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发表于 06-7-17 16:18:23
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先翻译一些东东看下：）
也许这种病例不多，不过我有兴趣：）先摘译一则东东吧：
What is SAD?
什么是季节性情感障碍？
Throughout the centuries, poets have described a sense of sadness, loss and lethargy which can accompany the shortening days of fall and winter. Many cultures and religions have winter festivals associated with candles or fire. Many of us notice tiredness, a bit of weight gain, difficulty getting out of bed and bouts of "the blues" as fall turns to winter.
千百年来，诗人作品中常描述秋冬季节伤感慵懒的情绪，许多文化、宗教中还有冬季燃起蜡烛或篝火的节日，许多人也会在秋冬季感觉体重增加、乏力、情绪低落。
However some people experience an exaggerated form of these symptoms. Their depression and lack of energy become debilitating. Work and relationships suffer. This condition, known as Seasonal Affective Disorder (SAD) may affect over 10 million Americans while the milder, "Winter Blues" may affect a larger number of individuals.
但有些人这些症状非常明显，抑郁与无力干扰了工作与人际关系，这就是影响上千万美国人的季节性情感障碍，而较轻微的冬季忧郁则影响着更多人。
The typical symptoms of SAD include depression, lack of energy, increased need for sleep, a craving for sweets and weight gain. Symptoms begin in the fall, peak in the winter and usually resolve in the spring. Some individuals experience great bursts of energy and creativity in the spring or early summer. Susceptible individuals who work in buildings without windows may experience SAD-type symptoms at any time of year. Some people with SAD have mild or occasionally severe periods of mania during the spring or summer. If the symptoms are mild, no treatment may be necessary. If they are problematic, then a mood stabilizer such as Lithium might be considered. There is a smaller group of individuals who suffer from summer depression.
典型的季节性情感障碍症状是抑郁、乏力、嗜睡、嗜甜品、体重增加。症状由秋季起至冬季达到顶峰，一般春季消褪。有的人在春夏精力过盛。敏感的人在任何季节在没有窗子的建筑中都会感受季节性情感障碍的症状。有的在春夏季有轻或偶尔躁狂症状。如轻微，可不治疗，如严重可考虑锂盐等情绪稳定剂。少数人有夏季抑郁。
SAD is recognized in the DSM-IV (The American Psychiatric Association's diagnostic manual) as a subtype of major depressive episode. The classic major depression involves decreased appetite, decreased sleep, and often, poor appetite and weight loss. It has long been recognized that some depressed individuals had a "atypical depression" with increased sleep and appetite along with decreased energy. Some, but not all of these atypical individuals also had a seasonal pattern. Some people with winter depression also have mild or occasionally severe manic mood swings in the spring and summer. If these episodes are severe, the individual might be diagnosed with Bipolar Disorder. (formerly called manic depressive illness)
美国心理学会的诊断手册中把季节性情感障碍归为抑郁的亚型。典型抑郁症状有食欲、睡眠减少、体重降低。有的个体有“非典型抑郁”症状，睡眠、食欲增加，体力下降。有些，但不是所有的非典型抑郁患者都呈现季节性。有些人有冬季抑郁症，春夏也有轻躁或间或躁狂情绪变化。如果症状严重，可能被诊断为双相障碍。
Epidemiology of SAD
季节性情感障碍流行病学研究
About 70-80% of those with SAD are women. The most common age of onset is in one's thirties, but cases of childhood SAD have been reported and successfully treated. For every individual with full blown SAD, there are many more with milder "Winter Blues." The incidence of SAD increases with increasing latitude up to a point, but does not continue increasing all the way to the poles. There seems to be interplay between an individual's innate vulnerability and her degree of light exposure. For instance, one person might feel fine all year in Maryland but develop SAD when she moves to Toronto. Another individual may be symptomatic in Baltimore, but have few symptoms in Miami. Some individuals who work long hours inside office buildings with few windows may experience symptoms all year round. Some very sensitive individuals may note changes in mood during long stretches of cloudy weather.
