cyclothymic disorder


Summary: An affective disorder characterized by periods of depression and hypomania. These may be separated by periods of normal mood.

Top Publications

  1. Akiskal K, Savino M, Akiskal H. Temperament profiles in physicians, lawyers, managers, industrialists, architects, journalists, and artists: a study in psychiatric outpatients. J Affect Disord. 2005;85:201-6 pubmed
    ..Such knowledge, in turn, can help the therapeutic process. ..
  2. Fava G, Rafanelli C, Tomba E, Guidi J, Grandi S. The sequential combination of cognitive behavioral treatment and well-being therapy in cyclothymic disorder. Psychother Psychosom. 2011;80:136-43 pubmed publisher
    There is a lack of controlled studies of psychological treatment of cyclothymic disorder. The aim of this investigation was to examine the benefits of the sequential combination of cognitive behavioral therapy (CBT) and well-being therapy ..
  3. Dauphinais D, Knable M, Rosenthal J, Polanski M, Rosenthal N. Zonisamide for bipolar disorder, mania or mixed states: a randomized, double blind, placebo-controlled adjunctive trial. Psychopharmacol Bull. 2011;44:5-17 pubmed
    ..In contrast to previous studies that suggested efficacy of adjunctive zonisamide in bipolar mania or mixed state, these results were not confirmed in this double blind controlled study. ..
  4. Rihmer A, Rozsa S, Rihmer Z, Gonda X, Akiskal K, Akiskal H. Affective temperaments, as measured by TEMPS-A, among nonviolent suicide attempters. J Affect Disord. 2009;116:18-22 pubmed publisher
    ..As only nonviolent suicide attempters were studied, our findings should pertain only for this patient-population. ..
  5. Angst J, Gamma A, Benazzi F, Ajdacic V, Rossler W. Does psychomotor agitation in major depressive episodes indicate bipolarity? Evidence from the Zurich Study. Eur Arch Psychiatry Clin Neurosci. 2009;259:55-63 pubmed publisher
    ..The findings do not support the hypothesis that agitated depressive syndromes are mixed states. The results are limited to a population up to the age of 40; bipolar-I disorders could not be analysed (small N). ..
  6. Baethge C, Salvatore P, Baldessarini R. Cyclothymia, a circular mood disorder. Hist Psychiatry. 2003;14:377-99 pubmed publisher
    ..The Kahlbaum-Hecker syndrome of cyclothymia survives in DSM-IV bipolar II disorder and cyclothymia. An annotated English translation of Hecker's 1898 paper is provided, with historical notes on Hecker and the significance of his work. ..
  7. Cassano G, Akiskal H, Musetti L, Perugi G, Soriani A, Mignani V. Psychopathology, temperament, and past course in primary major depressions. 2. Toward a redefinition of bipolarity with a new semistructured interview for depression. Psychopathology. 1989;22:278-88 pubmed
  8. Kwapil T, DeGeorge D, Walsh M, Burgin C, Silvia P, Barrantes Vidal N. Affective temperaments: unique constructs or dimensions of normal personality by another name?. J Affect Disord. 2013;151:882-90 pubmed publisher
    ..The findings support the validity of hyperthymic and cyclothymic/irritable temperaments as indicators of clinical psychopathology and indicate that they provide information beyond normal personality. ..
  9. Frizzo M, Bisol L, Lara D. Bullying victimization is associated with dysfunctional emotional traits and affective temperaments. J Affect Disord. 2013;148:48-52 pubmed publisher
    ..Being bullied was associated with a broad and profound impact on emotional and cognitive domains in all dimensions of emotional traits, and with internalized and unstable affective temperaments. ..

More Information


  1. Nery Fernandes F, Rocha M, Jackowski A, Ladeia G, Guimarães J, Quarantini L, et al. Reduced posterior corpus callosum area in suicidal and non-suicidal patients with bipolar disorder. J Affect Disord. 2012;142:150-5 pubmed publisher
    ..Furthermore, the study demonstrated that BP-S group had higher impulsivity even during euthymia, which points to a sustained association between lifetime history of suicide attempts and impulsivity in BD. ..
  2. Maremmani I, Dell osso L, Rovai L, Pacini M, Arduino G, Montagnari A, et al. TEMPS-A[p] temperament profile related to professional choice: A study in 1548 applicants to become a cadet officer in the Italian air force. J Affect Disord. 2010;124:314-8 pubmed publisher
  3. Weinstock L, Strong D, Uebelacker L, Miller I. DSM-IV depressive symptom expression among individuals with a history of hypomania: a comparison to those with or without a history of mania. J Psychiatr Res. 2010;44:979-85 pubmed publisher
    ..An exception to this conclusion may be in the area of suicidal ideation, which requires additional attention. ..
