Cyclothymic disorder and labileirritable variants History

Kraepelin^9) included the cyclothymic disposition as one of the temperamental foundations from which manic-depressive illness arose. Kretschmer(30) went one step further and proposed that this constitution represented the core characteristic of the illness: some patients were more likely to oscillate in a sad direction, while others would more readily resonate with cheerful situations; these were merely viewed as variations in the cyclothymic oscillation between these two extremes. Kurt Schneider,(20) who did not endorse the concept of 'temperament', instead referred to 'labile psychopaths' whose moods constantly changed in a dysphoric direction, and who bore no relationship to patients with manic depression. To confuse matters further, Schneider used the term 'cyclothymia' as a synonym for all manic depressive illness, from the mildest to the most severe psychotic forms. Today, 'cyclothymia' is still sometimes used in this broader sense in Germanophone psychiatry. But in much of the rest of the world, cyclothymia (short for 'cyclothymic disorder') is reserved for a form of extreme temperament related to bipolar disorder.

Cyclothymia, which in ICD-9 and DSM-II was subsumed under the affective personalities, was first introduced into DSM-III and DSM-IV and subsequently into ICD-10 as a form of attenuated chronic mood disorder. The diagnosis is not commonly made in clinical practice, because it is almost always seen when a patient presents with major depressive episodes, warranting the designation of 'bipolar II'. (8.,18> None the less, the construct is of great theoretical and practical significance as one of the possible substrates for major mood disorders. Moreover, it could shed light on social and occupational maladjustment and/or addictive behaviours that could otherwise be misattributed to personality disorder.

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