Cyclothymic Disorder: A Cognitive Behavioral Case Formulation
DOI:
https://doi.org/10.12974/2313-1047.2024.11.03Keywords:
Cyclothymia, Bipolar disorders, Hypomania, Mild depression, Cyclothymic disorder, CBT, WBT Cognitive behavior therapy, Well-Being Therapy, Case formulation, Case conceptualizationAbstract
Cyclothymic disorder is recognized as a mild, less severe and subthreshold form of bipolar disorder. The complexity of the disorder leads to difficulties in diagnosis and treatment. A dimensional approach to diagnosis may help identify the goals, and the planning of the psychological intervention. In this paper, a case of cyclothymic disorder is presented, focusing on the cognitive-behavioral conceptualization of the case and its treatment planning.
References
Akiskal, H. S., Djenderedjian, A. M., Rosenthal, R. H., & Khani, M. K. (1977). Cyclothymic disorder: validating criteria for inclusion in the bipolar affective group. The American journal of psychiatry, 134(11), 1227-1233. https://doi.org/10.1176/ajp.134.11.1227
Akiskal, H., Djenderedjian, A., Rosenthal, R., & Khani, M. (1977). Cyclothymic disorder: Validating criteria for inclusion in the bipolar affective group. The American Journal of Psychiatry, 134(11), 1227-1233. https://doi.org/10.1176/ajp.134.11.1227
Aldinger, F., & Schulze, T. G. (2017). Environmental factors, life events, and trauma in the course of bipolar disorder. Psychiatry and clinical neurosciences, 71(1), 6-17. https://doi.org/10.1111/pcn.12433
Alloy, L. B., Abramson, L. Y., Urosevic, S., Walshaw, P. D., Nusslock, R., & Neeren, A. M. (2005). The psychosocial context of bipolar disorder: environmental, cognitive, and developmental risk factors. Clinical psychology review, 25(8), 1043-1075. https://doi.org/10.1016/j.cpr.2005.06.006
Alnaes, R., & Torgensen, S. (1989). Personality and personality disorders among patients with major depression in combination with dysthymic or cyclothymic disorders. Acta Psychiatrica Scandinavica, 79, 363-369. https://doi.org/10.1111/j.1600-0447.1989.tb10271.x
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Angst, J., Gamma, A., Benazzi, F., Ajdacic, V., Eich, D., & Rössler, W. (2003). Toward a redefinition of subthreshold bipolarity: Epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. Journal of Affective Disorders, 73(1-2), 133-146. https://doi.org/10.1016/S0165-0327(02)00322-1
Angst, J., Gamma, A., Neuenschwander, M., Ajdacic-Gross, V., Eich, D., Rossler, W., et al. (2005). Prevalence of mental disorders in the Zurich Cohort Study: A twenty year prospective study. Epidemiologia e Psichiatria Sociale, 14(2), 68-76. https://doi.org/10.1017/S1121189X00006278
Aston, R. (2009). A literature review exploring the efficacy of case formulations in clinical practice. What are the themes and pertinent issues?. The Cognitive Behaviour Therapist, 2(2), 63-74. https://doi.org/10.1017/S1754470X09000178
Avasthi, A., Sarkar, S., & Grover, S. (2014). Approaches to psychiatric nosology: A viewpoint. Indian journal of psychiatry, 56(3), 301-304. https://doi.org/10.4103/0019-5545.120560
Beck, A. T. (1979). Cognitive therapy and the emotional disorders. Penguin.
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York: Guilford Press.
Beck, J. S. (2020). Cognitive behavior therapy: Basics and beyond. Guilford Publications.
