While most people have occasional periods of anxiety and stress from time to time, some people suffer from severe, debilitating, and unpredictable experiences of fear that cause them to have symptoms such as feeling as if they are having a heart attack, like they have lost their ability to breathe, or even that they are going to die. People that have these kinds of experiences are having panic attacks and may be suffering from a clinical condition called panic disorder. Panic disorder and other mental disorders are diagnosed by mental health professionals using a diagnostic manual called the DSM-5*. Symptoms of panic disorder are described using DSM-5 criteria in this article.

Panic attacks are defined as a sudden overwhelming feeling of fear that occurs without warning and may erupt when no real danger is present. A panic attack typically lasts less than 10 minutes and dissipates within half an hour. For a professional to make the diagnosis, the patient must describe four or more of the following symptoms during the panic attack:

• Rapid heartbeat
• Excessive sweating
• Shaking or trembling sensations
• Smothering sensations or shortness of breath
• Choking sensations
• Discomfort in the chest
• Abdominal discomfort or nausea
• Feelings of dizziness, lightheartedness, or that the individual is going to faint
• Chills or hot flashes
• Tingling of the hands, feet, or other body parts
• Feeling that the person is unreal, or that things around them are unreal
• Fear of dying, fear that they are going to go crazy or lose control
• Choking sensations
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Chills or heat sensations

A patient with panic disorder has panic attacks with some regularity. They may become worried about the possibility of having more attacks, or they may alter their behavior in an attempt to avoid the chance of having an unwanted attack. Sometimes people with panic disorder may avoid social situations or other environments where panic attacks have occurred in the past to try to maintain control of their symptoms. If this avoidance becomes severe, the person may develop a related condition called agoraphobia. In agoraphobia, the person will go to great lengths to avoid certain situations such as shopping malls, elevators, bridges, or airports. In severe cases, the individual may be unable to leave the house. Work, school, relationships, and overall quality of life can be severely impacted as a result of either panic disorder or agoraphobia.

If you or a loved one is suffering from symptoms of panic disorder, treatments are available to help decrease the severity of these symptoms and assist in getting back to normal functioning. Psychotherapy, specifically cognitive behavioral therapy (CBT) is widely used to control symptoms of panic disorder. Medications are also useful as a treatment for panic disorder. Certain medications can partially or entirely block panic attacks. Effective medication management allows the psychotherapist and patient to work on overcoming anxiety, depression, relationship problems, substance abuse, and other related problems.

---

* American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association, Arlington, VA.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a psychological disorder that involves a continuous pattern of difficulties sustaining focus and attention, hyperactive or impulsive behavior. While children may be diagnosed with the inattentive type of ADHD, the hyperactive type, or a combined inattentive/hyperactive type of ADHD, adults most commonly experience problems with inattention but not hyperactivity. An adult diagnosis of ADHD requires that the individual was showing several symptoms of ADHD before the age of 12.

Symptoms of ADHD in Adults

There are over a dozen symptoms associated with an adult diagnosis of ADHD. Some of the more common ones are:

Concentration Difficulties: Excessive distractibility and difficulty focusing, completing tasks, or listening intently. Individuals with ADHD often struggle with these symptoms find it difficult to focus on details of their work or the flow of conversations, which can lead to an increase in inaccurate or partially completed work and problems in their relationships.
Disorganization: Forgetfulness, misplacing items, trouble meeting deadlines or arriving to places on time, and difficulties maintaining organization of living and working spaces.
Hyperactivity: Feelings of restlessness or boredom, difficulties with feeling calm or sitting still, and experiences of racing thoughts and the need to be physically active during inappropriate times.
Impulsivity: Difficulty with self-control. This may be observed by patterns of interrupting others, spontaneous outbursts that seem out of context to the situation or which others experience as offensive or irritating, or exhibiting socially inappropriate or addictive behaviors.
Hyperfocused: Mentally absorbed in preferred activities or interests that the individual finds appealing, causing him or her to neglect responsibilities or tasks that need to be completed.
Emotion Instability: Symptoms of depression or mood swings, struggles with tolerating frustration, feelings of irritation, and changes in temperament and self-esteem.

