Cyclothymic Disorder Assessment

Cyclothymia (Cyclothymic Disorder) Assessment | Double Board Certified Counseling Services

Double Board Certified Counseling Services

Cyclothymia (Cyclothymic Disorder) — Patient Assessment (Fillable)

Patient Education Date: Private — not stored on server

Patient Information

Name

Date

Timeframe & Pattern

Have mood symptoms (ups and downs) been present for at least 2 years (≥1 year if under 18)?

During this period, were symptoms present at least half the time, with no symptom-free interval longer than 2 months?

Hypomanic-Like Symptoms (not meeting full hypomanic episode)

Rate how often you experienced the following during “up” periods.

Elevated/expansive or unusually irritable mood

Increased energy or goal-directed activity

Decreased need for sleep (feeling rested on less sleep)

Unusually talkative / pressured speech

Racing thoughts / flight of ideas

Distractibility or risk-taking (spending, sex, driving, substances)

Depressive-Like Symptoms (not meeting full major depressive episode)

Rate how often you experienced the following during “down” periods.

Low or sad mood most of the day

Loss of interest/pleasure (anhedonia)

Appetite or weight changes

Sleep problems (insomnia or hypersomnia)

Low energy / fatigue

Poor concentration or indecisiveness

Feelings of worthlessness or hopelessness

Exclusions & Clinical Impact

Have you ever had a full manic episode?

Have you had a major depressive episode during the first 2 years of these mood shifts?

To your knowledge, could substances or a medical condition explain these mood changes?

Functional impact (work/school, relationships, daily life):

Open-Ended Questions

Describe your typical “up” periods (energy, sleep, behavior, risks):

Describe your typical “down” periods (mood, sleep, motivation):

Triggers, patterns, or early warning signs you’ve noticed:

Strategies or supports that help (therapy skills, routines, medications):

Important: This screening tool does not provide a diagnosis. Cyclothymia requires clinical evaluation of duration, impairment, and exclusion of other conditions (including bipolar I/II, schizo-spectrum disorders, substances/medical causes). Share this form with your clinician.