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.However, in the latter, mood swings are almost alwaysdysphoric in nature.The mood swings of cyclothymes are biphasic and gobeyond mere alternation between dysphoric and buoyant moods, involvingeutonia alternating with anergic periods, people-seeking with self-absorption,sharpened thinking with mental paralysis, laconic speech with talkativeness;and low self-confidence with overconfidence.The mood swings of cyclothymes can lead to major social maladjust-ments.At one time or another, labile angry or irritable moods are observedin virtually all [34].However, these are not limited to the premenstrualEPILOGUE.RENAISSANCE OF ANCIENT CONCEPT OF TEMPERAMENT _______ 487phase in women.Unlike those with epilepsy, cyclothymes are aware of their  fits of anger  , which lead to considerable personal and social embarrass-ment after they subside.They often feel   on edge, restless, and aimlesslydriven  ; family and friends report that during these periods patients seeminconsiderate and hostile toward people around them.The contribution ofalcohol and sedative-hypnotic drugs to these moods cannot be denied, butthe moods often occur in the absence of drugs.The interpersonal costs of such unpredictable interpersonal explosivenessare often quite damaging.It is easy to understand how individuals withmercurial moods would charm others when in an expansive people-seekingmode, and rapidly alienate them when dysphoric.In effect, the life of manyof these individuals is a tempestuous chain of intense but brief romanticliaisons [14], often with a series of unsuitable partners.These may alternatewith sudden marriages, sometimes much above their social station(hypergamy).As expected, frequent marital separations, divorces, andsometimes remarriage to the same person occur.In the work arena,repeated and unpredictable shifts in work and study habits occur in mostpeople with cyclothymia, giving rise to a dilettante biography [34].Although some do better during their   high  periods, for others theoccasional   even  periods are more conducive to meaningful work.It issometimes unappreciated by clinicians inexperienced with bipolarity that  high periods  can be ones of disorganized and unpatterned busyness thatcould easily lead to a serious drop in net productivity.An alternatingpattern of use of stimulants and sedatives further complicates thebiographical instability of cyclothymes.Alternatively, the cyclothymicbasis of mood swings in alcohol- or substance-abusing individuals can bedocumented by demonstrating mood swings before the onset of or well pastthe period of detoxification.In some cases, escalating mood instabilitymakes its first appearance following abrupt drug or alcohol withdrawal.Although cyclothymes are often confused with patients affected by adultattention-deficit/hyperactivity disorder (ADHD), their social warmth is adistinguishing characteristic.Furthermore, one-third of cyclothymes studiedby us on a prospective basis [34] progressed to spontaneous affectiveepisodes, predominantly evolving into hypomanias and clinical depression.Such switches were enhanced by antidepressants.A larger National Institute of Mental Health study of patients with majordepression who switched to bipolar II disorder during a prospectiveobservation period of up to 11 years [40] found that a temperamental mix of  mood-labile  ,   energetic-active  , and   daydreaming  traits (reminiscentof Kretschmer s concept of the cyclothymic temperament [1]) were the mostspecific predictors of such outcome.Although cyclothymia can be sometimes complicated by full-blown manic-depressive illness, giving rise to mixed mania [27], it is more commonly488 __________________________________________________________________ PERSONALITY DISORDERSassociated with the bipolar II pattern (of recurrent major depression withself-limited hypomanias) [ Pobierz całość w formacie PDF ]