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Diagnosis and Treatment of Cyclothymia: the "primacy" of temperament.

Contrary to DSM-5 definition, based on the recurrence of hypomanic and depressive symptoms for a period of 2 years, cyclothymia is better defined in a neurodevelopmental perspective as a pathological variant of cyclothymic temperament. Emotional dysregulation with extreme mood instability and reactivity are the core features of the complex symptomatology. Available epidemiological and clinical data showed the frequent association of cyclothymia with anxiety, impulse control, substance use and cluster B and C personality disorders, suggesting a high prevalence in clinical samples and supporting its validity as a distinct form of bipolarity. Unresolved issues concern its diagnostic delimitation and the possible relationships with emotional dysregulation observed in other neurodevelopmental disorders. Further research is necessary to explore the specificity of cyclothymia in the early phase of life and to improve its recognition in youth. Early recognition means avoiding unnecessary complications and establishing specific treatments and clinical management since the beginning.

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