Study on diagnosis and differentiation of school refusals due to sleep-wake rhythm disorder

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Based on studies of patho-genesis, treatment, epidemiology and prognosis in sleep-wake rhythm disorders, we advanced the investigation of school refusals due to sleep-wake rhythm disorders and got the following results.1. Analysis of sleep-wake rhythm disorders in high school students using the questionnaire for chronotype of life-style (the revised-version from the Monteflore Medical Center, New York), 7,421 out of 174,000 public high school students in Aichi Prefecture were studied on delayd sleep phase syndrome (DSPS).(1) Compared DSPS group with non-DSPS group, there existed no significant differences in sleep-wake rhythm pattern of their parents except the "sleep-onset disturbance of mother". There also existed neither family factors nor environmental and regional factors differentiated two groups.(2) Picking up the limited items of the questionnaire which were characterized by DSPS,called "DSP-score", there was significant difference between DSPS group (possible DSPS) and non-DSPS group (22.20 (]SY.+-。[) 4.50 vs 11.43 (]SY.+-。[) 5.04)(3) SDS (Zung's) score of both groups (DIPS & non-DSPS) showed no significant difference in depressive state.2. Treatment trials with melatonin and its responseAccording to some reports that melatonin treatment for school refusals suffering from sleep-wake rhythm disorders had been successfully carried out by some Japanese researchers, we administered melatonin (1 to 3mg/day) to some adult patients with DSPS and non-24-hour sleep-wake syndrome. This preliminary experiment suggested the possibility of resetting in patients with sleep rhythm disorders who showed an acute improvement of their body temperature rhythm and sleep architecture with melatonin administration.