Passing your National Licensing Exam
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Passing your National Licensing Exam
Demystifying Disorders: Cyclothymic Disorder
Unlock the secrets to understanding cyclothymic disorder with hosts Dr. Linton Hutchinson and Eric Twachman as they guide you through the intricacies of this often-overlooked mood disorder. What unique challenges does cyclothymic disorder present for therapists, and how can it be distinguished from similar conditions like bipolar disorders and borderline personality disorder? This episode promises to arm you with critical knowledge, from the importance of duration in diagnosis to the finer points of differentiating symptoms, and why these insights are especially crucial for those preparing for licensure exams.
Join us for a comprehensive exploration of cyclothymic disorder's impact on everyday life and the effective interventions that can lead to improved outcomes. We delve into therapeutic approaches such as Cognitive Behavioral Therapy and interpersonal and social rhythm therapy, as well as medication options like mood stabilizers. Dr. Hutchinson and Eric also discuss the ethical responsibilities therapists must uphold, including informed consent and maintaining professional boundaries. This episode is your resource for empowering clients with cyclothymic disorder to achieve a more balanced and fulfilling life.
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Welcome to our podcast Exploring the DSM, where we examine the fascinating world of mental health disorders. I'm your co-host, dr Linton Hutchinson, joined by my colleague, eric Twachman. Today we'll discuss cyclothymic disorder, a lesser-known but equally important mood disorder that you might encounter on your licensing exam.
ERIC:Hello everyone, I am thrilled to bits to join Dr Hutchinson to clarify this frequently misunderstood condition. As therapists and test takers, it's important to understand how to treat cyclothymic disorder effectively.
LINTON:To begin, let's examine the diagnostic criteria for cyclothymic disorder as outlined in the DSM-5-TR. In fact, the DSM-5-TR is the version that the exam will be using, so would you like to?
ERIC:get us started, I would indeed, to be diagnosed with cyclothalamic disorder, someone must have experienced several periods of hypomanic symptoms and periods of depressive symptoms that don't meet the full criteria for a hypomanic or major depressive episode. The symptoms must be present for at least two years for adults, but only one year in children or adolescents. And if you're wondering, the answer is yes, duration is important when you're regarding answering the questions on the licensure exam.
LINTON:You're right on the money, on that, as or maybe if we had only invested in Bitcoin back in 2017, we'd be sitting on a gold mine right now.
ERIC:Bitcoin back in 2017, we'd be sitting on a gold mine right now, well, maybe a crypto mine, but anyway, if we had, the chances are, we'd be sitting in Aruba somewhere instead of here creating podcasts to help therapists pass their licensure exam. And isn't that better than just lazing about on a beach with your yacht, right off the?
LINTON:Yeah, I guess so. Absolutely, you could take that to the bank, eric. But before we go on, I've always had questions about timeframes. Why are the timeframes for criteria for children less than adults?
ERIC:Well, there are two reasons. In children, early intervention is crucial, so shorter time frames allow quicker identification and treatment, and children's symptoms can severely impact their development and learning. So it's best to catch it sooner rather than later.
LINTON:Yeah, that makes sense. Well, back to cyclothymic disorder criteria. It's important to note that during the two-year period, the individual can't have been without hypermanic or depressive symptoms for more than two months at a time. The symptoms must also cause clinically significant distress or impairment in rows or other important areas of functioning. So what the Dickens is rows, you ask? I was just going to ask. I know you were, but it's an easy way to remember areas of functioning relational, occupational, social and educational activity.
ERIC:Another criterion is that the symptoms cannot be better explained by another mental disorder, such as bipolar 1 or 2, major depressive or schizoaffective disorder. Also, if the symptoms are attributable to the physiological effects of a substance or another medical condition, they don't count.
LINTON:Well, now that we've covered the diagnostic criteria, let's discuss the differentials for cyclothymic disorder. It's essential to distinguish this condition from other mood disorders and related conditions.
ERIC:That's right, and one of the main differentials is bipolar I or II disorder. In cyclothymic disorder, the hypomanic and depressive episodes do not meet the full criteria to be considered the full hypomanic or depressive episodes, whereas in bipolar one or two disorders the individual experiences the full-blown manic and hypomanic episodes and major depressive episodes.
LINTON:So another differential to consider is borderline personality disorder. While both conditions involve mood instability, borderline personality disorder is characterized by more severe impairment in interpersonal relationships, self-image and impulsivity.
ERIC:Excuse me, it's also important to rule out substance or medication-induced bipolar and related disorder and bipolar and related disorder due to another medical condition. In those cases, the mood symptoms are attributable to the physiological effects of the substance or the medical condition.
