Prasko Jan, Brunovsky Martin, Latalova Klara, Grambal Ales, Raszka Michal, Vyskocilova Jana, Zavesicka Lucie
Department of Psychiatry, University Hospital Olomouc, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010 Dec;154(4):355-61. doi: 10.5507/bp.2010.053.
Borderline personality disorder (BPD) is typically characterized by instability and impaired behaviour, affectivity, interpersonal relations and lifestyle. The most common condition comorbid with BPD is a depressive episode. Depression is associated with severe disturbance of the circadian rhythms. This is apparent in depressive patients with BPD. Both sleep and diurnal rhythms are disturbed and the symptoms fluctuate. Bright light may be an effective in treatment of seasonal affective disorder, circadian sleep disorder and jet lag. It also improves sleep-wake patterns and behavioural disorders in hospitalized patients with Alzheimer's disease. Several studies have suggested antidepressant effects of phototherapy in non-seasonal depressive episodes. The treatment of comorbid depressive disorder and borderline personality disorder (BPD) is usually reported to be less successful than the treatment of patients without personality disorder. Studies describing the use of bright light in depressed patients with comorbid BPD have not been published so far.
The aim of this open study was to assess the effectiveness of a 6-week combined therapy with the application of bright light (10,000 lux, 6:30 to 7:30 a.m. for 6 weeks) added to SSRIs in drug-resistant depressed patients with comorbid BPD who did not respond with improvement to 6-week administration of antidepressants. The study comprised 13 female patients who met the ICD-10 diagnostic criteria for research and the DSM-IV-TR diagnostic criteria for major depression. The participants were regularly evaluated using the CGI, HAMD and MADRS scales and the BDI and BDI self-report inventories.
According to all the assessment instruments, the application of bright white light leads to a significant improvement. However, the results must be interpreted with caution due to the open nature of the study.
边缘型人格障碍（BPD）的典型特征是行为、情感、人际关系和生活方式不稳定且受损。与BPD共病最常见的情况是抑郁发作。抑郁症与昼夜节律的严重紊乱有关。这在患有BPD的抑郁患者中很明显。睡眠和昼夜节律均受到干扰，症状会波动。强光可能对季节性情感障碍、昼夜节律性睡眠障碍和时差反应有效。它还能改善阿尔茨海默病住院患者的睡眠-觉醒模式和行为障碍。几项研究表明光疗对非季节性抑郁发作有抗抑郁作用。据报道，共病抑郁障碍和边缘型人格障碍（BPD）的治疗通常不如无人格障碍患者的治疗成功。迄今为止，尚未发表关于在患有BPD的抑郁患者中使用强光的研究。
这项开放性研究的目的是评估在对6周抗抑郁药治疗无改善反应的共病BPD的耐药抑郁患者中，添加强光（10000勒克斯，上午6:30至7:30，持续6周）与选择性5-羟色胺再摄取抑制剂（SSRI）联合进行为期6周治疗的有效性。该研究包括13名符合ICD-10研究诊断标准和DSM-IV-TR重度抑郁症诊断标准的女性患者。使用临床总体印象量表（CGI）、汉密尔顿抑郁量表（HAMD）、蒙哥马利-阿斯伯格抑郁量表（MADRS）以及贝克抑郁量表（BDI）和BDI自评量表对参与者进行定期评估。
根据所有评估工具，应用亮白光可带来显著改善。然而，由于该研究的开放性，结果必须谨慎解读。
