Multi-center study of seasonal affective disorders in Japan. A preliminary report

A multi-center study on seasonal affective disorder (SAD) was conducted from the autumn of 1988 to the spring of 1989 with the cooperation of 16 facilities in Japan. Forty-six SAD patients were identified among 1104 respondents to our advertisements in mass media, or patients seen at the outpatient clinics. Essentially similar findings to other previous reports were obtained in terms of onset age of the first episode, duration of episode, high proportion of depression in first-degree relatives and atypical vegetative symptoms. However, a nearly equal sex ratio, together with a high proportion of unipolar depression, is characteristic of the present study. Increased appetite and carbohydrate craving were predominant only in female patients, whereas hypersomnia was prominent in both sexes. Effective response to light therapy was found in 17 SAD patients. However, a controlled study on a large number of patients is required to allow final conclusions on the efficacy of light therapy in Japanese SAD patients.     

Loneliness and self-consciousness in high-school students

To examine relationships between loneliness and various aspects of self-consciousness in high-school students, UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1980), Self-Esteem Scale (Rosenberg, 1979), Self-Consciousness Scale (Fenigstein, Scheier, & Buss, 1975), Self-Monitoring Scale (Synder, 1974), and a High-School Life Questionnaire were administered to the first grade students in a high school (N = 182). Loneliness (alpha = .885), higher for males than for females, was significantly correlated with various aspects of their high-school lives. Loneliness was negatively correlated with self-esteem and self-monitoring, and was positively correlated with social anxiety. Only for males, a positive correlation was obtained between loneliness and private self-consciousness. Discriminant analysis and other correlational analyses also suggested that loneliness in males was related to various aspects of self-consciousness.     

EEG mapping in seasonal affective disorder

Given that the nature of hemispheric dysfunction is different in heterogeneous disorders, in the present investigation EEG power mapping was applied to establish neurophysiological profiles that might potentially discriminate patients with seasonal affective disorder (SAD) among other affective disorders. The baseline resting EEG activity was recorded from 31 depressed SAD patients and 30 controls. Power in the delta, theta-1, theta-2, alpha, beta-1 and beta-2 frequency bands was extracted by Fourier transformation. Patients were found to have a lower delta (in central, parietal, occipital, temporal, posterior-temporal areas), theta-1 (in central and parietal), theta-2 (in anterior-frontal, parietal, occipital) and alpha activity (in anterior-frontal, midfrontal, central, parietal and occipital areas) than controls. SAD subjects showed, compared to controls, an asymmetrical distribution of delta, theta-1, theta-2 and alpha activity in parietal and temporal regions due to an increase of EEG power over the right electrode sites, and beta activity in the lateral frontal region due to an increase of beta power over the right electrode site. It is assumed that differential hemispheric contributions of EEG spectra may discriminate between the varieties of depression or different depressive states.     

Cognitive-behavioral factors in seasonal affective disorder

To longitudinally examine cognitive-behavioral correlates of seasonal affective disorder (SAD), the authors assessed women with a history of SAD and nondepressed, matched controls across fall, winter, and summer. SAD history participants reported more automatic negative thoughts throughout the year than controls and demonstrated a progression from decreased activity enjoyment during fall to reduced activity frequency during winter. Ruminative response style, measured in fall, predicted symptom severity during the winter. Across assessments, SAD history women endorsed greater depressive affect in response to low light intensity stimuli than to bright or ambiguous intensity stimuli, but less depressed mood to bright light stimuli than controls. These results suggest that the cognitive-behavioral factors related to nonseasonal depression may play a role in SAD.     

One pacemaker in seasonal affective disorder

Patients with winter seasonal affective disorder (SAD) often have abnormalities in the resetting of their circadian clock. The circadian cycle appears to be variable across days among these patients, deviating from the exact 24 hours, and peaking at unstable times. The findings suggest that the mean free-running circadian period is longer in winter SAD patients compared to healthy subjects. It is hypothesized that there would be a singular circadian pacemaker in the patients against the two pacemakers in healthy subjects.     