LINTON:Okay, just so that you'll be able to recognize that it's a cyclothymic disorder. Let's move on to some key points or key terms associated with cyclothymic disorder. Understanding these terms will help you better conceptualize and communicate about this condition.
ERIC:That's right, and the first term is hypomanic symptoms. These are symptoms of elevated or irritable mood, increased energy and activity and other features that are similar to a manic episode, but less severe and not meeting the full criteria for a hypomanic episode. It's important to note the difference between symptoms and episode.
LINTON:Why don't you elucidate on that a bit Well?
ERIC:a symptom, the full episode is made up of a bunch of symptoms. So if you need six symptoms to be counted to have an episode, that's one thing. If you only have two symptoms, that's the part of the hypomanic event that you will have experienced as part of your cyclothymic disorder.
LINTON:Okay, well, next we have depressive symptoms. These include feelings of sadness, emptiness or hopelessness, decreased energy and activity and other features that are similar to major depressive episodes, but less severe and not meeting the full criteria for a major depressive episode. And I think, on all of these, it seems like the things that you can use to differentiate is that less severe and not meeting the full criteria, right?
ERIC:Ez, that's right, that's. The major calling card of cyclothymic disorder is that it doesn't reach that full swing up or down. And another important term is mood lability. This refers to frequent, rapid and often unpredictable shifts in mood, which is a hallmark feature of cyclothymic disorder.
LINTON:Oh, now let's look at the development and course of cyclothymic disorder. Understanding how this condition typically progresses can help you provide more targeted interventions.
ERIC:It often begins in adolescence or early adulthood, although it can start at any age, which is why we talked about the. You know how long it lasts in children. The exact cause is unknown, but there is likely a genetic component, as the condition tends to run in families.
LINTON:Here's a question what's the age range that considered a child Anything?
ERIC:under 12 as a child and between 12 and 18 as an adolescent.
LINTON:Well, the course of cyclothymic disorder is typically chronic, with periods of hypomanic and depressive symptoms occurring over many years. While some clients may experience a spontaneous remission, most will continue to experience mood instability throughout their entire lives.
ERIC:Yes, and it's important to note that clients with cyclothymic disorder are at an increased risk of developing bipolar 1 or 2 disorder. In fact, studies suggested up to one-third of clients with cyclothymic disorder will go on to develop a more severe bipolar disorder.
LINTON:I wonder what triggers that. So it goes from one to the other.
ERIC:You'd think there'd be more research about that, since it's up to a third of people doing it, but they just know that it happens, which, when you think about it, makes sense. If you're going through the small ups and downs and you're not treated and it's not successful, then it seems like you might be at a greater risk for having those moods stretched out either higher or lower so it's sort of like a record, where you put a needle on it and it just carves those grooves deeper and deeper there you go.
ERIC:If only people knew what a record was or why you would put a needle on it. That's right. What are you shooting up? A CD for man.
LINTON:But what about those characteristics that are commonly seen in clients with this condition but are not part of the diagnostic criteria? You know, the associated features of cyclothymic disorder.
ERIC:That's right. Well, one of the common associated features is impairment in social and occupational functioning Remember, Rose, that you just talked about Right Another is an increased risk of substance abuse. Individuals with cyclothymic disorders may turn to alcohol and drugs as a way to cope with their mood instability and associated distress. Like you know, self-medicating and sleep disturbances are also common. They may experience insomnia during the hypomanic periods and hypersomnia during the depressive periods, which can further exacerbate their mood symptoms.
LINTON:Thanks, ez, and for the licensing exam, you need to be up to speed on comorbidity. Comorbidity refers to the presence of one or more additional disorders co-occurring with a primary disorder, which in this case, would be.
ERIC:The common ones associated with psychosomatic disorder, and one of the most frequent is anxiety disorder. So you have anxiety because your mood is out of control. Individuals with cyclothymic disorder may experience excessive worry, panic attacks or other anxiety symptoms in addition to and because of their mood instability.
LINTON:Right. So substance Substant Use Disorder is another common comorbidity. As we mentioned earlier, the use of alcohol or drugs can worsen mood symptoms and make treatment way more challenging you're having to deal with that instead of the mood instability.
ERIC:Also, attention deficit hyperactivity disorder. Adhd is also frequently seen in clients with cyclothymic disorder. The impulsivity and distractibility associated with ADHD can compound the difficulties in functioning caused by mood instability.
LINTON:Okay, now let's turn our attention to evidence-based treatment interventions for cyclothymic disorder. This is something you would need to know for your licensing exam. Absolutely, that's right.
