Morning bright light therapy: a helpful tool for reducing comorbid symptoms of affective and behavioral dysregulation in juvenile depressed inpatients? A pilot trial
Abstract
Abstract.Objective: In recent years, bright light therapy (BLT) has been used to treat depression and to stabilize circadian rhythms. In this study we evaluated whether it is also helpful for comorbid symptoms of affective and behavioral dysregulation in depressive inpatients. Method: This article reports a secondary analysis comparing two subgroups of depressive participants with comorbid affective and behavioral dysregulation, captured with the dysregulation-profile of the Strengths and Difficulties Questionnaire (SDQ-DP; n = 16 vs. n = 11). Participants were randomly allocated to active BLT (10,000 lux) or control BLT (approx. 100 lux), and received 45 minutes of BLT for 2 weeks. SDQ-DP scores, sleep parameters, and circadian preference were assessed at baseline, after the intervention, and 3 weeks later. Results: No direct effects on SDQ-DP scores were observed. Sleep improved in both conditions. Only in the active BLT condition was a circadian phase advance found. Correlation and regression analyses indicated an indirect, circadian effect for improved SDQ-DP scores. Conclusions: The data of this pilot trial should be considered preliminary and merely descriptive. Further research is warranted.
Zusammenfassung.Fragestellung: Lichttherapie wird zur Behandlung von Depressionen sowie zur Stabilisierung des zirkadianen Rhythmus’ eingesetzt. Die vorliegende Pilotstudie untersucht die Wirksamkeit von Lichttherapie bei stationären depressiven Jugendlichen mit Symptomen komorbider affektiver und behavioraler Dysregulation. Methodik: In dieser Studie werden Ergebnisse einer Sekundäranalyse berichtet, in der zwei Gruppen von depressiven Patienten mit komorbiden Symptomen affektiver und behavioraler Dysregulation (erfasst durch das Dysregulations-Profil des Fragebogens für Stärken und Schwächen – SDQ-DP; n = 16 vs. n = 11) randomisiert entweder der aktiven Lichttherapie (10 000 lux) oder der Kontrollbedingung zugeordnet (ca. 100 lux) wurden. Alle erhielten täglich 45 Minuten morgendliche Lichttherapie über einen Zeitraum von zwei Wochen. Werte des SDQ-DP, Schlafparameter und die zirkadiane Präferenz wurden vor Beginn der Studie, nach zwei Wochen Intervention und weitere drei Wochen später erhoben. Ergebnisse: Symptome der affektiven und behavioralen Dysregulation zeigten keine direkten Verbesserungen als Folge der Lichttherapie. Schlafparameter zeigten Verbesserungen unabhängig der Lichtbedingung. Eine Vorverlagerung des zirkadianen Rhythmus’ wurde nur bei den Teilnehmern der aktiven Lichtbedingung gefunden. Die Ergebnisse der Korrelationen und Regressionen legen die Vermutung nahe, dass eine Verbesserung der Symptome affektiver und behavioraler Dysregulation durch einen indirekten, zirkadianen Weg möglich ist. Schlussfolgerungen: Weitere Studien sind notwendig, um die vorläufigen Ergebnisse dieser Pilotstudie zu replizieren.
Literature
2010). Adult outcomes of childhood dysregulation: A 14-year follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 1105–1116.
(2013). Comparison of parent adolescent scores on Strengths and Difficulties Questionnaire. International Journal of Research in Medical Sciences, 18, 501–505.
(2009). Child Behavior Checklist Juvenile Bipolar Disorder (CBCL-JBD) and CBCL Posttraumatic Stress Problems (CBCL-PTSP) scales are measures of a single dysregulatory syndrome. Journal of Child Psychology and Psychiatry, 50, 1291–1300.
(2013). Morning light therapy for juvenile depression and severe mood dysregulation: Study protocol for a randomized controlled trial. Trials, 14, .
(2015). Lighting the mood of depressed youth: Feasibility and efficacy of a 2 week-placebo controlled bright light treatment for juvenile inpatients. Journal of Affective Disorders, 190, 450–456, DOI: 10.1016/j.jad.2015.09.026.
(2007). Sleep, circadian rhythms, and delayed sleep phase in adolescence. Sleep Medicine, 8, 602–612.
(2003). The cumulative cost of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep, 26, 117–126.
(2008). Efficacy of light therapy in nonseasonal depression: A systematic review. Journal of Affective Disorders, 108, 11–23.
(2002). Sleepiness in children and adolescents: Clinical implications. Sleep Medicine Reviews, 6, 287–306.
(2007). Association between sleep problems and symptoms of attention-deficit/hyperactivity disorder in young adults. Sleep, 30, 195–201.