Mortality in affective disorders

BACKGROUND: To investigate the mortality rates in affective disorders due to unnatural and natural causes with respect to illness subtype and social-demographic features. METHODS: Mortality data were determined from a prospective study of 354 outpatients with affective disorders during a follow-up period of 5 years. Death from natural and unnatural causes was compared to sex- and age-specific expectations in the general population. Standardized mortality rates (SMR) in diagnostic subgroups and the influence of social-demographic features were investigated. RESULTS: The observed 30 deaths represented nearly three times (SMR, 2.9) the number expected on the basis of age- and sex-standardized reference population rates. Death from natural causes occurred with the same rate as expected (SMR, 1.0), death from unnatural causes was 28.8 times higher than expected. Women with affective disorders had a considerable high risk to die from unnatural causes (SMR, 47.1). A significant excess of unnatural death was found in all subtypes of affective disorders, particularly in recurrent major depressive episodes (SMR, 46.7). LIMITATIONS: The sample was restricted in size. Therefore subgroup differences and multiple relationships of risk factors could not be analyzed with high statistical power. CONCLUSIONS: The results corroborate earlier findings of excess mortality in major affective disorders and strengthen the view that suffering from recurrent major depression confers per se an important biological risk for suicide. Natural causes of death in affective disorders are comparable to expectations from reference populations. Social-demographic characteristics may contribute to an additional risk of premature death by suicide, particularly in women.     

Prevalence of patients with lysosomal storage disorders and peroxisomal disorders: A nationwide survey in Japan

IntroductionLysosomal storage disorders and peroxisomal disorders are rare diseases caused by the accumulation of substrates of the metabolic pathway within lysosomes and peroxisomes, respectively. Owing to the rarity of these diseases, the prevalence of lysosomal storage disorders and peroxisomal disorders in Japan is unknown. Therefore, we conducted a nationwide survey to estimate the number of patients with lysosomal storage disorders and peroxisomal disorders in Japan.MethodsA nationwide survey was conducted following the “Manual of nationwide epidemiological survey for understanding patient number and clinical epidemiology of rare diseases (3rd version)”. A questionnaire asking for detailed information, such as disease phenotypes and medical history, was created and sent to 504 institutions with doctors who have experience in treating patients with lysosomal storage disorders and peroxisomal disorders.ResultA total of 303 completed questionnaires were collected from 504 institutions (response rate: 60.1%). The number of patients was estimated by calculating the rate/frequency of overlap. The estimated number of patients was 1658 (±264.8) for Fabry disease, 72 (±11.3) for mucopolysaccharidosis I, 275 (±49.9) for mucopolysaccharidosis II, 211 (±31.3) for Gaucher disease, 124 (±25.8) for Pompe disease, 83 (±44.3) for metachromatic leukodystrophy, 57 (±9.4) for Niemann-Pick type C, and 262 (±42.3) for adrenoleukodystrophy. In addition the birth prevalence was calculated using the estimated number of patients and birth year data for each disease, and was 1.25 for Fabry disease, 0.09 for mucopolysaccharidosis I, 0.38 for mucopolysaccharidosis II, 0.19 for Gaucher disease, 0.14 for Pompe disease, 0.16 for metachromatic leukodystrophy, 0.16 for Niemann-Pick type C, and 0.20 for adrenoleukodystrophy.DiscussionAmong the diseases analyzed, the disease with the highest prevalence was Fabry disease, followed by mucopolysaccharidosis II, adrenoleukodystrophy, Gaucher disease and metachromatic leukodystrophy. In particular, the high prevalence of mucopolysaccharidosis II and Gaucher disease type II was a feature characteristic of Japan.ConclusionWe estimated the number of patients with lysosomal storage disorders and peroxisomal disorders in Japan. The details of the age at diagnosis and treatment methods for each disease were clarified, and will be useful for the early diagnosis of these patients and to provide appropriate treatments. Furthermore, our results suggest that supportive care and the development of an environment that can provide optimal medical care is important in the future.     

