Perugi Giulio, Hantouche Elie, Vannucchi Giulia
Department of Clinical and Experimental Medicine, University of Pisa, Italy.
Institute of Behavioural Science, "G.De Lisio", Pisa, Italy.
Curr Neuropharmacol. 2017 Apr;15(3):372-379. doi: 10.2174/1570159X14666160616120157.
Contrary to DSM-5 definition based on recurrence of low grade hypomanic and depressive symptoms, cyclothymia is better defined in a neurodevelopmental perspective as an exaggeration of cyclothymic temperament. Emotional dysregulation with extreme mood instability and reactivity is the core features of the complex symptomatology.
In the present article, we critically reviewed the literature on the diagnosis and treatment of cyclothymia, focusing on the temperamental and neurodevelopmental perspectives.
Current epidemiological and clinical research showed the high prevalence and the validity of cyclothymia as a distinct form of bipolarity, frequently associated with multiple comorbidities with anxiety, impulse control, substance use, and so called "personality" disorders. Many patients receive correct diagnosis and treatments after many years of illness, when the superposition of complications reduces the possibility of complete remission. A therapeutic model combining the focus on symptomatic presentations with a temperamental perspective seems to represent an effective approach for cyclothymic patients with complex clinical presentations.
Cyclothymic mood instability is an understudied issue despite the evidence of its clinical relevance. Unresolved issues concern its diagnostic delimitation and the possible relationships with emotional dysregulation observed in other neurodevelopmental disorders. We need to confirm the specificity of the disorder and to improve its recognition in early phase of the life, especially in youth. Early recognition means avoiding unnecessary complications and establishing specific treatments and clinical management since the beginning.
与基于轻度躁狂和抑郁症状复发的《精神疾病诊断与统计手册》第五版定义相反，环性心境障碍从神经发育角度可更好地定义为环性气质的一种夸大表现。情绪调节障碍伴极端情绪不稳定和反应性是复杂症状学中的核心特征。
在本文中，我们批判性地回顾了关于环性心境障碍诊断和治疗的文献，重点关注气质和神经发育视角。
当前流行病学和临床研究表明，环性心境障碍作为双相情感障碍的一种独特形式具有高患病率和有效性，常与焦虑、冲动控制、物质使用及所谓的“人格”障碍等多种共病相关。许多患者在患病多年后才得到正确诊断和治疗，此时并发症的叠加降低了完全缓解的可能性。一种将关注症状表现与气质视角相结合 的治疗模式似乎是针对具有复杂临床表现的环性心境障碍患者的有效方法。
尽管有证据表明环性心境障碍的情绪不稳定具有临床相关性，但该问题仍研究不足。未解决的问题涉及其诊断界定以及与其他神经发育障碍中观察到的情绪调节障碍的可能关系。我们需要确认该障碍的特异性，并在生命早期阶段（尤其是青少年时期）提高对它的识别。早期识别意味着从一开始就避免不必要的并发症，并建立特定的治疗方法和临床管理措施。
