三维人格问卷的信度和效度研究

目的:检验中文版三维人格问卷(TPQ)的信度和效度。方法:对538例正常人进行TPQ问卷调查,其中108人首次测评后3周进行重测。采用Cronbachα系数、重测相关系数及结构效度三项指标。结果:总量表、寻求刺激(NS)、躲避伤害(HA)、奖赏依赖(RD)维度的Cronbachα系数分别为0.86、0.70、0.73、0.66。总分、NS、HA、RD维度重测相关系数分别为0.78、0.85、0.84、0.70,P<0.05。验证性因素分析示GFI=0.69,NFI=0.67,NNFI=0.79,CFI=0.79,AGFI=0.67。结论:中文版三维人格问卷具有较好的信度,但结构效度欠佳。     

Personality and seasonal affective disorder: results from the CAN-SAD study

BACKGROUND: Personality factors have been implicated in seasonal affective disorder (SAD). The present study investigated the relationship between the five-factor model of personality (neuroticism, extraversion, openness, agreeableness, conscientiousness) and SAD. METHODS: Ninety-five patients with SAD completed personality measures before and after treatment in a clinical trial and during the summer months. The personality scores of the SAD patients were compared with a matched group of non-seasonal depressed patients and published normative data. Stability and change in personality scores with changes in mood state were assessed. Personality dimensions were evaluated as possible predictors of treatment outcome. RESULTS: SAD patients showed elevated openness scores relative to both non-seasonal depressed patients and norms. Their neuroticism scores were lower than non-seasonal depressed patients, but higher than norms. All personality dimensions showed large and highly significant test-retest correlations but several personality dimensions, particularly neuroticism and extraversion, also showed considerable change with changing mood state. None of the personality dimensions were significantly associated with treatment outcome. LIMITATIONS: Personality assessment relied on self-report. CONCLUSIONS: The personality profile of SAD patients differs from both non-seasonal depressed patients and norms. Elevated openness scores appear to be a unique feature of patients with SAD. Since mood state has a significant impact on personality scores, assessment of personality in SAD patients should ideally be conducted when they are in remission. Further investigation of the relationship between personality and SAD, especially the potential significance of elevated openness scores, is warranted.     

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.     

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.     

A comparison of normal, bipolar and seasonal affective disorder subjects using the Seasonal Pattern Assessment Questionnaire

The Seasonal Pattern Assessment Questionnaire is an instrument for retrospective self-rating of change in mood and vegetative functions with the seasons. It has been used in studies to identify and characterise patients with Seasonal Affective Disorder (SAD) in three countries. In this paper, the test-retest reliability of all items and the sensitivity to differences between groups have been investigated. Clear differences were found between the SAD group and a normal group. A group of bipolar affective disorder patients had intermediate scores on reported seasonal changes between the normal and SAD groups. All groups reported significant changes in mood and vegetative functions during the winter in the direction symptomatic for SAD suggesting that SAD patients may suffer an exaggerated form of a normal seasonal variation.     

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.     

Personality of recovered patients with bipolar affective disorder

Personality traits of 45 patients with bipolar affective disorder who were fully recovered were compared with those of 78 patients with unipolar affective disorder (also fully recovered) and with those of 1172 never mentally ill first-degree relatives. The most striking finding is the similarity in personality between the recovered bipolar and unipolar patients, who both differed substantially from the never-ill group on measures of emotional strength. Bipolar men had normal levels of extraversion, whereas bipolar women, like unipolar women, were introverted.     

The Seasonal Health Questionnaire: a preliminary validation of a new instrument to screen for seasonal affective disorder

BACKGROUND: The main screening tool for Seasonal Affective Disorder (SAD) is the Seasonal Pattern Assessment Questionnaire, but its reliability and validity have been thrown into doubt by several studies. METHOD: In this study we developed a new questionnaire, the Seasonal Health Questionnaire (SHQ), which is scored by computer to derive the four main operational criteria for diagnosis of SAD. A group of clinically diagnosed SAD patients was contrasted with a group of patients with recurrent non-seasonal depressive disorder using the SPAQ and the SHQ. RESULTS: The SHQ could be completed without difficulty by patients with long histories of recurrent mood disorder. The SPAQ and the Rosenthal Criteria were the least specific of the criteria for identifying SAD - misclassifying many non-seasonal patients. CONCLUSIONS: After further development the SHQ may be a more appropriate screening instrument for SAD. The SPAQ should no longer be used for this purpose as it gives misleadingly high estimates of prevalence.     

Personality disorder clusters and the Defence Style Questionnaire

This research examined the relative contribution of 20 defence mechanisms assessed by the 40‐item Defence Style Questionnaire (DSQ‐40) as discriminating variables in predicting membership in personality disorder (PD) clusters. The odd, dramatic and anxious clusters of DSM‐III‐R and the detached, dependent, independent and ambivalent groups of Millon were used as PD types. PDs were assessed by the Coolidge Axis II Inventory and the Millon Clinical Multiaxial Inventory—II in a non‐clinical sample. Results of discriminant function analysis provide empirical support for the usefulness of both DSM and Millon classification schemes. The DSM's odd cluster and Millon's ambivalent types are classified most accurately with the CATI. The MCMI‐II classifies most accurately the DSM's odd and dramatic, and Millon's independent and ambivalent, personality types.     

