Effects of different wavelengths in seasonal affective disorder

The aim of this study was to compare the relative therapeutic efficacies of three different light sources for treating winter depression. A balanced incomplete block crossover design was employed, whereby all patients (n = 18) were randomly assigned to two out of the three treatment conditions: white, red and blue light. The degree of depression was assessed by the 21-item Hamilton Depression Rating Scale. The data suggest that at a photon density of 2.3 × 10¹⁵ photons/s/cm², white light has greater therapeutic benefit than red or blue light. It is clear that a larger sample population should be tested to confirm this result. This preliminary finding indicates that light sources currently in use for phototherapy could not be improved by narrowing the wavelengths provided and shifting them towards either end of the visible spectrum.     

Cognitive-behavioral therapy, light therapy, and their combination in treating seasonal affective disorder

Background: The need to develop supplementary or alternative treatments for seasonal affective disorder (SAD) is underscored by the significant minority (47%) of SAD patients that is refractory to light therapy, the persistence of residual symptoms despite light treatment, and poor long-term compliance with light use. Because preliminary studies suggest that cognitive and behavioral factors are involved in SAD, cognitive-behavioral therapy (CBT) warrants investigation as a possible treatment option. Methods: We piloted a 6-week randomized clinical trial to compare a standard light therapy protocol; a novel, SAD-tailored, group CBT intervention; and their combination in ameliorating and remitting a current SAD episode and as prophylaxis against episode recurrence. Depressive symptom severity and remission rates were assessed at post-treatment and at a 1-year follow-up visit to examine long-term treatment durability. Results: CBT, light therapy, and their combination all demonstrated significant reductions in depressive symptoms on two different outcome measures. Remission rates varied by measure, but did not reach statistical significance. During the subsequent winter, CBT, particularly in combination with light therapy, appeared to improve long-term outcome regarding symptom severity, remission rates, and relapse rates. No CBT-treated participant, with or without light, experienced a full SAD relapse compared to over 60% of those treated with light alone. Limitations: These results should be viewed as preliminary and are limited by the small sample size (n=23) and lack of a control group. Conclusions: The nearly half of SAD patients who do not remit with light alone may benefit from CBT as an adjunct or alternative treatment, especially as a prophylaxis against episode recurrence.     

Ethnic differences in seasonal affective disorder and associated factors among five immigrant groups in Norway

Background

Research studies on seasonal affective disorder (SAD) among immigrant populations are scarce. The objective of this article was to explore the associated risk and protective factors on prevalence of winter SAD (W-SAD), sub syndromal SAD (S-SAD) and Summer-SAD among five immigrant groups living in Oslo, Norway.

Methods

The Oslo Immigrants Health study (innvandrer HUBRO, 2002), is a large cross sectional epidemiological survey conducted among five of the largest immigrant groups living in Oslo. 1047 subjects were included in the analysis out of 3019 who participated in the survey. Mailed questionnaire which included selected items of the seasonal pattern assessment questionnaire (SPAQ), Hopkins symptom check list (HSCL) and other variables were used in the analysis.

Results

The lowest levels of W-SAD were found among Sri Lankan men and women and the highest among Iranians. W-SAD was significantly associated with country of birth, younger age, smoking, presence of mental distress, frequent visits to general practitioner or psychiatrist, self reported poor health and presence of chronic disorders. S-SAD was significantly associated with country of birth, smoking and higher levels of alcohol consumption.

Limitations

SPAQ was not culturally validated. Poor response rate (39.7%) can also be considered as a limitation.

Conclusions

Ethnic differences in W-SAD and S-SAD were observed. Sri Lankans had the lowest levels of W-SAD. However, there is a need for culturally validated instruments and further research must focus on exploring protective factors for SAD.     

Gender differences in seasonal affective disorder (SAD)

Summary 146 women and 44 men (out- and inpatients; treatment sample) with Seasonal Affective Disorder (SAD; winter type) were tested for gender differences in demographic, clinical and seasonal characteristics. Sex ratio in prevalence was (women : men) 3.6 : 1 in unipolar depressives and 2.4 : 1 in bipolars (I and II). Sex ratios varied also between different birth cohorts and men seemed to underreport symptoms. There was no significant difference in symptom-profiles in both genders, however a preponderance of increased eating and different food selection on a trend level occured in women. The female group suffered significantly more often from thyroid disorders and from greater mood variations because of dark and cloudy weather. Women referred themselves to our clinic significantly more frequently as compared to men. In summary gender differences in SAD were similar to those of non-seasonal depression: the extent of gender differences in the prevalence of affective disorders appears to depend on case criteria such as diagnosis (unipolar vs. bipolar), birth cohort and number of symptoms as minimum threshold for diagnosis. We support the idea of applying sex-specific diagnostic criteria for diagnosing depression on the basis of our data and of the literature.     

