Cyclothymia

CYCLOTHYMIA, a recurrent, wave-like alternation of mildly expressed states of psychic excitement and depression, frequently observed in a certain group of psychopathic personalities (cycloids). The appearance of cyclothymic fluctuations usually first becomes noticeable during puberty, when previously cheerful, lively, and joyful adolescents transform into melancholic, depressed, and pessimistically inclined youths and maidens. The states of excitement in cyclothymics are frequently so weakly expressed that they hardly attract attention and are not considered morbid; on the contrary, in such states patients often produce the impression of cloudless health: they are cheerful, constantly feeling well, sociable, witty, resourceful, and active. Only upon the intensification of excitement does it become clear that a morbid hypomaniacal state is present (see Hypomania). Much more easily noticed by both those around the patient and the patient himself is the pathological character of cyclothymic depressions, when the period of cheerfulness ends and the patient stops showing up in public, becomes cheerless, sluggish, inactive, withdrawn, and taciturn. Everything begins to appear to him in a gloomy light, routine work drives him to despair by its difficulties, and in fact he notices that his memory, quick-wittedness, and work capacity have considerably weakened. Most often, loss of appetite, constipation, headaches, and unpleasant sensations in various parts of the body, general weakness, and so forth join this, wherein all these phenomena are considerably intensified by the hypochondria developing simultaneously with them (see Hypochondria). Pletnev and others drew attention to cases where, in cyclothymics, depressive phases manifest not as psychic changes, but solely as somatic disorders, predominantly on the part of metabolism, e.g., attacks of gout, gastric disorders (cyclosomia). Usually, the phases of cyclothymia follow one another rather regularly, alternating with periods of a comparatively even state and sometimes revealing a tendency to appear at definite times of the year. In weakly expressed cases, cyclothymic fluctuations almost lose their pathological character and become a peculiar individual trait. Cyclothymia must be considered a mild form of manic-depressive psychosis (see) and its features often serve to prove the constitutional basis of this disease. (On the etiology, pathogenesis, and prognosis of cyclothymia, see Manic-depressive psychosis.) In differential-diagnostic respects, it is important to bear in mind that neurasthenic and hysterical (hystero-cyclothymia) symptoms frequently stand in the foreground in cyclothymics, sometimes masking the underlying depressive background. The therapy of cyclothymia presents certain features: those suffering from it do not consider themselves mentally ill, and therefore it is preferable to treat them either on an outpatient basis or (in more severe cases) in sanatorium-type institutions. Most of all, such patients are indicated a calm, regular regimen, light, non-fatiguing, and correctly dosed therapeutic labor, moderate physiotherapy (warm water procedures), and episodically small doses of narcotic medicaments. Psychotherapy exerts a very good influence on such patients, especially at the end of an attack.