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Cyclothymia — MRCPsych Paper B MCQ

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ModerateMood DisordersCyclothymiaMRCPsych Paper B

A 22-year-old woman describes frequent fluctuations in mood over the preceding 2 years. During low periods she has reduced energy, poor concentration and diminished interest. At other times she has elevated mood, increased energy, reduced need for sleep and increased sociability. These symptoms have been present for much of the 2-year period, with no symptom-free interval longer than 2 months. No period has met the diagnostic criteria for a depressive, hypomanic or manic episode. There is no psychosis, substance use or medical cause. Which is the most likely diagnosis?

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Correct answer: D — Cyclothymic disorder

The correct answer is D, cyclothymic disorder. The key features are chronic, frequent fluctuations between depressive and hypomanic symptoms over at least 2 years, without any period reaching the threshold for a depressive, hypomanic or manic episode. The absence of prolonged symptom-free intervals further supports cyclothymia. Bipolar I disorder requires a manic episode. Bipolar II disorder requires both a hypomanic episode and a major depressive episode, neither of which has occurred. Major depressive disorder cannot account for the recurrent elevated symptoms, while persistent depressive disorder is characterised by chronic depressive symptoms rather than alternating subthreshold depressive and hypomanic symptoms.

Reference: NHS. Cyclothymia, Symptoms of cyclothymia section. Page last reviewed 9 October 2023. https://www.nhs.uk/mental-health/conditions/cyclothymia/?mobileformat=false&muraadminpreview=