Comparison of Emotional Dysregulation Features in Cyclothymia and Adult ADHD

Background and Objectives: Emotional dysregulation is central to the problem of the overlap between attention-deficit/hyperactivity disorder (ADHD) and cyclothymia. The aim of the study was to evaluate comorbidity rates between ADHD and cyclothymic disorder and to explore demographic and clinical differences among the groups, focusing on affective temperament and emotional dysregulation. Materials and Methods: One hundred sixty-five outpatients attending the Second Psychiatry Unit at the Santa Chiara University Hospital (Pisa) were consecutively recruited: 80 were diagnosed with ADHD, 60 with cyclothymic disorder, and 25 with both conditions. Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-M) and the 40-item version of Reactivity, Intensity, Polarity, and Stability questionnaire (RI-PoSt-40) were administered. Results: Cyclothymic patients were more frequently female and older with respect to the ADHD groups. Both comorbid and non-comorbid ADHD patients showed significantly lower educational attainment and more frequently had substance use disorders. Panic disorder was common in non-comorbid cyclothymic patients, who showed significantly higher rates of familial panic disorder, major depressive disorder and suicide attempts in comparison with patients only diagnosed with ADHD. Cyclothymic patients without ADHD were also characterized by fewer hyperthymic temperamental traits, higher depressive and anxious dispositions, and a greater negative emotionality. No significant differences among groups were observed for cyclothymic temperament and overall negative emotional dysregulation, but comorbid patients with both conditions scored the highest in these subscales. This group also showed significantly higher affective instability with respect to ADHD patients without cyclothymia and was less frequently diagnosed with bipolar disorder type II than patients from both the other groups. Conclusions: ADHD and cyclothymia often co-occur and show similar levels of emotional dysregulation. However, cyclothymic patients may be more prone to negative emotionality in clinical settings. Subjects with “sunny” cyclothymic features might escape the attention of clinicians unless ADHD is present.

The Bipolar Spectrum

The chapter discusses disorders in the bipolar spectrum. Bipolar disorders (BDs) and cyclothymic disorder are marked by mania, a state of abnormally high energy and activity coupled with persistently elevated, expansive, or irritable mood. After an overview of these disorders, their developmental features, and the main risk factors identified in the epidemiological literature, the chapter critically reviews existing evolutionary models and suggests new directions for research. The final section applies the criteria developed earlier in the book to classify the disorders within the fast-slow-defense (FSD) model and identify functionally distinct subtypes. The author proposes to tentatively distinguish between two subtypes of BDs: a high-frequency fast spectrum subtype (F-BD) with strong links to schizophrenia and a low-frequency slow spectrum subtype (S-BD) marked by higher comorbidity with autism.

Drug-induced parkinsonism: A case report

Drug-induced parkinsonism is defined as the appearance of parkinsonism on treatment with pharmaceutical agents. Symptoms typically manifest within a few days, and 90% of cases emerge within 3 months. The patient was a 68-year-old white man with a past psychiatric history significant for bipolar I versus cyclothymic disorder. The patient presented with pressured speech, flight of ideas, distractibility, delusions, and disorganized thinking. He was started on risperidone and, due to a subclinical response, was cross-tapered from risperidone to olanzapine, and divalproex was started. The patient was then given paliperidone 234 mg long-acting injection (LAI) and a second loading dose of 156 mg 1 week later. The patient's cognitive and functional status subsequently declined, all neuroleptics were discontinued, and he was diagnosed with drug-induced parkinsonism. After a complicated hospital course the patient died approximately 5 months after the administration of paliperidone LAI. Although there are several confounding factors, due to the temporal relationship of events it is likely that paliperidone LAI was a contributing factor for the development of severe parkinsonism. Practitioners should be cognizant of the potential long-term consequences of paliperidone LAI.

Mood Disorders

In this chapter the topics that are reviewed include major depressive disorder, persistent depressive disorder (dysthymia), unspecified depressive disorder, bipolar I disorder, bipolar II disorder, cyclothymic disorder and unspecified bipolar disorder