  4. Oedegaard K, Syrstad V, Morken G, Akiskal H, Fasmer O. A study of age at onset and affective temperaments in a Norwegian sample of patients with mood disorders. J Affect Disord. 2009;118:229-33 pubmed publisher
    ..The presence of an affective temperament presents an additional affirmation of the early occurrence of mood symptoms in early onset forms of both MDD and BPD. ..
  5. Simon N, Otto M, Weiss R, Bauer M, Miyahara S, Wisniewski S, et al. Pharmacotherapy for bipolar disorder and comorbid conditions: baseline data from STEP-BD. J Clin Psychopharmacol. 2004;24:512-20 pubmed
    ..Our findings highlight the need for greater clinical guidance and treatment options for patients with bipolar disorder and comorbidity. ..
  6. Serretti A, Artioli P, Zanardi R, Rossini D. Clinical features of antidepressant associated manic and hypomanic switches in bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2003;27:751-7 pubmed
    ..Further studies are required to investigate the causal relationships between those factors. ..
  7. von Zerssen D. Development of an integrated model of personality, personality disorders and severe axis I disorders, with special reference to major affective disorders. J Affect Disord. 2002;68:143-58 pubmed
    ..This three-dimensional model is, by its very nature, more complex than the unidimensional one derived from Kretschmer's typological concept, but it is clearly more in accordance with empirical data. ..
  8. Schopf J, Rust B. Follow-up and family study of postpartum psychoses. Part II: Early versus late onset postpartum psychoses. Eur Arch Psychiatry Clin Neurosci. 1994;244:135-7 pubmed
    ..The global psychopathological outcome was also similar. There is no definite evidence that different diseases are provoked in the early and later postpartum period. ..
  9. Van Meter A, Youngstrom E, Youngstrom J, Feeny N, Findling R. Examining the validity of cyclothymic disorder in a youth sample. J Affect Disord. 2011;132:55-63 pubmed publisher
    ..uses the diagnostic validation method first proposed by Robins and Guze (1970) to systematically evaluate cyclothymic disorder as a distinct diagnostic subtype of BP...
  10. Landaas E, Johansson S, Halmøy A, Oedegaard K, Fasmer O, Haavik J. No association between the serotonin transporter gene polymorphism 5-HTTLPR and cyclothymic temperament as measured by TEMPS-A. J Affect Disord. 2011;129:308-12 pubmed publisher
    ..Although being used in clinical settings, TEMPS-A has not been officially validated in Norway. This study suggests that there is no association between the 5-HTTLPR polymorphism and cyclothymic temperament as measured by TEMPS-A. ..
  11. Rihmer A, Szilágyi S, Rozsa S, Gonda X, Faludi G, Rihmer Z. [The role of childhood abuse in adult suicidal behaviour]. Neuropsychopharmacol Hung. 2009;11:237-46 pubmed
    ..However, regardless of gender, it was significantly more severe (p<0.01) among those who were victims of both physical and sexual childhood abuse. ..
  12. Akiskal H, Hantouche E, Allilaire J. Bipolar II with and without cyclothymic temperament: "dark" and "sunny" expressions of soft bipolarity. J Affect Disord. 2003;73:49-57 pubmed
  13. Rihmer Z, Gonda X, Torzsa P, Kalabay L, Akiskal H, Eory A. Affective temperament, history of suicide attempt and family history of suicide in general practice patients. J Affect Disord. 2013;149:350-4 pubmed publisher
    ..Our findings also suggest that the presence of cyclothymic (and to lesser extent depressive) affective temperament in a patient with family history of completed suicide indicates a very high risk of suicidal behaviour. ..
  14. Cassano G, Akiskal H, Savino M, Musetti L, Perugi G. Proposed subtypes of bipolar II and related disorders: with hypomanic episodes (or cyclothymia) and with hyperthymic temperament. J Affect Disord. 1992;26:127-40 pubmed
    ..4% of the 'unipolar' universe by conventional definition) are 'genotypically' closer to Bipolar II defined by hypomania, and course-wise similar to other unipolars. ..