约70-80％季节性情感障碍患者为女性。常见年龄群为30-40，但有儿童患季节性情感障碍并治愈的报告。相对完全季节性情感障碍患者来说，“冬季忧郁”影响人数更多。一般所处纬度越高，患病机率越大，但此规律并非一直延续至南北两极。个人易患病特质与光照程度有相互作用。如：在马里兰州（美国中部偏东的一个州。）全年无事的人可能在搬到多伦多（加拿大安大略省首府和最大城市）后出现季节性情感障碍；而在巴尔的摩（马里兰州北部一城市）可能有症状但在迈阿密（佛罗里达州东南部的一座城市）则可能无症状。有些长时间在窗子很少的办公室内工作的人可能全年都有季节性情感障碍症状。部分非常敏感者可能在多云天气中感觉到情绪变化。
Theories about how light affects mood and sleep
光照影响情绪及睡眠的理论
In 1984, a psychiatrist at NIMH, Norman Rosenthal, published a paper on the use of bright light therapy in patients with this disorder. Since then, a large number of well-designed studies have confirmed and refined these findings. Researchers are still investigating mode by which bright light can lift depression or reset a sleep cycle. One theory is that an area of the brain, near the visual pathway, the suprachiasmatic nucleus responds to light by sending out a signal to suppress the secretion of a hormone called melatonin. Brain studies suggest that there is impairment serotonin function in neurons leading to the suprachiasmatic nucleus.
1984年心理健康研究所心理学家Norman Rosenthal发表了一篇关于光照疗法治疗此种障碍的论文。之后，大量计划精密的研究证实并优化了这些成果。研究人员还在调查光线减轻抑郁和调整睡眠周期的模式。一种理论认为大脑主导光线通路附近的某一区域――视交叉上核――受光线影响发出信号，抑制褪黑素的分泌。大脑研究表明引导视交叉上核的神经元5-羟色胺功能有损伤。
Initial theories suggested a pathway from the retina to the suprachiasmatic nucleus. However some recent research indicated that bright light applied to the back of an individual's knee could shift human circadian rhythms. (Daily sleep-wake cycle) This suggests that the bloodstream, not just the neurons of the visual pathways, might mediate the biological clock.
初步理论表明视网膜至视交叉上核间有一通道。但近期一些研究表明对患者膝后进行光照可能调整人的生理节奏。这表明不仅视觉通道的神经元，而且血流都可能调整生物钟。
How the Light Box is used
如何使用灯箱（微寒！）
Before embarking on a course of light treatment, it is best to have a complete psychiatric evaluation. Sometimes a medical illness or another psychiatric condition can masquerade as depression. Discuss various treatment alternatives with your doctor. Light therapy does take time, and regular use. Like exercise, not everyone who would benefit from it will actually do it on a regular basis. Your doctor will discuss the various types of light boxes or visors available. The time spent in front of the light is related to the intensity of the light source and the distance one sits from the light. The light devices cost about $250 to $500 and often are not covered by insurance. I will often lend out a box for a month so that the individual can see whether it helps before purchasing a box.
进行光线治疗前，最好进行全面的精神病学评估。有时身体疾病或其他精神状况可能表现出抑郁症状。与医生探讨多种治疗方式。光线疗法较费时并需固定使用。同锻炼一样，不是所有会受益的人都能做到定期进行。医生会讨论各种灯箱类型。治疗时间与光线强度及距离都有关系。灯价格约为250-500美元，一般不在医保范围之内。（原作者称可借灯试用，我们是鞭长莫及了。）
Some individuals who use a 10,000-lux box may only need 30 minutes of daily light treatment. However, the amount of light needed varies widely from individual to individual. The light treatment is most often done in the morning, but studies have suggested that either morning or evening light can help SAD. Some people may get insomnia when they use the light in the evening. Initially, researchers felt that one needed full spectrum light. Now, studies suggest that regular fluorescent lights will work as well. UV (ultraviolet) light can damage eyes and skin, so it must be filtered out. It is best to buy a commercially built light box to be sure of the exact amount of light and to be sure that there are no isolated "hot spots" which could damage eyes. Many people still prefer full spectrum (minus UV) light because it is closest to natural lighting.