Mood state dependency of dysfunctional attitudes in bipolar affective disorder

Introduction. Studies of cognitive styles among euthymic people with bipolar affective disorder (BAD) without use of mood induction techniques to access those cognitive styles give misleading impressions of normality of those cognitions. The aim of this study was to assess dysfunctional attitudes of participants with BAD, and control participants with no previous psychiatric histories, after mood inductions.

Methods. Sad and happy moods were induced within 49 BAD and 37 controls. Dysfunctional attitudes were measured following mood inductions using the Dysfunctional Attitude Scale—short form (DAS-24), which has three subscales of achievement, interpersonal, and goal attainment.

Results. It was hypothesised that within BAD the sad mood induction would help in accessing dysfunctional attitudes in all three domains relative to the happy mood induction. This was supported. It was also hypothesised that the mood inductions would not affect dysfunctional attitudes within controls. This was supported. When diagnosis was entered as a between group variable, achievement dysfunctional attitudes were significantly higher in BAD compared to controls after a happy induction.

Conclusions Both sad and happy moods provoked higher levels of dysfunctional attitudes within BAD. Euphoria may be related to elevated achievement dysfunctional attitudes, raising risk for mania.     

The role of fast and slow EEG activity during sleep in males and females with major depressive disorder

Sleep difficulties are highly prevalent in depression, and appear to be a contributing factor in the development and maintenance of symptoms. However, despite the generally acknowledged relationship between sleep and depression, the neurophysiological substrates underlying this relationship still remain unclear. Two main hypotheses were tested in this study. The first hypothesis states that sleep in depression is characterized by inadequate generation of restorative sleep, as indexed by reduced amounts of slow‐wave activity. Conversely, the second hypothesis states that poor sleep in depression is due to intrusions of fast‐frequency activity that may be reflective of a hyperaroused central nervous system. This study aimed to test both hypotheses in a large sample of individuals with clinically validated depression, as well as to examine sex as a moderator. Results suggest that depression is better characterized by an overall decrease in slow‐wave activity, which is related to elevated anxious and depressed mood the following morning. Results also suggest that females may be more likely to experience fast frequency activity related to depression symptom severity.     

Seasonal affective disorder and social deprivation in Aberdeen

Background: Unlike non-seasonal depression, there is some evidence that seasonal affective disorder (SAD) is more common among more affluent socioeconomic groups. Methods: In primary care settings in Aberdeen, 4557 subjects had previously completed a Seasonal Pattern Assessment Questionnaire (SPAQ). From the subjects’ postcodes they were allocated a Carstairs score which placed them in one of seven categories of socioeconomic deprivation. These categories were compared with regard to seasonal pathology from the SPAQ ratings. Results: Complete postcodes and Carstairs scores were established for 3772 (83%) of the 4557 subjects. No statistically significant relationship between socioeconomic deprivation and SPAQ ratings was detected. Limitations: The study population was an affluent one relative to Scotland as a whole which may have reduced the likelihood of a positive finding. The study was conducted 7 years after the census on which postcode deprivation scores were calculated, and changes therein may have occurred. Conclusions: SAD either has no relationship to social deprivation or is associated with affluence and this distinguishes it from non-seasonal depression.     

