Henriksen Tone E G, Skrede Silje, Fasmer Ole Bernt, Hamre Børge, Grønli Janne, Lund Anders
Department of Clinical Medicine, Section for Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway; Division of Mental Health Care, Valen Hospital, Fonna Local Health Authority, Norway and MoodNet Research Group, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
Bipolar Disord. 2014 Dec;16(8):894-8. doi: 10.1111/bdi.12265. Epub 2014 Sep 27.
Available pharmacological treatment of mania is insufficient. Virtual darkness therapy (blue light-blocking treatment by means of orange-tinted glasses) is a promising new treatment option for mania. The basis for this might be the recently identified blue light-sensitive retinal photoreceptor, which is solely responsible for light stimulus to the circadian master clock. This is the first case report describing the clinical course of a closely monitored, hospitalized patient in a manic episode first receiving clear-lensed, and then blue light-blocking glasses.
A 58-year-old Caucasian man, with bipolar I disorder and three previous manic episodes, was hospitalized during a manic episode. In addition to pharmacological treatment, he was treated with clear-lensed glasses for seven days, then one day without glasses, followed by six days of blue light-blocking glasses. During the entire observational period, he wore an actigraph with internal light sensors.
Manic symptoms were unaltered during the first seven days. The transition to the blue-blocking regime was followed by a rapid and sustained decline in manic symptoms accompanied by a reduction in total sleep, a reduction in motor activity during sleep intervals, and markedly increased regularity of sleep intervals. The patient's total length of hospital stay was 20 days shorter than the average time during his previous manic episodes.
The unusually rapid decline in symptoms, accompanied by uniform sleep parameter changes toward markedly increased regularity, suggest that blue-blockers might be targeting a central mechanism in the pathophysiology of mania that needs to be explored both in clinical research and in basic science.
现有的躁狂症药物治疗并不充分。虚拟黑暗疗法（通过橙色镜片眼镜进行蓝光阻断治疗）是一种有前景的躁狂症新治疗选择。其依据可能是最近发现的对蓝光敏感的视网膜光感受器，它是唯一负责向昼夜节律主时钟传递光刺激的感受器。这是首例描述一名密切监测的住院躁狂发作患者临床过程的病例报告，该患者先佩戴透明镜片眼镜，后佩戴蓝光阻断眼镜。
一名58岁的白种男性，患有双相I型障碍，既往有三次躁狂发作史，在一次躁狂发作期间住院。除药物治疗外，他先佩戴透明镜片眼镜7天，然后一天不戴眼镜，接着佩戴蓝光阻断眼镜6天。在整个观察期内，他佩戴了带有内置光传感器的活动记录仪。
在前七天，躁狂症状未发生改变。在转换为蓝光阻断模式后，躁狂症状迅速且持续下降，同时总睡眠时间减少，睡眠期间的运动活动减少，睡眠间隔的规律性明显增加。该患者的住院总时长比他之前躁狂发作的平均时长缩短了20天。
症状异常迅速地下降，同时睡眠参数一致朝着规律性明显增加的方向变化，这表明蓝光阻断剂可能针对的是躁狂症病理生理学中的一种核心机制，这需要在临床研究和基础科学中进行探索。
