Ruhr-University Bochum, LWL-University Hospital Hamm for Child and Adolescent Psychiatry, Heithofer Allee 64, D-59071 Hamm, Germany.
Med Hypotheses. 2011 Oct;77(4):692-5. doi: 10.1016/j.mehy.2011.07.019. Epub 2011 Aug 9.
Severe affective and behavioral dysregulation, labeled as severe mood dysregulation (SMD), is a widely spread phenomenon among adolescent psychiatric patients. This phenotype constitutes severe impairment across multiple settings, including various symptoms, such as non-episodic anger, mood instability, and hyperarousal. Moreover, SMD patients often show depression and reduced need for sleep. Despite a lifetime prevalence of 3.3%, systematic research is still scarce, and treatments that have been established do not account for the range of symptoms present in SMD. Considering the circadian dysfunctions, two hormones, melatonin and cortisol, are essential. When these hormones are dysregulated, the circadian rhythm gets out of synchrony. Since evidence is emerging showing that the worse the sleep-wake cycle is entrained, the worse the psychiatric symptoms are depicted, the importance of proper circadian functioning becomes clear. Chronotherapy as the controlled exposure to environmental stimuli (e.g. light) acting on biological rhythms has shown therapeutic effects. In both seasonal and major depression chronotherapy has been implemented, decreasing depressive symptoms and stabilizing circadian rhythms. Preliminary evidence from SMD related disorders, namely attention-deficit/hyperactivity disorder and pediatric bipolar depression, indicates that morning light therapy elicits positive influences on other symptoms as well. Hence, light therapy might not only be effective for depressive symptoms and circadian rhythms, but might also be beneficial for symptoms including inattention and irritability. We hypothesize that light therapy might be a helpful adjunctive treatment enhancing affective and circadian functioning, and eliciting positive influences on behavior. Physiologically, changes of both cortisol levels and melatonin production are expected.
严重的情感和行为失调，被标记为严重的情绪失调（SMD），是青少年精神科患者中广泛存在的现象。这种表型在多个环境中构成严重障碍，包括各种症状，如非发作性愤怒、情绪不稳定和过度兴奋。此外，SMD 患者经常表现出抑郁和减少睡眠需求。尽管终生患病率为 3.3%，但系统研究仍然很少，并且已经确立的治疗方法并未考虑到 SMD 中存在的各种症状。考虑到昼夜节律功能障碍，两种激素，褪黑素和皮质醇，是必不可少的。当这些激素失调时，昼夜节律就会失去同步。由于有证据表明，睡眠-觉醒周期的同步性越差，精神症状越严重，因此昼夜节律的正常功能就显得尤为重要。时间疗法作为对生物节律起作用的环境刺激（例如光）的受控暴露，已显示出治疗效果。在季节性和主要抑郁症的时间疗法中，已经实施了时间疗法，以减少抑郁症状和稳定昼夜节律。来自 SMD 相关障碍的初步证据，即注意缺陷/多动障碍和儿科双相情感障碍，表明晨光疗法也对其他症状产生积极影响。因此，光疗法不仅对抑郁症状和昼夜节律有效，而且对注意力不集中和易怒等症状也可能有益。我们假设光疗法可能是一种有益的辅助治疗方法，可以增强情感和昼夜节律功能，并对行为产生积极影响。在生理上，预计皮质醇水平和褪黑素产生的变化。
