Schindler Shird Dieter, Graf André, Fischer Peter, Tölk Anton, Kasper Siegfried
Department of General Psychiatry, University Hospital for Psychiatry, Vienna, Austria.
Int J Geriatr Psychiatry. 2002 Nov;17(11):1071-2. doi: 10.1002/gps.497.
Bright light therapy (BLT) is becoming increasingly popular as an adjunct in the treatment of non-SAD depression and circadian rhythm disturbances in demented patients. Although the rate of side-effects is low, special attention should be paid when treating new groups of patients. We present the case of an 80-year-old woman suffering from dementia of Alzheimer's type (DAT).
Bright light (2.500 lux) was administered two hours daily between 10 and 12 a.m. for 14 days. Changes in delusion or agitation were recorded using the confusion rating scale (CRS).
Out of five patients, three already had delusional symptoms which slightly improved during the course of BLT, one patient never showed delusions before or during BLT, and one patient, which we present here, showed an increase in agitation and developed delusional symptoms. After eight days of treatment, the patient developed conjunctival irritation with marked red eyes and complained about blurred vision. After 12 days of treatment, the patient was disorientated in time and place and after 14 days the patient started to hallucinate and BLT had to be discontinued. The paranoid delusions and hallucinations stopped one day after treatment discontinuation.
Looking at all the presented evidence, BLT seems to be a useful treatment supplement in DAT patients, when suffering from delusions or agitation. On the other hand, caution should be used when using BLT in demented patients if agitation develops or increases during BLT.
作为治疗非季节性情感障碍性抑郁症及痴呆患者昼夜节律紊乱的辅助手段，强光疗法（BLT）正变得越来越流行。尽管副作用发生率较低，但在治疗新患者群体时仍应格外注意。我们报告一例80岁患阿尔茨海默病型痴呆（DAT）的女性病例。
每天上午10点至12点给予强光（2500勒克斯）照射，持续2小时，共14天。使用混乱评定量表（CRS）记录妄想或激越的变化。
五名患者中，三名已有妄想症状，在强光疗法过程中略有改善；一名患者在强光疗法之前或期间从未出现过妄想；还有一名患者（即我们在此报告的这名患者）出现激越增加并产生了妄想症状。治疗八天后，该患者出现结膜刺激，眼睛明显发红，并抱怨视力模糊。治疗十二天后，患者出现时间和地点定向障碍，十四天后开始出现幻觉，不得不停止强光疗法。停止治疗一天后，偏执妄想和幻觉消失。
综合所有现有证据，对于患有妄想或激越的DAT患者，强光疗法似乎是一种有用的治疗补充手段。另一方面，在痴呆患者中使用强光疗法时，如果在治疗过程中激越症状加重，应谨慎使用。