有些人用1万勒克斯的灯箱，每天可能只需20分钟光照。但所需光度因人而异。光照疗法常用于清晨，但研究表明早晚光线都对季节性情感障碍有益。有人晚间使用会有失眠。起初研究人员认为需要全光谱光线。现在研究表明普通荧光也有效果。紫外光会伤害眼睛和皮肤，需滤出。最好使用商业产品保证光照量及没有可能伤害眼睛的“热点”。许多人还是使用全光谱光线（滤除紫外线）因为其更接近自然光。
The individual measures the distance from her face to the light source. This measurement is important, and should be repeated daily for several days and occasionally after that. The light needs to strike one's eyes, but one does not need to look directly into the light source. It is fine to occasionally glance directly into the light. Many people read a book or eat breakfast while using the lights. Sitting still for 30 minutes to several hours is not an option for some people. For these people, the light visor is an option. Others are able to take one of the compact light boxes to work and use it for several hours. It is best to use the light source in an uninterrupted time block, but it can be helpful even with some interruptions.
用者测量脸于光源距离，这很重要，并应反复测量几天，之后也要偶尔测量。光线要达到人的眼睛，但不必直视光源。偶尔看几眼没有关系。许多人在光照下看书或吃早饭。静坐30分钟到几小时对有些人不可能。这些人可使用light visor（怀疑是像眼罩一样，但可发光的东东，不知道叫什么）。也可以使用袖珍灯箱工作时使用几个小时。最好不间断光照，但有间断也可有效果。
Long term treatment compliance is often more difficult than one might initially anticipate. This is an important reason to have a professional monitoring. Having to account for your regular use (or the lack thereof) is a powerful motivator. It is also helpful to have an outside objective individual to help monitor your response to the treatment.
长期依从治疗通常比预想的困难，所以必须有专业指导。坚持固定使用。有客观的人员监督使用也有益处。
Since one of the symptoms of SAD can be difficulty awakening in the morning, some find it helpful to have the light turn on just before they are supposed to wake up. Some individuals like to use a Dawn Simulator. This is a bright light that is programmed to gradually increase its intensity such that it reaches its full intensity a set period before the individual is scheduled to awaken. Although it is less gentle, some people will put their light box beside their bed and hook it up to a timer set to turn on shortly before awakening.
由于季节性情感障碍一个症状是醒来难，有些人把灯调到快起床时亮起。有人使用一种调节器（英文名叫Dawn Simulator，黎明模拟器？），在起床前一段时间灯光逐渐亮起。也有人把灯放在床边设定起床前一段时间开灯，尽管这种方式不那么温柔。
Some people like to use full spectrum light bulbs for everyday household use. There is no evidence that these low intensity bulbs affect mood or sleep phase. Your plant light will not cure your SAD. Your 10,000-lux light however, may be nice for some of your plants.
有人喜欢把全光谱灯用于日常使用。没有证据表明低强度灯泡会影响情绪或睡眠。你的植物光不会治疗季节性情感障碍。你的1万勒克斯的灯却一些植物神经可能有好处。
Other treatments
其他治疗
Outdoor light, even when the sky is overcast, provides as much or more light than a light box. There has been a study showing improvement in SAD symptoms when individuals took a one-hour daily walk outside. Outside light is often brighter than the light boxes. Spending an hour outside each day can often produce beneficial results in some individuals. However, one cannot get early morning outside light in the winter. Not everyone's job will allow for an hour-long outside walk. Only highly motivated people will continue their daily walk when it the rains or snows.