Differential Diagnosis

Most of the symptoms listed here are shared by other psychiatric disorders such as bipolar disorder, anxiety disorders, psychotic disorders, drug and alcohol addiction, and other conditions. There are several medical conditions that also can cause many of these symptoms. To make things even more complicated, patients can share two or more diagnoses that have some overlapping symptoms, such as ADHD, bipolar disorder, and diabetes. Because a comprehensive accurate diagnosis is essential to providing excellent care, a diagnosis should only be made by a trained, licensed mental health professional such as a psychologist or a psychiatrist.

Having ADHD can cause a person to develop a variety of personal problems that can affect their lives, such as relational problems, difficulties maintaining a quality work environment, financial instability, and health concerns. A mental health professional can also assess these life stresses and help the person begin to develop a plan to get control over their life.

How to Get Help

If you or someone you live is diagnosed with ADHD, a variety of treatments can be used to help achieve a satisfying and functional life. Standard treatment for ADHD involved medication and psychotherapy. Group therapy and educational or career assistance can also assist those who need additional resources.

 

SMART Recovery is a scientifically based program designed to help individuals abstain from abuse of substances and other compulsive and addictive behaviors such as gambling, sex, eating, shopping, and self-harm. SMART Recovery is based on principles from Cognitive Behavioral Therapy (CBT), Rational Emotive Behavior Therapy (REBT), and Motivational Enhancement Therapy (MET). SMART stands for Self-Management and Recovery Training.

SMART Recovery is organized around a 4-Point Program that provides participants with a variety of ways of managing their addictive behaviors in order to achieve recovery. These four points are:

> Building and Maintaining Motivation
> Coping with Urges
> Managing Thoughts, Feelings, and Behaviors
> Living a Balanced Life

SMART Recovery Key Features

> There is no “higher power,” religious, or spiritual component. Spiritual beliefs are neither encouraged nor discouraged; it is up to the individual to decide what is helpful to his or her personal recovery.
> Participants are not considered powerless; instead, SMART Recovery emphasizes increasing self-reliance. Participants are given many tools and techniques to empower themselves in their recovery.
> Meetings are not leaderless, they are structured and run by trained volunteers.
> Interaction among members during a meeting, or “cross-talk,” is encouraged. Members are encouraged to talk with one another, rather than to one another.
> Participants are encouraged to attend for months or years, but not necessarily a lifetime.
> There are no steps and no sponsors.
> Members are supported in taking psychiatric medications prescribed by licensed healthcare professionals who are knowledgeable about addictive medications, if they feel that this is helpful.
> Members are supported in seeking psychotherapy from licensed professionals while attending meetings if they feel that this is helpful.
> While SMART is an abstinence-based program, participants are not required to be sober in order to attend meetings. Participants are welcomed at any of the 5 stages of change.
> Some participants like to attend SMART meetings and 12 Step meetings or other recovery programs such as LifeRing or Women or Men for Sobriety at the same time. Some participants try   SMART and then leave to try other recovery programs. SMART is not effective for everyone. Individuals who do not respond to SMART are encouraged to explore other recovery programs.       What is most important is for the individual to find their own path to recovery.

SMART Recovery Recognition

The National Institute on Drug Abuse (NIDA)
The Substance Abuse and Mental Health Services Administration (SAMHSA)
The American Society of Addiction Medicine (ASAM)
US Department of Health and Human Services
The President’s Office of National Drug Control Policy (ONDCP)
The American Academy of Family Physicians
The Center for Health Care Evaluation
The Bureau of Prisons
The National Association of Drug Court Professionals (NADCP)

SMART Recovery meetings are held in many areas in the United States and in several foreign countries. In addition, there are online meetings. There are treatment programs that are based on the SMART Recovery model. To learn more about SMART Recovery and to find a meeting or treatment program, visit the SMART Recovery website at www.smartrecovery.org.

 

Marijuana is defined as the dried leaves and female flowers of the cannabis plant. Users seeking its potentially relaxing or euphoria-inducing properties most commonly smoke it in a pipe or roll it into a cigarette or “joint.” The mind-altering effects of marijuana are created by chemical compounds called cannabinoids, which act directly on receptors in the central nervous system. The most prevalent cannabinoid in marijuana is tetrahydrocannabinol, or THC. Although THC has relatively low toxicity (one is highly unlikely to die from overdose), its psychoactive effects and addictive properties can be profound. THC is also fat soluble, meaning that it will remain in the body well after the effects have worn off. Heavy marijuana users can test positive for THC up to three months after cessation of use.