(2005). Controlled trial of bright light and negative air ions for chronic depression. Psychological Medicine, 35, 945–955.
(2005). The efficacy of light therapy in the treatment of mood disorders: A review and meta-analysis of the evidence. American Journal of Psychiatry, 162, 656–662.
(2007). Time of day, intellectual performance, and behavioral problems in Morning versus Evening type adolescents: Is there a synchrony effect? Personality and Individual Differences, 42, .
(1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38, 581–586.
(2001). Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1337–1345.
(2008). Treatment of circadian rhythm sleep disorders with light. Annals Academy of Medicine Singapore, 37, 669–676.
(2011). [SF-A/R and SF-B/R – Sleep questionnaires A and B – Revised]. Göttingen: Hogrefe.
(2002). Einsatz eines Fragebogens (D-MEQ) zur Bestimmung des Chronotyps bei der Zuweisung eines Schichtarbeitsplatzes. Zeitschrift für Arbeitswissenschaft, 3, 142–149.
(2001). Zur Validität der deutschen Übersetzung des Morningness-Eveningness-Questionnaires von Horne und Östberg. Somnologie, 5, 71–80.
(2006). Sleep and circadian rhythms in children and adolescents with bipolar disorder. Development and Psychopathology, 18, 1147–1168.
(2013). Association of eveningness with problem behavior in children: A mediating role of impaired sleep. Chronobiology International, 30, 919–929.
(2011). Severe mood dysregulation: In the “light” of circadian functioning. Medical Hypotheses, 77, 692–695.
(2011). Psychometric validity of the Strengths and Difficulties Questionnaire – dysregulation profile. Psychopathology, 44, 53–59.
(2007). Prevalence of the Child Behaviour Checklist – Pediatric bipolar disorder phenotype in a German general population sample. Bipolar Disorder, 9, 895–900.
(2008). CBCL-pediatric bipolar disorder phenotype: Severe ADHD or bipolar disorder? Journal of Neural Transmission, 115, 155–161.
(2011). Child Behavior Checklist – Dysregulation Profile predicts substance use, suicidality, and functional impairment: A longitudinal analysis. Journal of Child Psychology and Psychiatry, 52, 139–147.
(1976). A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. International Journal of Chronobiology, 4, 97–110.
(2005). Prevalence and genetic architecture of Child Behaviour Checklist – juvenile bipolar disorder. Biological Psychiatry, 58, 562–568.
(2011). Severe affective and behavioural dysregulation is associated with significant psychosocial adversity and impairment. Journal of Child Psychology and Psychiatry, 52, 686–695.
(1984). A Dutch-language questionnaire for the selection of morning and evening type individuals. Nederlandse Tijdschrift voor de Psychologie, 39, 281–294.
(2002). Children’s time of day preference: Age, gender and ethnic differences. Personality and Individual Differences, 33, 1083–1090.
(2000). Comparing the German versions of the Strengths and Difficulties Questionnaire (SDQ-Deu) and the Child Behavior Checklist. European Child and Adolescent Psychiatry, 9, 271–276.
(2011). Morningness-eveningness and behavioural problems in adolescents. Sleep and Biological Rhythms, 9, 12–18.
(2012). The affective storms of school children during nighttime: Do affective dysregulated school children show a specific pattern of sleep disturbances? Journal of Neural Transmission, 119, 989–998.
(2003). Length of light treatment trial: Does it influence outcome. Chronobiology International, 20, 1213–1214.
(2008). Parent and child agreement on reports of problem behaviour obtained from a screening questionnaire, the SDQ. European Child and Adolescent Psychiatry, 17, 491–197.
(2006). Correlates of sleep and pediatric bipolar disorder. Sleep, 29, 193–197.
(2010). Longitudinal relations between sleep quality, time in bed and adolescent problem behaviour. Journal of Child Psychology and Psychiatry, 51, 1278–1286.
(2005). Misperceptions of sleep can adversely affect daytime functioning in insomnia: A meta-analysis of treatment efficacy. Behaviour Research and Therapy, 43, 843–856.
(2008). The impact of analytic method on interpretation of outcomes in longitudinal clinical trials. International Journal of Clinical Practice, 62, 1147–1158.
(2006). An open trial of light therapy in adult attention deficit/hyperactivity disorder. Journal of Clinical Psychiatry, 67, 1527–1535.
(2012). Peeking into the minds of troubled adolescents: The utility of polysomnography sleep studies in an inpatient psychiatric unit. Journal of Affective Disorders, 139, 66–74.
(2009). Chronotherapeutics for affective disorders. A clinicians’ manual for light and wake therapy. Basel: Karger.
(2004). Normative data and scale properties of the German parent SDQ. European Child and Adolescent Psychiatry, 13, 3–11.
(