| 摘要: | 背景:思覺失調症病人常見憂鬱與失眠問題，兩者高度相關且在相互影響下會影響疾病穩定度，甚至增加疾病復發率。光照療法 (Bright light therapy, BLT) 是一種能改善季節性與非季節性憂鬱症與失眠的非藥物性輔助治療方式，雖然光照療法在思覺失調症病人的研究顯示能改善憂鬱，但年代久遠且文獻甚少，且無光照療法同時探討思覺失調症病人憂鬱與失眠之相關研究，引發本研究之動機。
目的:以光照療法為介入方案，探討光照療法對於思覺失調症病人之憂鬱與睡眠改善成效。
方法: 本研究以精神症狀穩定的思覺失調症病人，憂鬱程度符合卡爾加里思覺失調症憂鬱量表 (The Chinese version of the Calgary Depression Scale for Schizophrenia, CDSS-C) 評分6分以上為研究對象。以光照療法為介入措施，實驗組於週一~週五8:30AM-10:30AM之間，1次/天，每次時間50分鐘，照光強度506 lux，輻射能230μW/cm2，共15次，對照組則只接受一般室內光，無特別介入方案，以思覺失調症整體評估表(Clinical Global Impression-Schizophrenia Scale, CGI-SCH) 、正性與負性症狀量表 (Positive and Negative Syndrome Scale, PANSS-C)、生活壓力事件問卷表 (Stressful life events scale, SLES)、卡爾加里思覺失調症憂鬱量表 (Calgary Depression Scale for Schizophrenia, CDSS-C) 、失眠嚴重度量表 (Insomnia Severity Index, ISI-C) 收集前測、中測、光照結束當天 (後測一) 與光照治療結束後追蹤第14天 (後測二) 共4次資料分析。兩組在開始進行光照或對照觀察時就全日配戴腕動計 (沐浴時摘除) ，進行客觀監測睡眠參數直到光照結束後第14天結束，並收集腕動計從光照療法開始至中測、中測至後測一與後測一至後測二共三階段的資料。以CDSS-C為主觀憂鬱指標、ISI-C為主觀失眠指標與腕動計所收集客觀活動與睡眠參數進行分析，控制基本屬性有差異之變項與CGI-SCH、PANSS-C、SLES 3份量表之前測分數為傾向分數 (Propensity score) 後，以廣義估計方程式 (Generalize Estimating Equation, GEE) 分析組別與時間交互作用，探討光照療法對思覺失調症病人的憂鬱與睡眠成效。
結果:與控制組比較1.實驗組憂鬱程度在晨間光照療法施行3週 (15次) 後達統計顯著差異。2.實驗組失眠嚴重程度雖未達統計顯著差異，但亦有改善之趨勢。3.在控制失眠嚴重程度與Propensity score 後，實驗組憂鬱程度在光照療法施行後顯示有改善，達統計顯著差異。
結論:本研究之光照療法方案能改善思覺失調症病人憂鬱程度，對睡眠亦有改善趨勢，此提供臨床上對於思覺失調症病人憂鬱與睡眠以非藥物的照護策略及參考，協助情緒穩定與增進睡眠品質。
關鍵字:光照療法、思覺失調症、憂鬱、失眠
Background: Among the patients with schizophrenia, depression and insomnia are common comorbidities, which are highly correlated to each other and may increase the recurrence rate by affecting the stability of schizophrenia. Bright light therapy (BLT) is a non-pharmacological adjunct therapy that improves seasonal and non-seasonal depression and insomnia. Although there are studies showing improvement in depression among patients with schizophrenia receiving BLT, the number of studies is limited. Furthermore, there is no recent study and no study focusing on the effect of BLT on depression and insomnia in schizophrenia. Therefore, the present research was motivated.
Objective: To investigate the effects of BLT as an intervention on depression and sleep in patient with schizophrenia.
Methods: This study was conducted in schizophrenia patients, who had stable psychotic symptoms and score over 6 points in the Chinese version of the Calgary Depression Scale for Schizophrenia (CDSS-C). The experimental group received BLT as the intervention between Monday to Friday at 8:30AM to 10:30AM, once daily, 50 minutes each time, illumination intensity 506 lux, radiant energy 230μW/cm2, 15 times in total. The control group received the ordinary room light, with no special interventional program. The pre-test, mid-test, end of BLT (post-test 1), and 14 days after BLT (post-test 2) evaluation were done with Clinical Global Impression-Schizophrenia Scale (CGI-SCH), Positive and Negative Syndrome Scale (PANSS-C), Stressful Life Events Scale (SLES), Calgary Depression Scale for Schizophrenia (CDSS-S), Insomnia Severity Index (ISI-C). A total of 4 data were analysis. Both groups were equipped with wrist actigraphy from the beginning of the study to 14 days after BLT to record the objective sleeping data, including the beginning to mid-test, mid-test to post-test 1, and post-test 1 to post-test 2. Generalized estimating equation (GEE) was utilized to analyze the group-time interaction and the effect of BLT on depression and sleeping condition of patients with schizophrenia, with CDSS-C as the major subjective depression indicator, ISI-C as the subjective insomnia indicator, and objective data collected with actigraphy. Propensity score calculated from baseline characteristics and pre-test scores of CHI-SCH, PANSS-C, and SLES was utilized as the adjustment.
Results: Compared with the control group, the experiment group includes 1. The degree of depression in the experimental group reached a statistically significant difference after 3 weeks (15 times) of morning light therapy. 2. Although the severity of insomnia in the experimental group did not reach statistically significant differences, there was also a trend of improvement. 3. After controlling the severity of insomnia and the Propensity score, the degree of depression in the experimental group showed improvement after the implementation of BLT, and statistically significant differences were achieved.
Conclusion: The light therapy program of this study can improve the degree of depression in patients with psychotic disorders and improve the sleep. This light therapy provides clinical strategies and references for depression and sleep in patients with schizophrenia. And improve sleep quality.
Keywords: Bright light therapy, Schizophrenia, Depression, Insomnia. |