Bieling, P. J., & Kuyken, W. (2003). Is cognitive case formulation science or science fiction?. Clinical Psychology: Science and Practice, 10(1), 52. https://doi.org/10.1093/clipsy.10.1.52
Brieger, P., & Marneros, A. (1997). Dysthymia and cyclothymia: historical origins and contemporary development. Journal of Affective Disorders, 45(3), 117-126. https://doi.org/10.1016/S0165-0327(97)00053-0
Brieger, P., & Marneros, A. (1997). Dysthymia and cyclothymia: historical origins and contemporary development. Journal of Affective Disorders, 45(3), 117-126. https://doi.org/10.1016/S0165-0327(97)00053-0
Brus, M. J., Solanto, M. V., & Goldberg, J. F. (2014). Adult ADHD vs. bipolar disorder in the DSM-5 era: a challenging differentiation for clinicians. Journal of Psychiatric Practice®, 20(6), 428-437. https://doi.org/10.1097/01.pra.0000456591.20622.9e
Depue, R. A., Krauss, S., Spoont, M. R., & Arbisi, P. (1989). General behavior inventory identification of unipolar and bipolar affective conditions in a nonclinical university population. Journal of Abnormal Psychology, 98(2), 117. https://doi.org/10.1037/0021-843X.98.2.117
Dudley, R., Ingham, B., Sowerby, K., & Freeston, M. (2015). The utility of case formulation in treatment decision making; the effect of experience and expertise. Journal of Behavior Therapy and Experimental Psychiatry, 48, 66-74. https://doi.org/10.1016/j.jbtep.2015.01.009
Edvardsen, J., Torgersen, S., Røysamb, E., Lygren, S., Skre, I., Onstad, S., & Øien, P. A. (2008). Heritability of bipolar spectrum disorders. Unity or heterogeneity?. Journal of affective disorders, 106(3), 229-240. https://doi.org/10.1016/j.jad.2007.07.001
Ehlers, C. L., Frank, E., & Kupfer, D. J. (1988). Social zeitgebers and biological rhythms: a unified approach to understanding the etiology of depression. Archives of general psychiatry, 45(10), 948-952. https://doi.org/10.1001/archpsyc.1988.01800340076012
Ellis, A. (1957). Rational psychotherapy and individual psychology. Journal of individual psychology, 13(1), 38.
Emmelkamp, P. M. (1974). Self-observation versus flooding in the treatment of agoraphobia. Behaviour Research and Therapy, 12(3), 229-237. https://doi.org/10.1016/0005-7967(74)90119-3
Evans, John Mellor-Clark, Frank Margison, Michael Barkham, Kerry Audin, Janice Connell, Graeme McGrath, C. (2000). CORE: clinical outcomes in routine evaluation. Journal of mental health, 9(3), 247-255. https://doi.org/10.1080/713680250
Faravelli, C., & Incerpi, G. (1985). Epidemiology of affective disorders in Florence: preliminary results. Acta Psychiatrica Scandinavica, 72(4), 331-333. https://doi.org/10.1111/j.1600-0447.1985.tb02617.x
Fava, G. A. (1999). Well-being therapy: Conceptual and technical issues. Psychotherapy and psychosomatics, 68(4), 171-179. https://doi.org/10.1159/000012329
Findling, R., Youngstrom, E., McNamara, N., Stansbrey, R., Demeter, C., Bedoya, D., et al. (2005). Early symptoms of mania and the role of parental risk. Bipolar Disorders, 7 (6), 623-634. https://doi.org/10.1111/j.1399-5618.2005.00260.x
Fossati, A., Borroni, S., Somma, A., Krueger, R. F., & Markon, K. E. (2021). PID-5. Manuale e guida all'uso clinico della versione italiana. Milano: Raffaello Cortina Editore.
Giromini, L., Ales, F., de Campora, G., Zennaro, A., & Pignolo, C. (2017). Developing age and gender adjusted normative reference values for the Difficulties in Emotion Regulation Scale (DERS). Journal of Psychopathology and Behavioral Assessment, 39, 705-714. https://doi.org/10.1007/s10862-017-9611-0
Goodman, D. A. (1996). 20-year chronobiologic study of a middle-aged cyclothymic male subject. Progress in neuro-psychopharmacology & biological psychiatry, 20(8), 1325-1339. https://doi.org/10.1016/S0278-5846(96)00129-7
Grandin, L. D., Alloy, L. B., & Abramson, L. Y. (2006). The social zeitgeber theory, circadian rhythms, and mood disorders: review and evaluation. Clinical psychology review, 26(6), 679-694. https://doi.org/10.1016/j.cpr.2006.07.001
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of psychopathology and behavioral assessment, 26(1), 41-54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Hantouche, E., & Perugi, G. (2012). Should cyclothymia be considered as a specific and distinct bipolar disorder?. Neuropsychiatry, 2(5), 407. https://doi.org/10.2217/npy.12.45
Jacobsen, F. M. (1993). Low-dose valproate: A new treatment for cyclothymia, mild rapid cycling disorders, and premenstrual syndrome. Journal of Clinical Psychiatry, 54(6), 229-234.
