Studie úČinnosti světelné terapie 1981 2008 pramen: PubMed – service of the U. S. National Library of Medicine and the National Institutes of Health

НазваниеStudie úČinnosti světelné terapie 1981 2008 pramen: PubMed – service of the U. S. National Library of Medicine and the National Institutes of Health
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received one hour (09:30-10:30) of bright light exposure (> or = 2500 lux in

gaze direction) Monday through Friday for 10 weeks. The control group received

usual indoor light (150-200 lux). Nighttime sleep efficiency, sleep time, wake

time and number of awakenings and daytime wake time were assessed using

actigraphy. Circadian rhythm parameters were also determined from the

actigraphic data using cosinor analysis and nonparametric techniques. Repeated

measures analysis of variance (ANOVA) was used to test the primary study

hypotheses. RESULTS AND CONCLUSION: Although significant improvements were found

in subjects with aberrant timing of their rest-activity rhythm, morning bright light exposure did not induce an overall improvement in measures of sleep or the rest-activity in all treated as compared to control subjects. The results indicate that only subjects with the most impaired rest-activity rhythm respond significantly and positively to a brief (one hour) light intervention.

Randomized Controlled Trial

PMID: 16050432

64: Pediatrics. 2005 Jun;115(6):1555-61.

The impact of school daily schedule on adolescent sleep.

Hansen M, Janssen I, Schiff A, Zee PC, Dubocovich ML.

Science Department, Evanston Township High School, Evanston, Illinois, USA.

OBJECTIVES: This study was initiated to examine the impact of starting school on adolescent sleep, to compare weekday and weekend sleep times, and to attempt to normalize the timing of the circadian sleep/wake cycle by administering bright light in the morning. This was a collaborative project involving high school students and their parents, as well as high school and university faculty members, for the purpose of contributing information to the scientific community while educating students about research processes and their own sleep/wake cycles and patterns. METHODS: Sixty incoming high school seniors kept sleep/wake diaries beginning in August and continuing through 2 weeks after the start of school in September. Sleep diaries were also kept for 1 month in November and 1 month in February. Early-morning light treatments were given to 19 students in the last 2 weeks of November and the last 2 weeks of February. Neuropsychologic performance was measured with computer-administered tests. Paper-and-pencil tests were used for assessment of mood and vigor. A testing period consisted of 2 consecutive days at the beginning and end of November and at the beginning and end of February. Tests were given 3 times per day, ie, in the morning before school (6:30-8:00 AM), during midday lunch periods (11:30 AM to 1:00 PM), and in the afternoon (3:00-4:30 PM), on each of the test days. RESULTS: Adolescents lost as much as 120 minutes of sleep per night during the week after the start of school, and weekend sleep time was also significantly longer (approximately 30 minutes) than that seen before the start of school (August). No significant differences were found between weekday sleep in the summer and weekend sleep during the school year. Early-morning light treatments did not modify total minutes of sleep per night, mood, or computer-administered vigilance test results. All students performed better in the afternoon than in the morning. Students in early morning classes reported being wearier, being less alert, and having to expend greater effort. CONCLUSIONS: The results of this study demonstrated that current high school start times contribute to sleep deprivation among adolescents. Consistent with a delay in circadian sleep phase, students performed better later in the day than in the early morning. However, exposure to bright light in the morning did not change the sleep/wake cycle or improve daytime performance during weekdays. Both short-term and long-term strategies that address the epidemic of sleep deprivation among adolescents will be necessary to improve health and maximize school performance.

Research Support, N.I.H., Extramural

Research Support, Non-U.S. Gov't

Research Support, U.S. Gov't, P.H.S.

PMID: 15930216

65: Am J Geriatr Psychiatry. 2005 May;13(5):420-3.

Bright-light treatment reduces actigraphic-measured daytime sleep in nursing home patients with dementia: a pilot study.

Fetveit A, Bjorvatn B.

Dept. of Public Health and Primary Health Care, Section for General Practice,

University of Bergen, Kalfarveien 31, 5018 Bergen, Norway.

OBJECTIVE: The authors evaluated the effects of bright-light therapy on daytime sleep among nursing home patients with dementia. METHODS: Eleven patients with sleep/wake disturbances received 2 hours/day of morning bright-light exposure for 2 weeks. Sleep was measured with actigraphy and nursing staff diaries. RESULTS: Daytime sleep decreased significantly in the period from rising time to 3:00 P.M. with bright-light treatment. Treatment effects did not last into the 16-week post-treatment period. CONCLUSIONS: Bright light exposure was effective in reducing daytime sleep in nursing home patients with dementia; this finding is possibly related to bright light's acute alerting effects.

Research Support, Non-U.S. Gov't

PMID: 15879592

66: Encephale. 2005 May-Jun;31(3):309-16.