  15. MacKinnon D, Pies R. Affective instability as rapid cycling: theoretical and clinical implications for borderline personality and bipolar spectrum disorders. Bipolar Disord. 2006;8:1-14 pubmed
    ..While continued clinical investigation of the use of anticonvulsants in borderline personality disorder is needed, anticonvulsants may be useful in the treatment of this condition, combined with appropriate psychotherapy. ..
  16. Fornaro M, Ventriglio A, De Pasquale C, Pistorio M, De Berardis D, Cattaneo C, et al. Sensation seeking in major depressive patients: relationship to sub-threshold bipolarity and cyclothymic temperament. J Affect Disord. 2013;148:375-83 pubmed publisher
    ..If confirmed by replication studies, these findings may aid clinicians in delivering a more accurate diagnosis and a safer use of antidepressants in some MDD cases. ..
  17. Oedegaard K, Neckelmann D, Benazzi F, Syrstad V, Akiskal H, Fasmer O. Dissociative experiences differentiate bipolar-II from unipolar depressed patients: the mediating role of cyclothymia and the Type A behaviour speed and impatience subscale. J Affect Disord. 2008;108:207-16 pubmed
    ..Dissociative symptoms measured with the Dissociative Experience Scale are associated with bipolar features, using formal DSM-IV criteria, cyclothymic temperament and the speed and impatience subscale of the JAS. ..
  18. Harnic D, Pompili M, Mazza M, Innamorati M, Di Nicola M, Catalano V, et al. Affective temperaments and psychopathological dimensions of personality in bipolar and cyclothymic patients. Behav Med. 2013;39:17-23 pubmed publisher
    ..BD and cyclothymic patients differed significantly in temperament and personality, differences that may have important implications for treatment. ..
  19. Totterdell P, Kellett S. Restructuring mood in cyclothymia using cognitive behavior therapy: an intensive time-sampling study. J Clin Psychol. 2008;64:501-18 pubmed publisher
    ..Treatment of cyclothymia and related bipolar disorders may be enhanced by integrating understanding of circadian mood regulation into CBT treatment. ..
  20. Lehmkuhl G, Walter D, Lehmkuhl U. [Depressive disorders in children and adolescents]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008;51:399-405 pubmed publisher
    ..Based on the empirical evidence and clinical experience suggestions for the treatment are provided. ..
  21. Di Nicola M, Tedeschi D, Mazza M, Martinotti G, Harnic D, Catalano V, et al. Behavioural addictions in bipolar disorder patients: role of impulsivity and personality dimensions. J Affect Disord. 2010;125:82-8 pubmed publisher
    ..BAs are more frequent in bipolar patients than in healthy controls and are related to higher impulsivity levels and character immaturity. ..
  22. Schopf J, Rust B. Follow-up and family study of postpartum psychoses. Part IV: Schizophreniform psychoses and brief reactive psychoses: lack of nosological relation to schizophrenia. Eur Arch Psychiatry Clin Neurosci. 1994;244:141-4 pubmed
    ..These findings, together with the different liability to puerperal decompensations, suggest that SCHF and BRP beginning in the postpartum period are nosologically distinct from SCH. ..
  23. Bisol L, Lara D. Low-dose quetiapine for patients with dysregulation of hyperthymic and cyclothymic temperaments. J Psychopharmacol. 2010;24:421-4 pubmed publisher
    ..can be conceived as having bipolar disorder NOS (not otherwise specified), a bipolar spectrum disorder, cyclothymic disorder or cluster B personality traits...
  24. Maremmani I, Perugi G, Pacini M, Akiskal H. Toward a unitary perspective on the bipolar spectrum and substance abuse: opiate addiction as a paradigm. J Affect Disord. 2006;93:1-12 pubmed
    ..We therefore submit that the present conceptualization of the link between bipolar spectrum and addictive disorders has not only heuristic and scientific values, but also an important message for the clinician. ..
  25. Hantouche E, Kochman F, Demonfaucon C, Barrot I, Millet B, Lancrenon S, et al. [Bipolar obsessive-compulsive disorder: confirmation of results of the "ABC-OCD" survey in 2 populations of patient members versus non-members of an association]. Encephale. 2002;28:21-8 pubmed
    ..More in depth analyses are now undertaken in order to investigate the characteristics of "bipolar OCD" by comparison to "non bipolar OCD". ..
  26. Walsh M, Royal A, Barrantes Vidal N, Kwapil T. The association of affective temperaments with impairment and psychopathology in a young adult sample. J Affect Disord. 2012;141:373-81 pubmed publisher
    ..The results support previous research documenting the association of cyclothymic/irritable temperament with bipolar psychopathology and other negative outcomes. ..
