CLINICAL ASPECTS OF WINTER SEASONAL AFFECTIVE DISORDER (SAD)

我们之前已经描述了冬季季节性综合症 情感障碍(SAD)。忧郁症的特征是抑郁的症状 在秋季和冬季有规律地复发，在春季和 夏天。尽管SAD的临床图景已经被很好地描绘出来了， 对其纵向过程的研究很少。在本报告中 我们完成了对后续研究结果的描述，如 去年的报告。尽管SAD主要是在成人中描述的， 我们和其他人报道了一小部分儿童和青少年 患有综合症的人。我们通过学习流行病学来扩展我们的知识。 儿童青少年SAD的临床特点。可悲的是 被认为是以女性为主的综合征(5人中有4人)。然而， 到目前为止，系统的研究还没有检查性别和 关于临床表现或对光疗的反应。我们报道 历年收集的SAD患者的性别差异研究 好几年了。 一项对7年前出院的59名成人患者的研究 表示，有25人(42%)仍是“完全季节性的”。那些 有经验的其他非季节性病理证实了相当程度的 季节性，并继续表现出症状的季节性模式。 最初使用光疗法的54名患者中有24名(44%) 每年冬天继续定期并成功地使用光疗来 就是现在。 蒙哥马利县1835名中小学生 评估季节性的问卷调查。总体而言，3%的人报告了临床 巨大的困难。从6年级到9年级，患病率平均 从10年级到12年级，不到2%，平均超过5%。给定的先前版本 蒙哥马利县的成年人估计约为6%，似乎 季节性问题在15岁左右发作。女性代表 55%的病例和45%的男性。此外，患病率的分布 女性和男性的表现不同，女性的流行率 随着青春期和青春期前男性患病率的增加而增加 和青春期后的群体。一项多变量分析表明， 在年级和感觉最差和最易怒的冬天的几个月最好 区分SAD病例和非SAD病例。在女孩吃东西时也是如此 有助于区分SAD病例和非病例。 线性判别函数分析表明，四个变量最好 将女性与男性区分开来。这些都是对碳水化合物的渴望，冬天 睡眠时间、季节性体重变化百分比(女性的这一比例更大)，以及 季节性变化的严重性(男性更严重)。93%的女性但只有28%的女性 根据性别对男性进行了正确的分类，这表明患有 与患有SAD的男性相比，SAD是一个更同质性的群体。没有性别差异 关于光的响应，检测到了。

We have previously described the syndrome of winter seasonal affective disorder (SAD). SAD is characterized by symptoms of depression that recur regularly during the fall and winter and remit in spring and summer. Although the clinical picture of SAD has been well delineated, little research has been done on its longitudinal course. In this report we complete the description of the follow-up study findings described in last year's report. Although SAD has been described primarily in adults, we and others have reported on a small number of children and adolescents with the syndrome. We expanded our knowledge by studying epidemiological and clinical features of SAD in children and adolescents. SAD has been recognized as a syndrome predominant in females (4 out of 5). However, systematic studies to date have not examined differences in gender with respect to clinical presentations or response to light therapy. We report on the gender difference findings for SAD patients collected over the years. A study of 59 adult patients, discharged from our clinic over 7 years ago indicated that 25 (42%) remained "exclusively seasonal." Those who experienced other, non-seasonal pathology endorsed substantial degrees of seasonality and continue to demonstrate seasonal patterns of symptoms. Twenty-four of the 54 (44%) patients who initially used light treatment continued to use light therapy regularly and successfully each winter to the present. 1,835 Elementary and middle school students of montgomery County were given questionnaires assessing seasonality. Overall, 3% reported clinically significant difficulties. For grades 6 through 9 the prevalence averaged less than 2% for grades 10 through 12 it averaged over 5%. Given previous adult estimates in Montgomery County at approximately 6%, it appears that seasonality problems fulminate around 15 years of age. Females represented 55% of cases and males 45%. In addition, the distribution of prevalence appeared different for females and males such that female prevalence increased with puberty and male prevalence was split between prepubertal and postpubertal groups. A multivariate analysis indicated that a decline in grades and feeling worst and most irritable in the winter months best discriminated between SAD cases and non-cases. In girls eating also contributed to discriminating SAD cases from non-cases. A linear discriminant function analysis revealed that four variables best differentiated women from men. These were carbohydrate craving, winter sleep length, percent seasonal weight change (all greater in women), and severity of seasonal change (greater in men). 93% of women but only 28% of men were correctly classified regarding gender, suggesting that women with SAD are a more homogeneous group than men with SAD. No gender differences with regard to light response were detected.