Psoralens in association with seasonal affective disorder

There is a diurnal variation in the pineal serotonin content, with a maximum at 7–8 h after the onset of light and a minimum at 3–4 h after the onset of darkness in rats. The levels of serotonin and melatonin can rapidly be altered by changing the level of ambient light. The diurnal changes in serotonergic activity are hypothesized to counteract two phenomena. First, the increased levels of serotonin would decrease the high propensity to drowsiness in the afternoon. Second, the decreased levels of serotonin would also decrease the high propensity to waking up at night, which occurs because of decreased melatonin secretion.     

Why not treat melancholia with melatonin and tryptophan and treat seasonal affective disorders with bright light?

Symptoms, signs, and biologic markers in melancholia are suggested to be secondary to a deficiency of melatonin, with the resultant increase of monoamine oxidase activity, increase in plasma cortisol, and alteration of sleep physiology. Tryptophan and melatonin, given shortly before bedtime, seem to be rational treatment for melancholia. Bright light may be effective in seasonal affective disorder because it markedly strengthens the zeitgeber that controls biologic rhythms in human beings.     

Assortative mating and affective disorders

Seventy-two spouses of subjects with recurrent primary affective disorders (PAD), were investigated for the presence of psychiatric disorders in their lives and in those of their first degree relatives, and compared with 71 spouses of non-psychiatrically ill control subjects. No difference was found in the risk for PAD; on the other hand spouses of affective patients manifested a greater occurrence of psychiatric disorders belonging to the affective spectrum, as did their respective first-degree relatives.     

Assortative mating in affective disorders

Assortative mating was determined in 170 spouses of patients with major affective illness (bipolar and unipolar). An increase in affective disorders was found in both wives of affected men and husbands of affected women. The data suggest that assortative mating is present in the familial transmission of affective disorder.     

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.     

Extrapineal melatonin and exogenous serotonin in seasonal affective disorder

Visible light inhibits the binding of melatonin and serotonin to cultured human peripheral blood mononuclear leukocytes (PBMLs) in winter. The decreased binding switches the metabolism in PBMLs towards serotonin synthesis, resulting in the reduced production of melatonin. The ingestion of L-tryptophan during the day is hypothesized to increase the levels of melatonin, released from the gastrointestinal tract, in patients with winter seasonal affective disorder (SAD). Due to the relative shortage of light, coincident with a predisposed metabolic error, there would be no switch towards serotonin synthesis among winter SAD patients in winter. The rate of serotonin synthesis could thus remain inadequately low to maintain optimal mood in winter SAD patients.     

Phototherapy and its mechanisms of action in seasonal affective disorder

Eleven depressed patients with seasonal affective disorder completed three different treatments of 1 week each given in a balanced order with a 1-week withdrawal between each week of treatment. The three treatments were photoperiod extension with bright light, or with dim light, and light augmentation with bright light without a change in photoperiod. Most patients improved on all treatments, with a trend in favour of bright light over dim. Only light augmentation was significantly better than dim light and was also superior to photoperiod extension. These findings do not replicate earlier studies and, as the most successful treatment involved no change in photoperiod, they suggest that modification of melatonin secretion may not be the mechanism of action of phototherapy.     

HLA antigens in affective disorders and schizophrenia

The distribution of HLA antigen frequencies has been studied in patients with affective disorders. There were no significant differences between bipolar patients, unipolar patients, or controls. Preliminary data on HLA antigen distribution in schizophrenic patients are reported. Our negative results in affective disorders are discussed in relation to HLA studies reported from other laboratories, with special reference to some potential methodological problems.     

Concordance of atopic and affective disorders

The personal and family history of bronchial asthma and/or hay fever was obtained from a series of 82 psychiatric patients. We report a significantly higher incidence of atopic disorders in affective patients (16/48) than in schizophrenic patients (2/34) (chi-square = 8.754, P less than 0.005). There was also a significantly higher incidence of atopic disorders among the first-degree relatives of patients with affective disorders (48/356) than among the first-degree relatives of patients with schizophrenia (10/182) (chi-square 8.501, P less than 0.005).