  27. Azorin J, Kaladjian A, Adida M, Hantouche E, Hameg A, Lancrenon S, et al. Factors associated with rapid cycling in bipolar I manic patients: findings from a French national study. CNS Spectr. 2008;13:780-7 pubmed
  28. Kesebir S, Vahip S, Akdeniz F, Yuncu Z, Alkan M, Akiskal H. Affective temperaments as measured by TEMPS-A in patients with bipolar I disorder and their first-degree relatives: a controlled study. J Affect Disord. 2005;85:127-33 pubmed
    ..More research is needed on the relevance of cyclothymic and other temperaments to the genetics of bipolar disorders selected by rigorous subtyping along the clinical spectrum of bipolarity. ..
  29. Viederman M. The induction of noninterpreted benevolent transference as a vehicle for change. Am J Psychother. 2011;65:337-54 pubmed
    ..To implement this change the therapist develops a therapeutic stance through specific actions and an attitude that offers the patient a new and benevolent object. ..
  30. Mendlowicz M, Akiskal H, Kelsoe J, Rapaport M, Jean Louis G, Gillin J. Temperament in the clinical differentiation of depressed bipolar and unipolar major depressive patients. J Affect Disord. 2005;84:219-23 pubmed
    ..the unipolar depressive group supports the theoretical assumptions upon which the scale is based, and suggests that it might become a useful tool for clinical and research purposes. ..
  31. Zimmerman M, Galione J, Ruggero C, Chelminski I, Dalrymple K, Young D. Are screening scales for bipolar disorder good enough to be used in clinical practice?. Compr Psychiatry. 2011;52:600-6 pubmed publisher
    ..Low positive predictive value does not support the use of the MDQ or any bipolar disorder screening scale in psychiatric clinical practice. ..
  32. Parker G, McCraw S, Fletcher K. Cyclothymia. Depress Anxiety. 2012;29:487-94 pubmed publisher
  33. de Rezende M, Garcia Leal C, de Figueiredo F, Cavalli R, Spanghero M, Barbieri M, et al. Altered functioning of the HPA axis in depressed postpartum women. J Affect Disord. 2016;193:249-56 pubmed publisher
    ..Thus, improvements in the mental health care of postpartum women are needed. ..
  34. Bowen R, South M, Hawkes J. Mood swings in patients with panic disorder. Can J Psychiatry. 1994;39:91-4 pubmed
    ..Thirty-four percent (n = 37) were classified as suffering from a mood disorder. Of the mood disordered patients, 25 of 37 (68%) (23% of the total) were classified as suffering from bipolar or cyclothymic mood disorder. ..
  35. Rey G, Piguet C, Benders A, Favre S, Eickhoff S, Aubry J, et al. Resting-state functional connectivity of emotion regulation networks in euthymic and non-euthymic bipolar disorder patients. Eur Psychiatry. 2016;34:56-63 pubmed publisher
    ..However, these preliminary findings require replication with larger samples of patients. ..
  36. Pluzhnikov I, Omelchenko M, Krylova E, Kaleda V. [Neuropsychological syndromes of non-psychotic mental disorders of youthful age]. Zh Nevrol Psikhiatr Im S S Korsakova. 2013;113:19-25 pubmed
  37. Freckelton I. Bipolar disorders and the law. J Law Med. 2005;13:153-63 pubmed
    ..It argues in favour of greater judicial and tribunal member education about the disorders. ..
  38. Erermis S, Bellibaş E, Ozbaran B, Büküşoğlu N, Altintoprak E, Bildik T, et al. [Temperamental characteristics of mothers of preschool children with separation anxiety disorder]. Turk Psikiyatri Derg. 2009;20:14-21 pubmed
    ..We think that this study can be used to inform future community based, prospective studies. ..
  39. Reulbach U, Biermann T, Bleich S, Hillemacher T, Kornhuber J, Sperling W. Alcoholism and homicide with respect to the classification systems of Lesch and Cloninger. Alcohol Alcohol. 2007;42:103-7 pubmed
    ..An excessive noradrenergic reaction of anxiety offenders with initial withdrawal is discussed as a possible explanatory model. ..
  40. Bauer M, Beaulieu S, Dunner D, Lafer B, Kupka R. Rapid cycling bipolar disorder--diagnostic concepts. Bipolar Disord. 2008;10:153-62 pubmed publisher
    ..In addition to improving the diagnostic criteria, insight into neurophysiologic mechanisms of mood switching and episode frequency may have important implications for clinical care. ..