The effects of marijuana are both physiological and psychological, and can vary from user to user. Some experience euphoria, relaxation, and an alteration of conscious perception that is pleasing. Other pleasurable effects reported include heightened sensuality, heightened libido, and the feeling of increased creativity and insight. Alternately, some people may experience negative effects such as anxiety and panic, paranoia, hallucinations, distorted perceptions of time, and even acute psychosis. It is not uncommon for marijuana use to induce panic attacks, and there is strong evidence to suggest that marijuana use can hasten the onset of schizophrenia in vulnerable individuals. Most marijuana use can result in increased heart rate, dry mouth, and reddening of the eyes.

Marijuana is highly addictive: it is a potent, mood-altering substance that acts quickly when ingested. 49% of the U.S. population have used marijuana. Of that population, 9% become dependent. Young people and individuals with mood disorders (anxiety, depressive, and bipolar spectrum disorders) are at particularly high risk for marijuana dependence. Those dependent on marijuana can suffer social and occupational impairment, as well as severe withdrawal symptoms upon cessation. Marijuana withdrawal commonly results in irritability, anger or aggression, anxiety, depression, insomnia, restlessness, shakiness, stomach pain, and weight loss. The onset of these symptoms often sends the marijuana-dependent individual back to the drug for relief, making quitting very difficult. It is therefore essential that individuals withdrawing from marijuana seek professional help.

References:

Budney, Alan J., Moore, Brent A., et al. (2003). The time course and significance of cannabis withdrawal. Journal of Abnormal Psychology, 112 (3), 393-402.
Budney, AJ., Roffman, R., Stephens, RS., Walker, D. (2007). Marijuana dependence and its treatment. Addiction science & clinical practice 4 (1), 4–16.
Large, M., Sharma, Swapnil., Compton, Michael T., Slade, Tim., Nielssen, Olav. (2011). Cannabis use and earlier onset of psychosis”. Archives of General Psychiatry 68 (6), 555–61.

 

Thought Broadcasting is a psychotic symptom in which the patient has the experience that his or her thoughts are being broadcast aloud so that people around can hear the thoughts. This symptom is most common in bipolar disorder, schizoaffective disorder, and schizophrenia. The experience can be extremely upsetting and sort of like being “mentally naked.” Suppose that when a young man standing in line at the local coffeehouse notices a cute girl, he believes that she can hear all of his private thoughts about her. Also imagine that he thinks the guy he is standing behind in line also might go after this girl. He is jealous of him, but he also thinks the other man can hear everything he is thinking. He is afraid the man in front of him can hear his every thought, and as a result is going to turn around and smack him in the face, and the girl is going to laugh at him. He gets very upset, leaves the coffee shop without getting his coffee, and goes home embarrassed, frightened, and discouraged. The patient who is having the experience of thought broadcasting believes that all of this is really happening. It can be a devastating and crippling condition.

Consequences of Thought Broadcasting

Patients with Thought Broadcasting rarely volunteer that they are having this symptom. They can go years without family, friends, or treating professionals becoming aware of the presence or severity of this symptom. It is always a good idea to ask a patient who might be at risk for Thought Broadcasting whether they are experiencing these symptoms.  Patients with Thought Broadcasting often withdraw from social interactions. They frequently stay at home and become socially isolated so as to avoid having others hear their thoughts. In extreme cases they believe that people on the street or in the house next door can hear their thoughts. These symptoms often wax and wane in response to stress, and may be less severe around people whom they are familiar with.

Treatment for Thought Broadcasting

Antipsychotic medication is the first line treatment for Thought Broadcasting. Medications such as Abilify, Zyprexa, Risperdal, and Clozaril can reduce or eliminate Thought Broadcasting. Psychotherapy can help the patient manage symptoms of Thought Broadcasting. Avoiding alcohol and street drugs also is very important. Social support networks such as 12 Step meetings are often difficult for these patients because they believe that everyone in the meeting can hear what they are thinking. As a result, meeting attendance drops off and then discouragement sets in. Helping the patient find a sober plan that they can adhere to if they have an addiction is another key predictor of success when helping to overcome this sometimes debilitating symptom.