Prevalence of premenstrual dysphoric disorder in female patients with seasonal affective disorder

BACKGROUND: Both seasonal affective disorder/winter type (SAD) and premenstrual dysphoric disorder (PMDD) are cyclical disorders characterized by so-called atypical depressive symptoms. In the present study we compared the point prevalence rates of PMDD between a sample of premenopausal female patients suffering from SAD and healthy female controls. METHODS: Forty-six female patients with SAD and 46 healthy controls were included in our study. All subjects underwent a semistructured clinical interview according to DSM IV criteria and completed the Seasonal Pattern Assessment Questionnaire. PMDD was diagnosed in a self-rating interview for PMDD according to DSM IV criteria. To verify the diagnosis of PMDD, all patients were followed up in stable summer remission using daily self-rating scales for two full menstrual cycles. RESULTS: Patients with SAD fulfilled significantly more often the diagnostic criteria for PMDD than female healthy controls (46% vs. 2%, respectively; chi-square: P<0.001). CONCLUSIONS: These results provide preliminary evidence for a high point prevalence rate of PMDD in premenopausal females with SAD. CLINICAL IMPLICATIONS: It would be worthwhile to investigate whether an additional diagnosis of PMDD has an impact on the clinical outcome and the response to bright light therapy in female patients with SAD.     

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.     

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.     

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.     

Cognitive characteristics of seasonal affective disorder: A preliminary investigation

Light therapy, the current treatment for Seasonal Affective Disorder (SAD), does not help everyone suffering from SAD. This paper examines whether patients with SAD potentially might benefit from cognitive behaviour therapy by investigating whether they show a similar cognitive profile to those with non-seasonal depression for whom cognitive therapy has been shown to be effective. Ten subjects with SAD were compared to 11 non-seasonally depressed and 10 normal controls on a range of measures including the Automatic Thoughts Questionnaire and the Dysfunctional Assumptions Scale. One-way analysis of variance showed that the SAD group reported significantly more negative automatic thoughts and dysfunctional attitudes than a non-depressed control group but did not differ from a group with non-seasonal depression. The results suggest that patients with SAD may respond to cognitive behaviour therapy like those with non-seasonal depression. Further research is therefore recommended to examine the efficacy of cognitive therapy as a complementary addition to light therapy in the treatment of SAD and to examine other cognitive aspects of SAD.     

Delayed sleep phase syndrome is related to seasonal affective disorder

Background

Both delayed sleep phase syndrome (DSPS) and seasonal affective disorder (SAD) may manifest similar delayed circadian phase problems. However, the relationships and co-morbidity between the two conditions have not been fully studied. The authors examined the comorbidity between DSPS and SAD.

Methods

We recruited a case series of 327 DSPS and 331 controls with normal sleep, roughly matched for age, gender, and ancestry. Both DSPS and controls completed extensive questionnaires about sleep, the morningness-eveningness trait, depression, mania, seasonality of symptoms, etc.

Results

The prevalences of SAD and subsyndromal SAD (S-SAD) were higher in DSPS compared to controls (χ² = 12.65, p = 0.002). DSPS were 3.3 times more likely to report SAD (odds ratio, 3.34; 95% CI, 1.41-7.93) compared to controls as defined by the Seasonal Pattern Assessment Questionnaire (SPAQ). Correspondingly, DSPS showed significantly higher seasonality scores compared to controls in mood, appetite, and energy level subscores and the global seasonality score (t = 3.12, t = 0.002; t = 2.04, p = 0.041; t = 2.64, p = 0.008; and t = 2.15, p = 0.032, respectively). Weight fluctuation during seasons and winter-summer sleep length differences were also significantly higher in DSPS than controls (t = 5.16, p < 0.001 and t = 2.64, p = 0.009, respectively). SAD and S-SAD reported significantly higher eveningness, higher depression self-ratings, and more previous mania symptoms compared to non-seasonal subjects regardless of whether they were DSPS or controls.

Conclusions

These cases suggested that DSPS is partially comorbid with SAD. These data support the hypothesis that DSPS and SAD may share a pathophysiological mechanism causing delayed circadian phase.     

Natural summer and winter sunlight exposure patterns in seasonal affective disorder

Twelve subjects with winter depression who lived in the Chicago area recorded their times of going outside during daylight hours for one week during the winter and one week during the summer. These records produced estimates of the duration of daily sunlight exposure and of perceived dawn, dusk and skeleton photoperiod. There was more than twice as much sunlight exposure in summer compared to winter (3.0 vs. 1.2 h/day). The perceived skeleton photoperiod was 4-5 h longer in summer than winter, with a later perceived dusk contributing more to the lengthening than an earlier perceived dawn. The duration of sunlight exposure and perceived skeleton photoperiod in both seasons was much less than what was possible given the available daylight. These results are discussed with reference to the modern urban life style, bright light treatment of winter seasonal affective disorder, and factors which affect the perceived intensity of sunlight.