Dysfunctional beliefs and attitudes about sleep in children

The objective of the study was to determine whether associations between dysfunctional beliefs and attitudes about sleep and sleep disturbance are evident in children. Cross‐sectional data were collected from 123 children aged 8–10 years (49% boys). The participants came from ethnically diverse backgrounds from two inner‐city schools in London, UK. Children completed the Sleep Self‐Report (SSR) and the Dysfunctional Beliefs and Attitudes about Sleep (DBAS) questionnaire (which was adapted for use with children). Parents completed the Child Sleep Habits Questionnaire (CSHQ). The total DBAS score was associated with sleep disturbances defined as total SSR score (β = 0.40, P < 0.001, r² = 0.15), the SSR insomnia items (β = 0.29, P < 0.01, r² = 0.08) and the total CSHQ score (β = 0.22, P < 0.05, r² = 0.04). Some dysfunctional beliefs about sleep predicted sleep disturbance to a greater extent than others. For example, when controlling for the other DBAS subscales, the ‘control and predictability of sleep’ subscale, but not the ‘sleep requirements expectations’ subscale, predicted total SSR score and SSR insomnia items. Given this preliminary evidence that dysfunctional beliefs and attitudes about sleep appear to be associated with sleep difficulties in children, future work is needed to further developmentally adapt a version of the DBAS appropriate for use with children.     

Memory mood congruency phenomenon in bipolar I disorder and major depression disorder patients

The objective of the present study was to evaluate memory performance in tasks with and without affective content (to confirm the mood congruency phenomenon) in acutely admitted patients with bipolar I disorder (BD) and major depression disorder (MDD) and in healthy participants. Seventy-eight participants (24 BD, 29 MDD, and 25 healthy controls) were evaluated. Three word lists were used as the memory task with affective content (positive, negative and indifferent). Psychiatric symptoms were also evaluated with rating scales (Young Mania Rating Scale for mania and Hamilton Depression Rating Scale for depression). Patients were selected during the first week of hospitalization. BD patients showed higher scores in the word span with positive tone than MDD patients and healthy controls (P = 0.002). No other difference was observed for tests with affective tone. MDD patients presented significantly lower scores in the Mini-Mental State Exam, logical memory test, visual recognition span, and digit span, while BD patients presented lower scores in the visual recognition test and digit span. Mood congruency effect was found for word span with positive tone among BD patients but no similar effect was observed among MDD patients for negative items. MDD patients presented more memory impairment than BD patients, but BD patients also showed memory impairment.     

Cardiac stability at differing levels of temporal analysis in panic disorder,post‐traumatic stress disorder,and healthy controls

The panic disorder (PD) literature provides evidence for both physiologic rigidity and instability as pathognomonic features of this disorder. This ambiguity may be a result of viewing PD at differential levels of temporal analysis. We assessed cardiac variability across three levels of temporal scale in PD patients, post‐traumatic stress disorder (PTSD) patients, and healthy controls. Sixteen healthy controls, 14 PD patients, 23 PTSD patients, and 16 PTSD + PD patients presented for a polysomnogram. Differences were assessed in respiratory sinus arrhythmia (RSA), autoregressive stability of heart rate (HR), and the number of nonspecific accelerations in HR over the night. No differences in RSA were found between groups; however, PD patients exhibited significantly lower autoregressive HR stability, and all patients had significantly more HR accelerations than controls. These data reinforce prior findings demonstrating physiologic instability in PD and indicate that prior equivocalities regarding physiologic variability in PD may be due to limited temporal scaling of measurements.     

The assessment of anhedonia in clinical and non-clinical populations: further validation of the Snaith-Hamilton Pleasure Scale (SHAPS)

BACKGROUND: Anhedonia, the inability to experience pleasure, is a major endophenotype of depression. In addition to this, it is an important clinical feature of schizophrenia and substance abuse disorders. Valid instruments to measure anhedonia are sparse. METHODS: In the present study, a short, 14-item instrument, the Snaith-Hamilton Pleasure Scale (SHAPS) to measure anhedonia in normal and clinical samples was further validated. Various aspects of the reliability and validity of the SHAPS that have not been addressed before, were examined in three separate studies. First, we assessed the internal consistency, convergent and discriminative validity of the SHAPS in a non-clinical sample. Second, the test-retest reliability of the SHAPS was investigated in another sample. In the third study, the internal consistency, convergent and discriminative validity of the SHAPS was tested by administering the scale in three clinical samples of psychiatric inpatients. RESULTS: The SHAPS was found to be highly reliable in terms of internal consistency and test-retest stability. Further, the SHAPS correlated in a theoretically meaningful way with other measures of affect and personality. Patients with a depression, psychosis or substance dependence scored significantly higher on the SHAPS than non-patient controls. Patients with a depression displayed the highest SHAPS-score. LIMITATIONS: The absence of structured assessment data to validate the clinical diagnoses. CONCLUSIONS: The current study shows that the SHAPS is a reliable and valid questionnaire to assess hedonic tone in patient and non-patient populations. Because it is a brief scale it seems to be a very useful instrument for measuring anhedonia in clinical and research settings.     