 

Obsessive-compulsive disorder, also referred to as OCD, is a mental disorder characterized by recurrent, persistent obsessions and/or compulsions. In this article we will explore the signs and symptoms of OCD and what kinds of treatment are available for this condition.

Obsessions are repetitive and unwanted intrusive thoughts, impulses, or urges that keep coming into the person’s mind, causing discomfort and distress. An example of an obsession would be the recurring distressing thought that one’s hands are dirty, even after having washed one’s hands 10 times in a row. Compulsions are behaviors that the person feels compelled to repeat over and over again in response to an obsession. Continuing with our example, the person with OCD who is struggling with the obsession that their hands are dirty may respond by washing their hands yet an 11th time in hopes that this will finally make the obsession go away. Unfortunately engaging in ongoing compulsive behavior of this type will actually make the OCD symptoms worse, not better.

Clinically significant OCD can be highly disruptive to the afflicted individual as well as to those around him or her. OCD sufferers typically spend at least an hour a day engaging in ritualized thoughts or behaviors. Their symptoms interfere with social relationships, work, school, or other important areas of life functioning.

Diagnosing Obsessive-Compulsive Disorder

OCD should not be confused with being other behavior patterns such as being overly neat, precise, or demanding. Excessive worrying, ruminating about negative thoughts, and engaging in stereotyped behavior such as repetitively crossing one’s fingers or twirling one’s hair are not necessarily signs of OCD. Accurate diagnosis of OCD should be made by a trained mental health professional who is qualified to rule out other psychological and medical conditions that may look similar to true OCD.
Patients who are diagnosed with OCD are at higher than average lifetime risk of developing other conditions. 76% of patients with OCD are at risk of developing an additional anxiety disorder such as panic disorder, social anxiety disorder, generalized anxiety disorder, or a specific phobia. 63% of OCD patients are at risk of developing depression or bipolar disorder, and 30% of OCD patients also have a tic disorder. 12% of individuals with schizophrenia or schizoaffective disorder also have OCD. Approximately 25% of OCD patients also abuse drugs and/or alcohol.

Getting Help with Obsessive-Compulsive Disorder

There are highly effective psychological and medication treatments for OCD. Exposure therapy and cognitive behavioral therapy are effective psychological treatments for OCD. Various types of antidepressant medications are commonly used to treat OCD including: selective serotonin reuptake inhibitors, tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, and serotonin partial agonist reuptake inhibitors. Some patients respond well to psychotherapy or medications alone, and others will get best outcomes with a combination of psychotherapy and medication management.
Other treatments may include attending an Intensive Outpatient Program, a Partial Hospitalization Program, a Residential Treatment Program, or even inpatient hospitalization in severe cases.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C., American Psychiatric Association.
Mancebo, M.C., Grant, J.E. et al. (2009). Substance use disorders in an obsessive compulsive disorder clinical sample. Journal of Anxiety Disorders, 23(4), 429-435.
Stahl, S.M. (2014). Prescriber’s Guide, 5th Edition. Cambridge University Press. https://stahlonline.cambridge.org.

Everyone feels sad and blue from time to time. Feeling a bit down is a normal emotional state and can have a positive effect by helping us work through a loss or resolve a significant event in our lives.

Clinical depression occurs when a person experiences symptoms that go beyond normal sadness and “having a bad day.” Mental health professionals look to the duration of the symptoms, the intensity of the symptoms, and the type of symptoms to help distinguish normal experiences from clinical depression. For duration, symptoms lasting a week or longer, and especially two weeks or longer, are more likely to be clinically significant. For intensity, symptoms that interfere with everyday functioning like going to work or school are more likely to be clinically significant. For type, some symptoms such as suicide are not typically associated with everyday experiences of sadness or “the blues.”

