Chapter

Dysthymia, cyclothymia, and hyperthymia

Hagop S. Akiskal

in New Oxford Textbook of Psychiatry

Second edition

Published on behalf of Oxford University Press

Published in print February 2012 | ISBN: 9780199696758
Published online October 2012 | e-ISBN: 9780191743221 | DOI: http://dx.doi.org/10.1093/med/9780199696758.003.0091
Dysthymia, cyclothymia, and hyperthymia

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Long before psychiatry moved to the outpatient arena in the latter part of the twentieth century, psychiatrists had observed milder mood disturbances among the kin of patients hospitalized for endogenous or psychotic depressions or mania. Some were described as sullen, morose, or otherwise moody, without discrete episodes; others reported self-limited episodes, but often went untreated. With the advent of modern treatments, practitioners are being increasingly consulted by patients presenting with attenuated affective disturbances. Although the relationship of these ambulatory mood states and more classical severe affective disorders has not been resolved, there is emerging sleep electroencephalography (EEG) and familial-genetic evidence that a continuum exists between them. Along the same lines, studies conducted in the United States and Germany into what were once described as ‘neurotic’ depressions have revealed a progression to more endogenous, psychotic, or bipolar switching. For these and related reasons, current official classification systems such as the ICD-10 and DSM-IV, have dropped the neurotic-endogenous dichotomy. Sceptics would perhaps argue that the new categorization of depressive disorders into dysthymic and major subtypes is not much of an improvement. Nonetheless, the new terminology has drawn attention to a large universe of human suffering that had been neglected in the past, and the conceptualization of dysthymia as a variant of mood disorder has had a far-reaching impact on diagnostic and therapeutic habits of clinicians worldwide. The emerging concept of the bipolar spectrum, which does include manic, cyclic depressive (bipolar II), cyclothymic, hyperthymic and related conditions, is beginning to have a similar impact on practice. The subthreshold mood disorders are not only in continuum with more pathological mood states, but they also provide a bridge with normal affective conditions. In this context, temperament, as a construct encompassing affective personalities, is currently enjoying a renaissance as one of the possible substrates for the origin of mood disorders. Temperament classically refers to an adaptive mixture of traits which, in the extreme, can lead to illness or modify the expression of superimposed affective states. The subthreshold conditions covered in this chapter represent the extreme expressions of these temperaments. A new self- administered instrument, the TEMPS-A, now validated in 10 language versions, is being used internationally to measure the classical constructs of depressive, cyclothymic, hyperthymic, and irritable, as well as anxious temperaments.

Chapter.  12872 words.  Illustrated.

Subjects: Psychiatry

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