No association of the tryptophan hydroxylase gene with bipolar affective disorder,unipolar affective disorder,or suicidal behaviour in major affective disorder

Tryptophan hydroxylase (TPH) is the rate-limiting enzyme in the synthesis of 5-hydroxytryptamine (5-HT). An association study in bipolar affective disorder I or unipolar major affective disorder was performed by using a Bfa I restriction site polymorphism within intron 7 of the tryptophan hydroxylase gene. A total of 118 bipolar, 125 unipolar, and 437 control subjects were used in the study (1:3.7 bipolar:control, 1:3.5 unipolar:control). There were no significant differences in TPH allele or genotype frequencies between the affective disorder and control groups. In addition, bipolar and/or unipolar subjects with or without a history of suicide attempts were compared for the TPH polymorphism. No significant differences were found between suicidal and nonsuicidal groups in major affective disorder, in contrast to a previous study suggesting an association of this polymorphism with a history of suicide attempts among alcoholic violent offenders. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 81:245–247, 1998. © 1998 Wiley-Liss, Inc.     

Diagnoses in school-age children of bipolar affective disorder patients and normal controls

A family study of psychiatric diagnoses was performed in 29 children of bipolar patients and 37 children of normal controls, ages 6-17. There were no differences in major or minor affective diagnoses between the patient and control groups, but there was an increase of non-specific diagnoses in the patient group. Using DSM-III criteria, 10% of patients' children and 14% of controls' children had had at least one episode of major depression. This suggests that major depression in children is not familially related to adult bipolar major affective disorder. The observed prevalence of depression in childhood is increased when both direct interview of children and interview of parents are performed.     

Differences in beliefs about mood between people with and without bipolar disorder

Psychological models of bipolar disorder (BD), such as the self‐regulation model (SRM; Leventhal, Nerenz, & Steele, 1984), highlight the crucial role of beliefs about mood in relapse vulnerability. To date, no studies have directly compared these beliefs between people with and without BD. Based on the SRM, the current research examined beliefs about mood in people with and without BD and explored the impact of current affect on these beliefs. Fifty euthymic people with a diagnosis of BD and 50 controls were recruited through an online screening study, clinical services, and support organizations. Experience sampling methodology (ESM) was used to assess beliefs (according to the Brief Illness Perceptions Questionnaire; Broadbent, Petrie, Main, & Weinman, 2006) across a typical week of everyday life. Data were analysed using multilevel modelling. Forty‐two people with a diagnosis of BD and 50 controls were included in the analyses. Results indicated that the BD group reported less control over mood, a shorter duration of mood, and less understanding of mood and were more likely to report the cause of depressive symptoms as something internal, compared with controls. When controlling for current affect, the BD group also reported more positive consequences, made more internal attributions for hypomanic symptoms, and reported less concern about mood, compared with controls. Findings suggest important differences in beliefs about mood between people with and without BD that are not the result of current affect. These beliefs may be particularly important in understanding underlying vulnerability to future relapse into depression and/or mania.     

Effects of melatonin on performance testing in patients with seasonal affective disorder

Psychomotor performance and memory were assessed in 6 patients with seasonal affective disorder following one week of daily administration of oral melatonin. No effect was noted on either vigilance or memory testing, but reaction time on a simple visual/tactile task was significantly reduced. Identical testing following a week of placebo administration showed no changes from baseline. Clinical status was monitored by both observer and self ratings; no clinical changes were detected that could account for the performance difference. The reaction time finding is in contrast to a previous report of a reaction time increase following melatonin administration. We discuss the possibility that this discrepancy is due to different dosages of melatonin administered or to the effects of melatonin on circadian rhythms of performance.     

The role of presleep negative emotion in sleep physiology

Although daytime emotional stressful events are often presumed to cause sleep disturbances, the few studies of stressful life events on sleep physiology have resulted in various and contradictory findings. As research has focused in particular on stress in itself, the present study is the first to investigate the effect using polysomnography (PSG). Results indicate a significant increase in sleep fragmentation, as expressed by decreased sleep efficiency, total sleep time, percentage of rapid eye movement (REM) sleep, and an increased wake after sleep onset latency, total time awake, latency to SWS, number of awakenings and number of awakenings from REM sleep. The results demonstrate that negative emotion correlates with enhanced sleep fragmentation helping us to understand why sleep patterns change and how sleep disturbances may develop.     