Nine Key Symptoms of Clinical Depression

Psychologists and psychiatrists have identified nine core symptoms that may indicate that an individual is suffering from depression. These are:

Feeling Depressed: Feeling depressed, sad, “down-in-the-dumps,” most of the day, every day
Loss of Interest or Pleasure in Daily Activities: A loss of pleasure or enjoyment when engaging in activities that were previously enjoyable, such as watching movies, eating meals, playing sports, or sex
Sleep Disturbance: Either insomnia, which is the inability to fall asleep or stay asleep, or hypersomnia, which involves sleeping too many hours per day
Appetite Disturbance: Either persistent loss of appetite, which may have accompanying weight loss, or persistent increased appetite which may have accompanying weight gain
Cognitive Impairment: Difficulties with attention, concentration, decision making, and memory
Loss of Energy: Feeling tired and worn out most of the time, even when there is no objective reason to be so fatigued
Behavioral Disturbance: Persistently agitated behavior, such as restlessness and pacing about, or persistently sedated behavior, such as having difficulty getting out of bed, walking very slowly, or “dragging about”
Low Self-esteem: Feelings of poor self-esteem, worthlessness, or excessive guilt about things others might not judge themselves so harshly over
Suicide: Suicidal thoughts, impulses, or plans; or any suicide gesture or action

A mental health professional is more likely to make a diagnosis of depression if these symptoms are of sufficient intensity and duration, and if several symptoms are present at the same time. Additionally, other factors can cause depression such as medical illness and drug and alcohol addiction. These factors must be ruled out before making a diagnosis of depression.

Getting Help

If you or someone you know appears to suffer from depression, it is important to get help at the earliest opportunity. Excellent treatments are available for depression, including psychotherapy and medications. For more severe forms of depression, additional treatments are available such as transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), and vagus nerve stimulation. Many treatments are available on an outpatient basis. Some group therapy treatments are best offered in a Partial Hospitalization Program or an Intensive Outpatient Program, perhaps while the patient is a Transitional Living facility. In some cases, the patient requires hospitalization for safety or stability while treating severe depression.

Anosognosia, or impaired awareness of one’s own illness, is a common symptom in patients with severe bipolar disorder and schizophrenia. In some cases, the afflicted individual may not have any awareness that they are ill. As a result of this symptom, patients may believe that their delusions and hallucinations are real. They may not see any impairments in their day to day functioning, even though those around them are having to cope with severe consequences of their lack of motivation, initiative, social skills, or ability to live independently. They may have difficulty with their elevated mood and manic behavior is creating a problem, even though they are spending money they don’t have, engaging in promiscuous sex, or making risky and dangerous life decisions, none of which is characteristic of their behavior when not manic.

How common is Anosognosia?

As many as 50% of patients with schizophrenia, and 40% of bipolar patients, suffer from this condition. Anosognosia is caused by damaged to the right side of the brain.  Anosognosia may fluctuate over time within the same individual, so that they may be more or less aware of their own illness at different points in time. It is important to distinguish anosognosia from denial, which is a psychological defense in which the individual does not want to face the seriousness of their problems because it is too painful to do so.

Anosognosia is the most common reason that patients with bipolar disorder and schizophrenia are not compliant with their medications. It makes sense from the patient’s point of view – if you don’t believe you’re sick, why take medications? Unfortunately, taking medications is one of the most effective ways to decrease these symptoms and increase awareness of illness. Patients with this condition are more likely to be hospitalized involuntarily and to end up in the emergency room as well.

How to Get Help for Anosognosia

If you have a loved one with anosognosia, seek help from a mental health professional at the earliest opportunity. Even if the person with the condition will not seek treatment, help is available for you and your family. A qualified mental health professional can explain the legal and clinical procedures that are available to get help for your loved one even if they do not realize that they need help.

References

Lerner, D.S., and Lorenz, J. Anosognosia in schizophrenia: Hidden in plain sight. Innovations in clinical neuroscience, 11 (5-6), 10-17.

Treatment Advocacy Center Briefing Paper (2005). Anosognosia (impaired awareness of illness): A major problem for individuals with schizophrenia and bipolar disorder.

Bipolar Disorder

Bipolar disorder (BPD) is actually a group of mental disorders with similar features and characteristics, called the bipolar spectrum. BPD is a mental disorder that is characterized by swings in mood from mania (mood that is too high) to depression (mood that is too low), back to normal mood. Individuals with BPD experience mood swings in two directions, or two poles (bipolar).

Bipolar disorder is a separate disorder from what most people refer to as “depression,” a different condition in which individuals only experience depression but not mania. This type of depression is referred to as unipolar depression rather than bipolar depression, as these patients only experience mood swings in one direction, from normal mood to depressed.

