Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett St, Camperdown, NSW 2050, Australia.
BMC Med. 2013 Mar 22;11:79. doi: 10.1186/1741-7015-11-79.
Clinical psychiatry has always been limited by the lack of objective tests to substantiate diagnoses and a lack of specific treatments that target underlying pathophysiology. One area in which these twin failures has been most frustrating is major depression. Due to very considerable progress in the basic and clinical neurosciences of sleep-wake cycles and underlying circadian systems this situation is now rapidly changing.
The development of specific behavioral or pharmacological strategies that target these basic regulatory systems is driving renewed clinical interest. Here, we explore the extent to which objective tests of sleep-wake cycles and circadian function - namely, those that measure timing or synchrony of circadian-dependent physiology as well as daytime activity and nighttime sleep patterns - can be used to identify a sub-class of patients with major depression who have disturbed circadian profiles.
Once this unique pathophysiology is characterized, a highly personalized treatment plan can be proposed and monitored. New treatments will now be designed and old treatments re-evaluated on the basis of their effects on objective measures of sleep-wake cycles, circadian rhythms and related metabolic systems.
临床精神病学一直受到缺乏客观测试来证实诊断和缺乏针对潜在病理生理学的特定治疗方法的限制。在这两个方面都失败的一个领域是重度抑郁症。由于睡眠-觉醒周期和基础昼夜节律系统的基础和临床神经科学取得了非常大的进展，这种情况正在迅速改变。
针对这些基本调节系统的特定行为或药物策略的发展正在重新引起临床兴趣。在这里，我们探讨了客观测试睡眠-觉醒周期和昼夜节律功能的程度，即那些测量昼夜节律依赖生理学的时间或同步性以及白天活动和夜间睡眠模式的程度，这些测试可以用来识别具有紊乱昼夜节律特征的重度抑郁症患者亚类。
一旦这种独特的病理生理学得到表征，就可以提出并监测高度个性化的治疗计划。新的治疗方法将根据其对睡眠-觉醒周期、昼夜节律和相关代谢系统的客观测量的影响进行设计，而旧的治疗方法将重新评估。