Effects of sleep deprivation and exercise on cognitive, motor performance and mood

This study examined the effect of 30 h of sleep deprivation and intermittent physical exercise, on both cognitive and psychomotor function as well subjective ratings of mood. Six subjects with the following physical characteristics participated in the study (Mean +/- S.D.): age 22 +/- 0.3 years, height 180 +/- 5 cm, body mass: 77 +/- 5 kg, VO2peak 44 +/- 5 ml kg(-1) min(-1). Three subjects engaged in normal sedentary activities while three others cycled on a cycle ergometer at 50% VO2peak for 20 min out of every 2 h during 30 h of sleep deprivation. One week later sleep deprivation was repeated with a cross over of subjects. Every 4 h, subjects completed simple and two-choice reaction time tasks at both rest and during exercise, a computerized tracking task, a number cancellation task, and an assessment of subjective mood state as measured by the POMS questionnaire. A 3 x 4 repeated measures ANOVA revealed that resting but not exercising reaction times were significantly slower with sleep deprivation. Sleep deprivation was also associated with significantly greater negative disturbances to subjective vigour, fatigue and depression assessed by the Profile of Mood States questionnaire. Compared to those who have been deprived of sleep alone, individuals that performed 5 h of intermittent moderate exercise during 30 h of sleep deprivation appeared to be more vulnerable to negative mood disturbances and impairment in reaction times. This could result in greater risk of accident due to a reduced capacity to respond quickly.     

Mood and metabolic consequences of sleep deprivation as a potential endophenotype’ in bipolar disorder

It has been commonly recognized that circadian rhythm and sleep/wake cycle are causally involved in bipolar disorder. There has been a paucity of systematic research considering the relations between sleep and mood states in bipolar disorder. The current study examines the possible influences of sleep deprivation on mood states and endocrine functions among first-degree relatives of patients with bipolar disorder and healthy controls. Blood samples were taken at two time points in the consecutive mornings at predeprivation and postdeprivation periods. Participants simultaneously completed the Profiles of Mood States at two time points after giving blood samples. Plasma T3 and TSH levels increased after total sleep deprivation in both groups. Sleep deprivation induced TSH levels were reversely associated with depression–dejection among healthy controls. A paradoxical effect was detected for only the first-degree relatives of the patients that changes in plasma cortisol levels negatively linked to depression–dejection and anger–hostility scores after total sleep deprivation. Plasma DHEA levels became correlated with vigor-activity scores after sleep deprivation among first-degree relatives of bipolar patients. On the contrary, significant associations of depression–dejection, anger–hostility, and confusion–bewilderment with the baseline plasma DHEA levels became statistically trivial in the postdeprivation period. Findings suggested that first-degree relatives of patients with bipolar disorder had completely distinct characteristics with respect to sleep deprivation induced responses in terms of associations between endocrine functions and mood states as compared to individuals whose relatives had no psychiatric problems. Considering the relationships between endocrine functions and mood states among relatives of the patients, it appears like sleep deprivation changes the receptor sensitivity which probably plays a pivotal role on mood outcomes among the first-degree relatives of patients with bipolar disorder.     

Association of polymorphisms in HCN4 with mood disorders and obsessive compulsive disorder

Hyperpolarization activated cyclic nucleotide-gated (HCN) potassium channels are implicated in the control of neuronal excitability and are expressed widely in the brain. HCN4 is expressed in brain regions relevant to mood and anxiety disorders including specific thalamic nuclei, the basolateral amygdala, and the midbrain dopamine system. We therefore examined the association of HCN4 with a group of mood and anxiety disorders. We genotyped nine tag SNPs in the HCN4 gene using Sequenom iPLEX Gold technology in 285 Caucasian patients with DSM-IV mood disorders and/or obsessive compulsive disorder and 384 Caucasian controls. HCN4 polymorphisms were analyzed using single marker and haplotype-based association methods. Three SNPs showed nominal association in our population (rs12905211, rs3859014, rs498005). SNP rs12905211 maintained significance after Bonferroni correction, with allele T and haplotype CTC overrepresented in cases. These findings suggest HCN4 as a genetic susceptibility factor for mood and anxiety disorders; however, these results will require replication using a larger sample.