ERIC:What would be some of the most effective approaches, eric Well one of the primary treatment options is psychotherapy, which is why it's on the test. Treatment options is psychotherapy, which is why it's on the test. Cognitive behavioral therapy, or CBT, has been shown to be particularly effective in helping clients with cyclothymic disorder manage their mood symptoms and improve their coping skills and if that is an option on your licensing exam, you might want to consider interpersonal and social rhythm therapy IPSRT. You made that up, didn't?
LINTON:you, I didn't make that up. No, ok, real thing. So You've never heard of it. I never have. No, it's an integrated approach that recognizes that both interpersonal and relationships and daily routines play critical roles in emotional stability and mental health. The objective is to help clients understand how disruptions in their social relationships and daily routines can trigger mood episodes, while teaching them practical strategies to maintain stability and improve overall functioning.
ERIC:Well, that really makes sense, doesn't it? Yeah, it does. Well, that's a new one. At least, if I run across it. On a question on a licensure exam, I'll know what they're talking about, right. A question on the licensure exam? I'll know what they're talking about, Right. Medication may also be used in conjunction with psychotherapy, because mood stabilizers can help produce the frequency and intensity of hypomanic and depressive symptoms.
LINTON:Okay, now you need to remember it's not a like one size fits all. It's important to note that the treatment approach should be individualized, based on the specific needs and preferences of your client. A collaborative and flexible approach, with close monitoring of symptoms and side effects is really essential for dealing with this disorder. Well, right you are.
ERIC:Another area to be aware of, and really related to what you just said, is the ethical realm, because I can assure you you'll have more ethical problems to deal with on your exam than you will ever see in private practice. It's crucial that you consider the ethical implications of working with these clients, and one key concern is informed consent. You have to ensure that your clients fully understand the nature of their condition, the proposed treatment plan and any potential risks or side effects. This involves providing clear and comprehensive psychoeducation and allowing ample opportunity for questions and discussions. Another ethical consideration is maintaining appropriate boundaries, because it turns out that individuals with cyclothymic disorder may experience intense and fluctuation in their mood which makes it hard for them to set reasonable boundaries, and that they have that boundary crossing behavior. And as therapists, you have to be vigilant in maintaining professional boundaries while still providing a warm and supportive therapeutic relationship.
LINTON:Okay, and you know, obviously confidentiality is a critical ethical concern. You've got to protect your client's privacy and only share information with others when necessary and with the client's explicit consent.
ERIC:That's right. So now let's see if we can apply what we've learned by presenting a case study. Linton, would you like to present a lengthy and complicated, hard-to-understand case of cyclothymic disorder? Yes, I would, ed, as I hoped you would.
LINTON:Yes, I would, but well, I think we can skip that one for now, as it's getting really closer to lunchtime right now for me.
ERIC:well, now that you mentioned that it is so, I suppose that means you're off the publics to get some sushi with a lot of wasabi, is that it? That's it? And now you're cooking sushi with a lot of wasabi, is that it? That's it? And now you're cooking.
LINTON:Cooked sushi. Come on, surely you just Well you wouldn't want to use raw rice to wrap up sushi. Goodness, would you Well? Speaking of which, let's wrap up today's podcast by reviewing some of the key takeaways about cyclothymic disorder.
ERIC:There you go. Well, first, it's characterized by frequent and persistent shifts between hypomanic and depressive symptoms, lasting for at least two years in adults or one year in children or adolescents.
LINTON:Second, recognizing differentials is critical as it can be mistaken for other mood or personality disorders. A thorough assessment and understanding of the diagnostic criteria is essential. That's right.
ERIC:Third, remember ROSE. It's associated with significant impairment in relational, occupational, social and educational functioning, as well as an increased risk of substance abuse and sleep disturbances.
LINTON:Fourth, interventions for psychothymic disorder include psychotherapy, particularly CBT, interpersonal and social rhythm therapy and medications such as mood stabilizers.
ERIC:Finally, as therapists, you need to be mindful of the ethical considerations when working with these clients, including informed consent, maintaining appropriate boundaries and protecting their confidentiality.
LINTON:Okay, well, we hope the podcast has been informative and helpful in deepening your understanding of cyclothymic disorder for your practice and for your licensing exam. Disorder for your practice and for your licensing exam. Remember, as therapists, your role is to provide support, guidance and effective interventions to help your clients manage and eliminate the symptoms that lead to a more balanced and fulfilling life.
ERIC:Thank you for joining us today and until next time, keep learning, keep growing, keep making a difference in the lives of the people around you. And joining us today and until next time, keep learning, keep growing, keep making a difference in the lives of the people around you and those you serve. And remember it's in there, you got it.