室外光即使在多去时也同灯箱一样甚至更多地提供光照。有研究表明每天进行一小时户外散步可改善季节性情感障碍症状。室外光通常比灯箱亮。每天户外度过一小时通常可产生有益效果。但冬季无法获得晨光。也不是每个人的工作都允许户外一小时的散步。只有非常有自主性的人才能在雨雪天坚持户外散步。
SSRI (Selective Serotonin Reuptake Inhibitors--Paxil, Zoloft etc.) have been shown to be effective in SAD and in some cases of PMS. Some people prefer to take a pill because it is less time consuming than sitting in front of a light box. Some individuals need a combination of light therapy, medication, and psychotherapy. For those with winter depression and spring-summer mania, a mood stabilizer such as Lithium may be useful.
选择性5-羟色胺再摄取抑制剂（SSRIs）对季节性情感障碍，有时对经前综合症，都有效果。有些人更喜欢用药，因为比光线更省时。有人需要光线、药物和心理疗法并用。对有冬季抑郁和春夏躁狂的人，可以使用锂盐等情绪稳定剂。
Daily exercise has been shown to be helpful, particularly when done outdoors. For those who tend to crave sweets during the winter, eating a balanced diet may help one's mood. Conversely, as the mood improves, craving for sweets may abate.
日常锻炼，特别是户外锻炼，有益病情。对冬季嗜甜品者，平衡饮食可帮助情绪。反之，随着情绪改善对甜食的欲望可能减少。
Psychotherapy can help the depressed individual look at her depressive assumptions and negative expectations. It can also help one identify relationship difficulties so that interpersonal mistakes might not be repeated. Research has shown that cognitive psychotherapy does help relieve depression faster and more completely than no therapy.
心理疗法可帮助抑郁患者对待其抑郁性的消极看法，也可帮助辩明人际关系的困难以免重复犯错。研究表明认知心理疗法比不用任何疗法更能更快减轻抑郁。
Some individuals continue to have a certain amount of energy fluctuation with the seasons. If one is aware of this, one can plan for it and work the expected fluctuations into one's life plans.
有些人季节性精力起伏一共持续。如果意识到这一点，可以做出计划，将预期变化计入生活计划中。
Side Effects of Light therapy
光线疗法的副作用
Potential side effects of light therapy are rare and most often include jitteriness, a feeling of eyestrain and headache. Light therapy, like antidepressant medications, occasionally will cause someone to switch into a manic state. There has been debate on whether there might be long term retinal effects, but none have been documented when lights with proper screening of UV wavelengths are used. Individuals taking certain medications such as Lithium, tricyclic antidepressants, and neuroleptics and individuals with conditions such as diabetes or retinal degeneration should be monitored by an ophthalmologist. Because this form of treatment is fairly new, many doctors recommend a baseline eye exam and annual monitoring.
光线疗法副作用很罕见，最常见的有神经紧张、眼涩、头疼。光线疗法同抗抑郁药一样偶尔诱发躁狂。对于是否有长期视网膜作用有长期争论，但对适当滤去紫外线的光线使用尚无此方面记录。服用如锂盐、三环类抗抑郁药、精神抑制剂及有糖尿病或视网膜变性的人群应由眼科专家监督。由于此种疗法较新，许多医生推荐在用前进行基线眼科检查，并进行年度监督。
Sleep Disorders
睡眠障碍
Humans and animals generally have innate sleep-wake cycles close to but not exactly 24 hours. They depend on the daily light-dark cycle to keep their circadian rhythms to a regular 24 hours. If a human is left in a room with no light-dark cues, he or she will gradually shift into a sleep-wake cycle that is not exactly 24 hours long. Body temperature and the secretion of the hormone melatonin follow the daily cycle. Other factors, such as work schedule can modify the sleep-wake cycle in humans. The autonomous cycle length varies at different periods in the life span. Adolescents often have an innate cycle longer than 24 hours so that they have the desire to stay up late and sleep in when it is time to get up. The innate cycle then shifts closer to 24 hours for adults, but for the elderly, the autonomous sleep-wake cycle may be shorter than 24 hours resulting in evening tiredness, sleep difficulty and waking too early.
