Deparment of Clinical and Experimental Medicine, University of Pisa, Italy; Institute of Behavioural Science "G. De Lisio", Pisa, Italy.
Centre des Troubles Anxieux et de l'Humeur - Anxiety & Mood Center, 117, Rue de Rennes, Paris 75006, France.
J Affect Disord. 2015 Sep 1;183:119-33. doi: 10.1016/j.jad.2015.05.004. Epub 2015 May 13.
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.
从学术中心、公立和私立门诊机构涌现的数据表明,在所有寻求情绪、焦虑、冲动和成瘾障碍帮助的人群中,经过仔细筛选,有 20%到 50%的人最终被诊断为环性心境障碍。如果重新考虑 DSM-5 提出的诊断规则并采用更广泛的方法,将符合环性心境障碍的患者比例会显著上升。与基于轻度轻躁狂和抑郁症状反复发作的 DSM-5 定义不同,环性心境障碍最好被定义为环性心境气质(基本情绪和情绪不稳定)的夸大,其具有早期发病和极端情绪反应,与人际和分离敏感性相关,在抑郁状态下频繁出现混合特征,轻躁狂症状的阴暗面,多种共病,以及冲动和自杀行为的高风险。流行病学和临床研究表明,环性心境障碍的患病率很高,而且应该将其视为一种独特的双相形式,而不仅仅是一种较温和的形式,这一概念是有效的。误诊和随后的不当治疗与将环性心境障碍转化为严重复杂的类似边缘型双相障碍的高风险相关,尤其是在慢性和反复接触抗抑郁药和镇静剂的情况下。早期发现和治疗环性心境障碍可以保证长期预后的显著改善,此时采用适当的心境稳定剂药物治疗和特定的心理方法和心理教育。作者介绍并讨论了该领域的临床研究以及他们在理解和治疗环性心境障碍及其复杂共病方面的专业知识。