Older terms for bipolar disorder are manic-depression or manic-depressive disorder. These terms are not commonly used by mental health professionals anymore.

BPD can be very serious if not treated properly. Untreated BPD can lead to severe damage in interpersonal relationships, loss of employment, financial ruin, legal problems, risky behavior with unintended negative consequences, and even suicide.

Mania Phase of Bipolar

“Mania” or “manic” refers to an abnormal mood state lasting more than a few days in which the person is unusually cheerful, euphoric, or irritable, not attributable to drugs or a medical condition. During a manic episode, the individual can go days without sleeping, feel unusually good about themselves, have rapid, exciting thoughts, and speak very quickly. They may be restless and distractible and engage in uncharacteristically risky behavior such as spending sprees, indiscriminate sex, drug use, or other reckless behavior. In severe cases the manic individual can have a break with reality (psychotic symptoms).

Depression Phase of Bipolar

“Depression” refers to an abnormal mood state lasting at least a few weeks in which the person feels depressed and sad or has a loss of enjoyment and pleasure about most daily activities. Individuals with severe depression can also experience changes in appetite, sleep, problems with their attention and concentration, feeling chronically tired, have poor self-esteem or excessive guilt, and have thoughts of suicide or even make a suicide attempt.

Family and Bipolar Disorder

Bipolar disorder can have a devastating effect on the family members of a patient with untreated BPD. Family members often are left to “pick up the pieces” and the emotional, financial, and legal consequences of the patient’s behavior when ill. Family members often recognize the onset of a bipolar episode long before the patient realizes that they are ill. Mania usually feels good in the initial stages, and many patients are reluctant to let go of the good or “high” feelings that accompany a new episode of mania. As family members realize that the bipolar patient is “ill” rather than “bad,” they can become a tremendous asset in the treatment of BPD by helping the patient get into treatment and stay in treatment.

If any of the above description sounds familiar to you, or seems to describe a loved one, get professional help right away. There are very effective psychological and medication treatments for BPD when administered by qualified mental health experts.

Because bipolar symptoms can also have other medical and psychological causes, it is essential to have an evaluation by a clinical psychologist or a psychiatrist who is a specialist in diagnosing bipolar disorder as quickly as possible.

Cyclothymic disorder is a type of bipolar disorder defined by long periods of fluctuating mood. Individuals with cyclothymia will experience persistent cycling between feelings of elevated or expansive mood and more depressive “down” states. Untreated, these ups and downs can go on for years. Cyclothymic symptoms are less severe than bipolar symptoms: the “highs” are not as high and the “lows” are not as low. Cyclothymic mood episodes do not meet full criteria for manic episodes, hypomanic episodes, or major depressive episodes. However, the cycling between mood episodes is chronic, pervasive, and clinically significant.

An individual with cyclothymia never goes more than two months without experiencing symptoms, and spends at least half the time feeling either too “up” or too “down.” There are rarely periods of wellness, and when they occur, they are short. And though less acute in nature than bipolar disorder, cyclothymic disorder presents with many of the same symptoms.  When in a depressive state, individuals with cyclothymia experience some of the following symptoms:

Depressed mood most of the day, nearly every day
Diminished interest or pleasure in usually pleasurable things
Significant weight loss
Insomnia or hypersomnia
Physical agitation
Fatigue or loss of energy
Feelings of worthlessness or inappropriate guilt
Diminished ability to concentrate
Recurrent thoughts of death or suicide

In an “up” (also called “hypomanic”) state, cyclothymic patients can experience some of the following symptoms:

Inflated self-esteem or grandiosity
Decreased need for sleep
Pressured speech (pressure to keep talking)
Racing thoughts
Distractibility
Increase in goal-oriented activity
Engagement in risky behavior (buying sprees, sexual indiscretions)

Unlike more severe forms of bipolar disorder, cyclothymic disorder rarely results in impairment severe enough to require hospitalization. However, it still leaves the individual in a state of virtually constant emotional instability. Cyclothymic Disorder can be confused with other psychiatric and medical conditions and intoxication by drugs.  It is important to have a mental health expert evaluate the patient in order to make an accurate diagnosis.

References

American Psychiatric Association. and American Psychiatric Association. DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C., American Psychiatric Association.