Cyclothymia in primary care: an important diagnosis but easy to miss (with consequences)


Cyclothymic disorder is a mood disorder, characterised by a 2-year period during which an individual experiences multiple hypomanic (such as euphoria, irritability, or expansiveness, and psychomotor activation) and dysthymic (such as feeling down, diminished interest in activities, and fatigue) symptoms that are present during more of the time than not; but do not reach the threshold for a manic episode or a depressive episode.

Cyclothymia is often diagnosed late after many years of illness when the superposition of complications such as increased suicidality, substance misuse, and the tendency for conversion to bipolar disorder reduces the possibility of complete remission. Consideration of cyclothymia in the differential diagnosis of patients with unresolving depressive symptoms may aid referral to specialist care for diagnosis and advice on management.

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