives to be more equitable, certain mental health disparities still exist. This means that the experiences of marginalized individuals, as well as the way others treat them, will inevitably affect their mental health journeys. This includes the severity of mental health issues, the likelihood of seeking treatment, the likelihood of diagnosis, the presence of comorbidities, mental and physical health outcomes, and the general quality of life. The social safety net does not catch underprivileged people and those who lack access to means or opportunities and are often left behind by the systems that are supposed to protect them.
Approved Practice Guidelines for Pharmacological Treatment
Existing information regarding the proper treatment of cyclothymic disorder remains limited, as the disorder is not officially recognized universally. Due to a reduction in severity compared to bipolar I, doctors are not obligated to prescribe any medication to the patients. However, mood stabilizers appear to be more common in managing the onset of symptoms and mitigating their effect on daily life.
Side Effects, Warnings, Potential Points of Concern
A warning must be made on the use of anti-depressants for cyclothymic disorder patients. The use of anti-depressant medication has the capacity to induce episodes of mania or hypomania. Because of this, the proper dosage and use of anti-depressants must be determined on a client-to-client basis.
Prescription Examples
The standard universal prescription form includes several items that must be filled. Among these are the patient’s name, age or date of birth, the name of the medication, its strength and route, the frequency of administration, and an indication of diagnosis. There may be additional remarks to remind the patient if the medication is to be given: dietary prerequisites for the treatment period or the prohibition of alcohol consumption, for example. The following may be suggested as samples of such prescriptions for the current disorder adult treatment, omitting the name, age, and date of prescription:
- RX: Lamotrigine 25 mg P.O. daily (Q.D.) 2 weeks, cyclothymia, mood disorder;
- RX: Lurasidone 20 mg/d P.O. 96h q.d. cf; DX: cyclothymic disorder;
- RX: Lithium 900 mg/day p.o. (450mg b.i.d/ 300mg t.i.d.); DX: cyclothymia regular release long-term control.
Conclusion
In conclusion, it can be said that cyclothymic disorder is one of many disorders on the bipolar spectrum. After discussing its effects, diagnostics, treatment, and influence on the individual, it can be asserted that the condition is less dangerous or life-changing than other types of bipolar disorder. However, this does not change the need to help affected individuals. Doctors and other health professionals must find proper pathways to quickly and decisively diagnosing cyclothymic disorder, as the failure to do so endangers the lives of the patients.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, fifth edition, text revision (DSM-5-TR (TM)). American Psychiatric Association Publishing.
Bielecki, J. E., & Gupta, V. (2022). Cyclothymic Disorder. In StatPearls. StatPearls Publishing.
Bipeta, R. (2019). Legal and ethical aspects of mental health care. Indian Journal of Psychological Medicine, 41(2), 108-112. Web.
Cyclothymic disorder. (2022). United Brain Association. Web.
Gopalkrishnan, N. (2018). Cultural diversity and mental health: Considerations for policy and practice. Frontiers in Public Health, 6. Web.
Malhi, G. S., & Bell, E. (2019). Fake views: Cyclothymia – A dithering disorder? The Australian and New Zealand Journal of Psychiatry, 53(8), 818–821. Web.
Sanches, M., & Soares, J. C. (2020). Prevention of bipolar disorder: Are we almost there? Current Behavioral Neuroscience Reports, 7(2), 62–67. Web.