[Selective serotonin reuptake inhibitors in major depressive disorder in children and adolescents (ratio of benefits/risks)]

[Article in French]

Hjalmarsson L, Corcos M, Jeammet P.

Département de Psychiatrie des Adolescents et Adultes jeunes, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris.

Major depressive disorder in children and adolescents is associated with high risk of suicide and persistent functional impairment. While psychological treatments are used as a first line treatment in mild and moderately severe depression in this age group, the number of prescriptions for antidepressant medication (SSRI) has grown in recent years. Recently, FDA and MHRA advised that most of SSRI should not be used to treat MDD under the age of 18 years. They may increase the risk of suicidal thoughts and self harm. We reviewed the recent literature on efficacy and suicide risks of SSRI in depressed young people. Conflicting findings of SSRI efficacy have been reported in clinical studies. The discrepancies could be related to the heterogeneous samples and the absence of a standard definition of treatment effectiveness. In randomised placebo-controlled antidepressant clinical trials (RCT), the assessment of treatment effectiveness is commonly made with the CDRS-R (improvement of 20% or 30% or 40%) and CGI. SSRI demonstrated significantly, but modest, improvement compared with placebo in CGI score of 1 or 2: 10% more for sertraline, 16.8% more for paroxetine and between 16 to 24% more for fluoxetine. In adults, RCT studies have shown placebo response rates of 30% to 50%, drug response rates of 45% to 50% and drug-placebo differences of 18% to 25%. The highest placebo response rates, in young people, may be related to the highly selected group not representative of the general population of depressed patients and/or to the high youths' sensibility of psychotherapy. Patients participating in antidepressant clinical trials have a low BDI and CDI in Emslie's study for example (2002). In adults, previous reports suggest that SSRI use is associated with increased suicidal risk. But the analyse of 48 277 depressed patients participating in RCT for nine FDA approved antidepressants fail to support an overall difference in suicide risk between antidepressants (SSRI) and placebo treated subjects. An inverse relationship between regional change in use of antidepressants (increased) and suicide (decreased) is found in young -people in United States from 1990 and 2000. We can not draw a conclusion from few studies with few -participants. None suicide have been reported in pharmacological studies. And the link between "suicidality" and MDD can not be excluded. The instruments of assessment in depressed young patients are based on extensions of adult procedures. Whereas clinical picture of MDD in children, adolescents and adults have some differences. Depressed youngsters have more pronounced mood lability. Depressed adolescents have more anhedonia than depressed children. Future investigations into the efficacy and safety of treatments for children and adolescents depression should use specific instruments directly built on phenomenological and clinical picture of depressed children and adolescents. Comparison studies of pharmacotherapy, specific psychotherapies (not only CBT) and combined therapies are necessary to identify the adolescents who will benefit the most from specific or combined therapies. Further studies into the factors that influence treatment outcome including clinical picture (clinical dimensions, severity, duration, co morbidity), genetic factor, age, and i-llness course may help identify appropriate treatments for children and adolescents with MDD. Studies should include patients more severely ill, with associated psychiatric troubles, treatment resistance, history of relapses... In clinical studies, the link between "suicidality" and some clinical dimensions (which take part in clinical picture or not) must be analysed by assessing anhedonia, hopelessness feel, impulsive trait, borderline personality, familial inter-action, biological indices. New treatment should be expand and their efficacy and safety must be study: St John's worth, Bright light therapy, Trans-cranial Magnetic Stimulation. In practice: suicide and MDD have a strongest relation and it must be investigate syste-matically during the course of MDD. The suicide risk increases in the context of past history of suicide attempts, hopelessness, psychosis, impulsivity traits, substance abuse, familial dysfunction, life events, open access of arms. The use of SSRI in depressed children and adolescents is also the question of the quality and the support of the consultant and the mode of the prescription.

English Abstract

PMID: 16142045

67: Psychiatr Pol. 2005 May-Jun;39(3):449-58.

[Observations of tolerance of bright light treatment in psychiatry]

[Article in Polish]

Krzystanek M, Krupka-Matuszczyk I, Bargiel-Matusiewicz K.

Katedra i Klinika Psychiatrii i Psychoterapii Slaskiej AM, Katowicach.

Bright light (BL) treatment is a new biological treatment used in psychiatry. The probable mechanisms of action of BL treatment are synchronisation of biological rhythms and increase of serotonin transmission in the human brain. The main indication for BL treatment is seasonal affective disorder (SAD). Indications, tolerance and mechanism of action of BL treatment are still under exploration. AIM OF THE STUDY: To present 3 years of experience from the treatment of different psychiatric disorders with BL. METHOD: The examined group consisted of 104 out-patients with different diagnoses. The mean age was 41.1 and the mean number of sessions of BL treatment was 17.2. Besides-of BL treatment (1 hour, 5000 lux) the patients were treated with psychotropic drugs. Side effects and BL tolerance were observed. RESULTS: Side effects were present in 34 (32.6%) patients. They were: tearsing (11.5%), headaches (6.7%), restlessness and agitation (5.7%), eyeball pain (3.8%) and eye burning (4.8%). Tearsing and eyeball pain subsided in the first 15 minutes, the other symptoms subsided by 1 hour after a session. Six patients discontinued the BL treatment due to intolerance of a side effect. CONCLUSIONS: BL treatment is a safe and well-tolerated form of biological treatment in psychiatry. The absence of a control group limits the specificity of these side effects. New indications for BL treatment may include psychiatric disorders with brain serotoninergic system or biological rhythms disturbances.