先天接近但不准确为24小时的睡――醒周期是人和动物与生俱来的。光――暗循环使其生理节奏保持在24小时。如果在无光线的暗室中，人的睡――醒周期将不再是24小时。体温及褪黑素分泌都受周期影响。其他因素，如工作日程也会影响周期。自动周期的年度随人生不同阶段而不同。青春期青少年周期长于24小时，所以他们晚睡晚起。成人周期更接近24小时，但老人的自动周期可能短于24小时，导致晚间疲劳、睡眠困难、早醒。
Individuals who have more severe difficulty with the timing of their sleep-wake cycle may have either Delayed Sleep Phase Disorder (difficulty falling sleep and the urge to sleep late) or Advanced Sleep Phase Disorder (tiring too early and waking too early) Both conditions can be treated with bright light. However, the proper timing of the exposure to light and darkness is more critical than it is for SAD. In these conditions, improperly timed light and dark exposure can make the problem worse, not better.
睡――醒周期有严重问题的人可能有“耽误性睡眠周期障碍”（难以入睡及醒来）或“提前性睡眠周期障碍”（过早疲劳，早醒）。两种情况都可用光照治疗。但适当的光暗时间控制比对季节性情感障碍更为重要。这些情况中，不适当的光暗时间可恶化病情。
Jet Lag and Shift Work
时差与倒班
In the cases of jet lag or shift work, the individual does not have a disorder, but is reacting to externally induced changes in the sleep-wake cycle. Traveling west to east over three or more time zones is the most difficult shift. Large forced changes in the timing of sleep periods can lead to irritability and decreased alertness. Many people can deal with this by getting extra rest while traveling or by switching to a job with a more regular schedule. However, for those who must deal with frequent sleep timing changes, one may use a special calculator to help determine the timing for exposure to light and darkness just before and during travel or shift change. If one calculates the timing wrong, one may actually make the time phase shift worse instead of better. A travel kit can consist of a calculator, a light visor and wrap-around dark glasses. Some use small timed doses of Melatonin to achieve the same purpose.
在时差及倒班的情况中，个人并无障碍，但周期受外部变化影响。自西向东跨3个以上时区的旅行最难调整。大幅改变睡眠时间可导致易怒及注意力下降。许多人可通过旅行中额外休息或更换时间规律的工作应对这种情况。但对于必须应对睡眠时间变化的人，可以使用特制计算器决定旅行或倒班前的光暗时间。如果计算错误，也会使情况恶化。旅行中可携带一个计算器，一个light visor和环绕式墨镜（眼罩也可以吧）。有人使用小剂量褪黑素也可以达到效果。
Other uses of bright light therapy
光线疗法的其他应用
There has been research using light therapy for PMS, obesity and non-seasonal depression. The results have not been as striking as the results for SAD. More research needs to be done. However, it may make sense to use light therapy as an augmentation of other depression treatments or in cases in which the individual is unable to use other forms of treatment. The study on obesity was small and needs to be repeated with a larger, more carefully selected group. The obese individuals may have lost weight because their depression was better. Individuals whose PMS was worse in the winter responded better to light therapy than individuals with PMS without a seasonal variation.
对经前综合症、肥胖及非季节性抑郁症的光线疗法研究结果并不像对季节性情感障碍一样显著。需要更多研究。但辅助其他疗法或在不能使用其他疗法时使用光线疗法可能有效果。对肥胖症的研究很少，需要进行深入研究。肥胖人士可能由于抑郁症改善而减轻部分体重。冬季经前综合症更严重的人士对光线疗法的反应优于没有季节变化者。 |
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发表于 06-7-14 10:27:23
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