Kessler, R., Avenevoli, S., Green, J., Gruber, M., Guyer, M., He, Y., et al. (2009). National Comorbidity Survey replication adolescent supplement (NCS-a): III. Concordance of DSM-IV/CIDI diagnoses with clinical reassessments. Journal of the American Academy of Child and Adolescent Psychiatry, 48(4), 386-399. https://doi.org/10.1097/CHI.0b013e31819a1cbc
Krueger, R. F., Derringer, J., Markon, K. E., Watson, D., & Skodol, A. E. (2012). Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychological medicine, 42(9), 1879-1890. https://doi.org/10.1017/S0033291711002674
Mayo Clinic Staff, Cyclothymia: symptoms and causes (december 2022), https://www.mayoclinic.org/diseases-conditions/cyclothymia/symptoms-causes/syc-20371275
Merikangas, K. R., Jin, R., He, J. P., Kessler, R. C., Lee, S., Sampson, N. A., & Zarkov, Z. (2011). Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Archives of general psychiatry, 68(3), 241-251. https://doi.org/10.1001/archgenpsychiatry.2011.12
Moini J., LoGalbo A., Ahangari R (2024) Chapter 17 - Affective disorders in Foundations of the Mind, Brain, and Behavioral Relationships, Pages 283-303, Academic Press, ISBN 9780323959759. https://doi.org/10.1016/B978-0-323-95975-9.00006-8
Owen, G. (2023). What is formulation in psychiatry?. Psychological medicine, 53(5), 1700-1707. https://doi.org/10.1017/S0033291723000016
Palmieri, G., Evans, C., Hansen, V., Brancaleoni, G., Ferrari, S., Porcelli, P., & Rigatelli, M. (2009). Validation of the Italian version of the clinical outcomes in routine evaluation outcome measure (CORE‐OM). Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 16(5), 444-449. https://doi.org/10.1002/cpp.646
Paris, J. (2018). Differential diagnosis of borderline personality disorder. Psychiatr Clin North Am, 41(4), 575-582. https://doi.org/10.1016/j.psc.2018.07.001
Parker, G. (2011). Clinical differentiation of bipolar II disorder from personality-based "emotional dysregulation" conditions. Journal of affective disorders, 133(1-2), 16-21. https://doi.org/10.1016/j.jad.2010.10.015
Perugi, G., & Akiskal, H. S. (2002). The soft bipolar spectrum redefined: focus on the cyclothymic, anxious-sensitive, impulse-dyscontrol, and binge-eating connection in bipolar II and related conditions. Psychiatric Clinics, 25(4), 713-737. https://doi.org/10.1016/S0193-953X(02)00023-0
Perugi, G., Hantouche, E., Vannucchi, G., & Pinto, O. (2015). Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder. Journal of affective disorders, 183, 119-133. https://doi.org/10.1016/j.jad.2015.05.004
Perugi, G., Hantouchec, E., & Vannucchia, G. (2017). Diagnosis and treatment of cyclothymia: the "primacy" of temperament. Current neuropharmacology, 15(3), 372-379. https://doi.org/10.2174/1570159X14666160616120157
Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic advances in psychopharmacology, 8(9), 251-269. https://doi.org/10.1177/2045125318769235
Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of personality and social psychology, 57(6), 1069. https://doi.org/10.1037/0022-3514.57.6.1069
Sighinolfi, C., Pala, A. N., Chiri, L. R., Marchetti, I., & Sica, C. (2010). Difficulties in emotion regulation scale (DERS): Traduzione e adattamento italiano. Psicoterapia cognitiva e comportamentale.
Totterdell, P., & Kellett, S. (2008). Restructuring mood in cyclothymia using cognitive behavior therapy: an intensive time‐sampling study. Journal of clinical psychology, 64(4), 501-518. https://doi.org/10.1002/jclp.20444
Van Meter, A. R., Youngstrom, E. A., & Findling, R. L. (2012). Cyclothymic disorder: a critical review. Clinical Psychology Review, 32(4), 229-243. https://doi.org/10.1016/j.cpr.2012.02.001
Van Meter, A., Youngstrom, E. A., Youngstrom, J. K., Feeny, N. C., & Findling, R. L. (2011). Examining the validity of cyclothymic disorder in a youth sample. Journal of Affective Disorders, 132(1-2), 55-63. https://doi.org/10.1016/j.jad.2011.02.004
Weissman, M. M., & Myers, J. K. (1978). Affective disorders in a US urban community: the use of research diagnostic criteria in an epidemiological survey. Archives of General Psychiatry, 35(11), 1304-1311. https://doi.org/10.1001/archpsyc.1978.01770350030002
Youngstrom, E., Van Meter, A., & Algorta, G. P. (2010). The bipolar spectrum: myth or reality?. Current Psychiatry Reports, 12, 479-489. https://doi.org/10.1007/s11920-010-0153-3
