Clinical management

The proper pharmacological treatment for cyclothymic excesses is low doses of lithium (600-900 mg/day) or valproate (500-750 mg/day). These are based on open systematic studies/8 9910°) There is some data from a controlled trial with lithium about the prevention of depression in cyclothymic individuals. (101) Similarly controlled data exist for a related construct—'labile personality'.(.1.02) Generally speaking, patients with cyclothymia object to the 'overcontrol' that may come from mood stabilizers, and this is particularly the case with lithium.

Patients should be taught how to live with the extremes of their temperamental inclinations, and to seek professions where they determine the hours that they work.(l03) Marriage to a rich older spouse might sustain them for a while, but eventually interpersonal friction and sexual jealousy terminate such marriages. The artistically inclined among them should be encouraged to live in those parts of a city inhabited by artists and other intellectuals, where temperamental excesses are better tolerated. Ultimately, the decision to use mood stabilizers in such individuals should balance any benefits from decreased mood instability against the social and creative spurts that the cyclothymic disposition can bring to them. Their clinical management represents a challenging task for the psychiatrist who is willing to learn about the lifestyle of these individuals, not prejudging them by the more mundane norms of society. But the psychiatrist should also be there to help them during the multiple crises of their lives. Low-dose sedating neuroleptics, both classical (e.g. thioridazine 50 mg at bedtime) and atypical (e.g. olanzapine 2.5 mg at bedtime) may temporarily help to diffuse such crises. It is only when a clinician has earned therapeutic alliance with a patient that the latter will permit limit-setting on his or her extravagant or outrageous behaviour. Parents might also benefit from some counselling, because the dilettante life of their children is often a source of great sorrow for them. Rarely, parents or spouses are rewarded by great artistic or intellectual achievement, which does not necessarily reduce the pain that the volatile cyclothymes bring to their loved ones.

Kurt Schneider(20) admonished the kin of labile individuals (who might approximate the contemporary concept of borderline personality disorder) 'on their bad days...to keep out of their way as far as possible'. Cyclothymes with some insight into their own temperament would give the same advice to their loved ones. A cautious trial of anticonvulsants will often prove effective in those distressed enough by their behaviour to comply with such treatment.

Funny Wiring Autism

Funny Wiring Autism

Autism is a developmental disorder that manifests itself in early childhood and affects the functioning of the brain, primarily in the areas of social interaction and communication. Children with autism look like other children but do not play or behave like other children. They must struggle daily to cope and connect with the world around them.

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