English Abstract

PMID: 16149755

68: Sleep. 2005 May 1;28(5):616-23.

Comment in:

Sleep. 2005 May 1;28(5):540-1.

Sleep. 2005 May 1;28(5):548-9.

The treatment of early-morning awakening insomnia with 2 evenings of bright light.

Lack L, Wright H, Kemp K, Gibbon S.

School of Psychology, Flinders University, GPO Box 2100, Adelaide, South

Australia 5001.

STUDY OBJECTIVE: To assess the effectiveness of brief bright-light therapy for the treatment of early-morning awakening insomnia. PARTICIPANTS: Twenty-four healthy adults with early-morning awakening insomnia were assigned to either the bright-light condition (2,500-lux white light) or the control (dim red light) condition. MEASUREMENTS AND RESULTS: The circadian phase of rectal temperature and urinary melatonin rhythms were assessed with 26-hour constant routines before and after 2 evenings of light therapy. Sleep and daytime functioning were monitored using sleep diaries, activity monitors, and mood scales before light therapy and for 4 weeks during the follow-up period. While there were no significant circadian phase changes in the dim-light control group, the bright-light group had significant 2-hour phase delays of circadian temperature and melatonin rhythm. Compared to pretreatment measures, over the 4-week follow-up period, the bright-light group had a greater reduction of time awake after sleep onset, showed a trend toward waking later, and had a greater increase of total sleep time. Participants in the bright-light condition also tended to report greater reductions of negative daytime symptoms, including significantly fewer days of feeling depressed at the 4-week follow-up, as compared with the control group. CONCLUSION: Two evenings of bright-light exposure phase delayed the circadian rhythms of early-morning awakening insomniacs. It also improved diary and actigraphy sleep measures and improved some indexes of daytime functioning for up to 1 month after light exposure. The study suggests that a brief course of evening bright-light therapy can be an effective treatment for early-morning awakening insomniacs who have relatively phase advanced circadian rhythms.

PMID: 16171276

69: Sleep. 2005 May 1;28(5):540-1.

Comment on:

Sleep. 2005 May 1;28(5):616-23.

Is bright light exposure an effective therapy for insomnia?

Bootzin RR.



PMID: 16171264

70: Am J Psychiatry. 2005 Apr;162(4):656-62.

Comment in:

ACP J Club. 2005 Sep-Oct;143(2):48.

Am J Psychiatry. 2006 Jan;163(1):162-3; author reply 163.

Evid Based Ment Health. 2006 Feb;9(1):21.

The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence.

Golden RN, Gaynes BN, Ekstrom RD, Hamer RM, Jacobsen FM, Suppes T, Wisner KL, Nemeroff CB.

Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel

Hill, NC 27599-7160, USA.

OBJECTIVE: The purpose of this study was to assess the evidence base for the efficacy of light therapy in treating mood disorders. METHOD: The authors systematically searched PubMed (January 1975 to July 2003) to identify randomized, controlled trials of light therapy for mood disorders that fulfilled predefined criteria. These articles were abstracted, and data were synthesized by disease and intervention category. RESULTS: Only 13% of the studies met the inclusion criteria. Meta-analyses revealed that a significant reduction in depression symptom severity was associated with bright light treatment (eight studies, having an effect size of 0.84 and 95% confidence interval [CI] of 0.60 to 1.08) and dawn simulation in seasonal affective disorder (five studies; effect size=0.73, 95% CI=0.37 to 1.08) and with bright light treatment in nonseasonal depression (three studies; effect size=0.53, 95% CI=0.18 to 0.89). Bright light as an adjunct to antidepressant pharmacotherapy for nonseasonal depression was not effective (five studies; effect size=-0.01, 95% CI=-0.36 to 0.34). CONCLUSIONS: Many reports of the efficacy of light therapy are not based on rigorous study designs. This analysis of randomized, controlled trials suggests that bright light treatment and dawn simulation for seasonal affective disorder and bright light for nonseasonal depression are efficacious, with effect sizes equivalent to those in most antidepressant pharmacotherapy trials. Adopting standard approaches to light therapy's specific issues (e.g., defining parameters of active versus placebo conditions) and incorporating rigorous designs (e.g., adequate group sizes, randomized assignment) are necessary to evaluate light therapy for mood disorders.
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