CLINICAL ASPECTS OF WINTER SEASONAL AFFECTIVE DISORDER

我们以前曾描述过冬季季节性情感综合征， 抑郁症（SAD），其特征是抑郁症状， 在秋季和冬季定期复发，并在春季缓解， 夏天 虽然SAD的临床表现已经得到很好的描述， 关于它的纵向过程的研究很少。 条件 主要在成年人中描述，尽管我们和其他人 报告说，儿童和青少年的人数相对较少， 伤心. 虽然SAD患者通常被认为是高度敏感的， 他们的物理环境的变化，最显着减少 环境光的可能致病作用的心理 对压力源的研究较少。 一项对23名成年患者的随访研究， 平均6年前显示，16名（70%）患者仍然“完全 季节性”。 13人（57%）继续定期使用光疗， 平均八年后的每个冬天， 诊断为SAD。 所有患者继续经历 在冬季的几个月里，他们的情绪恶化，最常见的是在 2月，所有人都继续支持，并继续投资于， 构建SAD。 对七名SAD儿童和青少年中的六名进行电话采访 以前的研究表明，所有继续经历某种形式的 季节性功能障碍，虽然有关疾病的知识 使他们能够有效地应对冬天。 五个有灯箱 在他们的家中，他们在“需要时”和非结构化的 方式 所有人都报告说，他们认真努力地花时间在户外 在冬季和发展户外爱好。 两个报告说， 从氟西汀中获益。个别病例的病理学模式 随着时间的推移保持相当稳定。 37例SAD患者的应激、认知评价及应对方式 显示SAD患者的抑郁发作通常不是 由重大生活事件引发的。 SAD患者报告更频繁 和严重的轻微的日常压力比29个正常对照组期间， 冬天的时候，他们很沮丧。 SAD患者与 控制或跨季节在他们的重要性的评价， 压力事件或他们对可用资源和应对的看法 选项. 然而，当他们抑郁时，SAD患者确实会使用应对方法， 一般抑郁症患者的典型策略，即那些涉及更多 避免、调节或释放情感，较少解决问题。

We have previously described the syndrome of winter seasonal affective disorder (SAD), which is characterized by symptoms of depression that recur regularly during the fall and winter months 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. The condition has been described predominantly in adults, though we and others have reported on a relatively small number of children and adolescents with SAD. While SAD patients are generally considered to be highly sensitive to changes in their physical environment, most notably decreased environmental light the possible pathogenic role of psychological stressors has been less well explored. A follow-up study of 23 adult patients, discharged from our clinic on average 6 years ago revealed that 16 (70%) patients remained "exclusively seasonal". Thirteen (57%) continued to use light therapy regularly and successfully each winter after an average of eight years since the diagnosis of SAD had been made. All patients continued to experience worsening of their moods during the winter months, most often in February, and all continued to endorse, and remain invested in, the construct of SAD. Phone interviews with six of the seven children and adolescents with SAD previously studied indicated that all continued to experience some form of seasonal dysfunction, although knowledge about the condition has enabled them to deal effectively with the winter. Five had light boxes in their homes, which they used in an "as needed" and unstructured manner. All reported making conscientious efforts to spend time outdoors during the winter and developed outdoor hobbies. Two reported great benefit from fluoxetine. Patterns of symptomatology for individual cases remained quite stable over time. Evaluation of stress, cognitive appraisal and coping in 37 SAD patients revealed that depressive episodes in SAD patients were not generally precipitated by major life events. SAD patients reported more frequent and severe minor daily stressors than 29 normal controls during the winter when they were depressed. SAD patients did not differ from controls or across seasons in their evaluation of the significance of stressful events or their perception of available resources and coping options. When they were depressed, however, SAD patients did use coping strategies typical of depressives in general, namely those involving more avoidance, regulation or discharge of affect and less problem solving.