Gin S. Malhi: A critical analysis of concepts in psychiatry.

Gin S. Malhi and Erica Bell: False views-Cyclothymia-Dithering disorder.


Janusz K. Rybakowski comment


            In their review paper on cyclothymia, Perugi, Hantouche and Vannucchi (2017) suggest that cyclothymia can be defined as an exaggeration of cyclothymic temperament. Therefore, I would postulate as a diagnostic aid for cyclothymia, assessing the features connected with cyclothymic temperament. The most available measure of cyclothymic temperament is a part of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A), introduced by Akiskal and Akiskal (2005), and translated into more than 30 languages. In the TEMPS-A, the part of the assessment of cyclothymic temperament is a self-report that consists of 21 questions. In a recent study on the association of cyclothymic temperament with ADHD, other psychopathology and medical co-morbidity in the general population, Norwegian researchers (Syrstad, Oedegaard, Fasmer  et al. 2020) defined a positive score for cyclothymic temperament as ≥11 points. However, it could be considered that for diagnostic purposes of cyclothymia this score could be higher, e.g., ≥14 points.

            Certainly, this additional diagnostic feature should not preclude a possible debate on the duration of symptoms and their importance for more exact recognition of cyclothymia.



Akiskal HS, Akiskal KK. Special issue: TEMPS: Temperament Evaluation of Memphis, Pisa, Paris and San Diego. J. Affect. Disord. 2005; 85:1–242. 

Perugi G, Hantouche E, Vannucchi G. Diagnosis and treatment of cyclothymia: The "primacy" of temperament. Curr Neuropharmacol 2017; 15:373-5. 

Syrstad VEG, Oedegaard KJ, Fasmer OB, Halmoy A, Haavik J, Dilsaver S, Gjestad R. Cyclothymic temperament: Associations with ADHD, other psychopathology, and medical morbidity in the general population. J Affect Disord 2020; 260:440-7.


August 6, 2020