  41. Pompili M, Girardi P, Tatarelli R, Iliceto P, De Pisa E, Tondo L, et al. TEMPS-A (Rome): psychometric validation of affective temperaments in clinically well subjects in mid- and south Italy. J Affect Disord. 2008;107:63-75 pubmed
  42. Akiskal H. Demystifying borderline personality: critique of the concept and unorthodox reflections on its natural kinship with the bipolar spectrum. Acta Psychiatr Scand. 2004;110:401-7 pubmed
  43. Perugi G, Del Carlo A, Benvenuti M, Fornaro M, Toni C, Akiskal K, et al. Impulsivity in anxiety disorder patients: is it related to comorbid cyclothymia?. J Affect Disord. 2011;133:600-6 pubmed publisher
    ..For the diagnosis of cyclothymic disorder, we used both the DSM-IV-TR criteria and also a modified threshold for hypomania with a duration of 2 days...
  44. Van Camp L, Oldenburg J, Sabbe B. How self-reflection and self-certainty are related to neurocognitive functioning: an examination of cognitive insight in bipolar disorder. Cogn Neuropsychiatry. 2016;21:130-45 pubmed publisher
    ..In addition, there was no association between cognitive insight and clinical insight. Better neurocognitive functioning was more related to higher levels of self-reflectiveness than to diminished self-certainty. ..
  45. Inoue T, Kohno K, Baba H, Takeshima M, Honma H, Nakai Y, et al. Does temperature or sunshine mediate the effect of latitude on affective temperaments? A study of 5 regions in Japan. J Affect Disord. 2015;172:141-5 pubmed publisher
    ..The findings might not generalize to residents across Japan or other countries. The present findings suggest that latitude affects hyperthymic temperament, and ambient temperature might mediate this effect. ..
  46. Perugi G, Toni C, Passino M, Akiskal K, Kaprinis S, Akiskal H. Bulimia nervosa in atypical depression: the mediating role of cyclothymic temperament. J Affect Disord. 2006;92:91-7 pubmed
    ..The data overall, in particular the cyclothymic reactivity in the absence of differences in BP-I and II, all support the hypothesis that places BN in the "ultra-soft" bipolar realm. ..
  47. Edvardsen J, Torgersen S, Røysamb E, Lygren S, Skre I, Onstad S, et al. Heritability of bipolar spectrum disorders. Unity or heterogeneity?. J Affect Disord. 2008;106:229-40 pubmed
    ..Future genetic and clinical work might consider that all variants of the bipolar spectrum are an expression of one underlying genetic liability. ..
  48. Marangell L, Dennehy E, Wisniewski S, Bauer M, Miyahara S, Allen M, et al. Case-control analyses of the impact of pharmacotherapy on prospectively observed suicide attempts and completed suicides in bipolar disorder: findings from STEP-BD. J Clin Psychiatry. 2008;69:916-22 pubmed
  49. Walsh M, Brown L, Barrantes Vidal N, Kwapil T. The expression of affective temperaments in daily life. J Affect Disord. 2013;145:179-86 pubmed publisher
    ..This was the first study to examine affective temperaments in daily life. The findings offer further validation of the TEMPS-A, as well as the maladaptive nature of the cyclothymic/irritable temperament. ..
  50. Miklowitz D, Chang K. Prevention of bipolar disorder in at-risk children: theoretical assumptions and empirical foundations. Dev Psychopathol. 2008;20:881-97 pubmed publisher
    ..This model attempts to address the multiple interactions of psychosocial and biological risk factors in the onset and course of bipolar disorder. ..
  51. Akiskal H, Pinto O. The evolving bipolar spectrum. Prototypes I, II, III, and IV. Psychiatr Clin North Am. 1999;22:517-34, vii pubmed
  52. Placidi G, Signoretta S, Liguori A, Gervasi R, Maremmani I, Akiskal H. The semi-structured affective temperament interview (TEMPS-I). Reliability and psychometric properties in 1010 14-26-year old students. J Affect Disord. 1998;47:1-10 pubmed
    ..Prospective studies are needed to demonstrate the stability of these traits over time. ..
  53. Manning J, Connor P, Sahai A. The bipolar spectrum: a review of current concepts and implications for the management of depression in primary care. Arch Fam Med. 1998;7:63-71 pubmed
    ..An introduction to the concept of affective temperaments and a brief review of treatment strategies and treatment complications are included. ..