Light treatment of seasonal affective disorder in combination with citalopram or placebo with 1-year follow-up.

This placebo-controlled, double-blind, 1-year pilot study aimed at investigating possible clinical advantages of combining initial light therapy with the selective serotonin reuptake inhibitor (SSRI) citalopram as well as the effects of continuous long-term administration of this drug in patients with seasonal affective disorder (SAD). Eight physically healthy women who met the DSM-III-R criteria for SAD were included in the study. Four women were randomized to the citalopram group receiving 40 mg citalopram daily from the first of 10 light treatment days and throughout the 1-year study. The remaining four women were allocated to the placebo group using the same double-blind repeated measures design. The clinical outcome was measured by using three versions of the Comprehensive Psychopathological Rating Scale (CPRS) and Visual Analog Scales (VAS), respectively. Taking the initial rating scores into account in covariance analyses, no statistically significant group difference was found during the light treatment period. However, during the follow-up period the full version of the CPRS and the self-rating version of CPRS and the VAS-scales for global condition and depressed mood were statistically significantly lower in the citalopram group compared with the placebo group. Thus, in this small but carefully observed sample of SAD-patients combining initial light therapy and long-term citalopram treatment was clinically more effective over time than the placebo combination. Our findings support the notion that light therapy with concomitant and continued SSRI (citalopram) treatment is a useful strategy to achieve beneficial long-term effects in patients with the SAD syndrome.

Platelet serotonergic functions and light therapy in seasonal affective disorder.

We investigated platelet 14C-serotonin uptake and platelet [3H]LSD and [3H]paroxetine binding in 11 patients with seasonal affective disorder (SAD). Patients were reinvestigated after light therapy, applied at 07.00-09.00 h for 10 consecutive days. The degree of depression was rated before and after light therapy using the Comprehensive Psychopathological Rating Scale (CPRS). Baseline data in patients were compared with data from a control group consisting of 11 age- and sex-matched healthy volunteers. Seven patients responded to light therapy with a > 50% reduction in CPRS scores. In non-responders, the reduction in CPRS was 24.7 +/- 5.5%. There was a significant inverse correlation (P = 0.014) between Km for platelet 14C-serotonin uptake and CPRS scores. Patients had significantly higher Bmax for platelet [3H]LSD binding (P = 0.04) and significantly lower Bmax for platelet [3H]paroxetine binding (P = 0.016). There was a strong, multiple correlation between Bmax for [3H]LSD, as the dependent variable, and Km, Vmax and Bmax for [3H]paroxetine binding in patients (P < 0.0001) but not in controls. Responders to light therapy had significantly higher Km (P = 0.023) and significantly lower Bmax for [3H]paroxetine binding (P = 0.028) than non-responders. Bmax for [3H]paroxetine binding increased significantly to normal levels after light therapy. The results indicate that SAD is associated with aberrations in the serotonin uptake mechanism. The enhanced 5-HT2-receptor density may reflect a consequential up-regulation.

Cortisol in light treatment of seasonal and non-seasonal depression: relationship between melatonin and cortisol.

The effect of bright light on cortisol and the relationship between melatonin and cortisol were studied in 63 depressed patients (42 patients with a seasonal pattern and 21 patients with a non-seasonal pattern). The patients were matched for age, time of treatment and severity of depression. Before and after light treatment the severity of the depression was rated with the Comprehensive Psychopathological Rating Scale (23 items) and the Hamilton Depression Rating scale (18 items), and serum cortisol and melatonin were drawn at nine time-points between 20.00 and 08.00 hours. Two hours of light treatment (350 cd m-2) was given daily for 10 days either in the morning (06.00-08.00 hours) or in the evening (18.00-20.00 hours). As reported earlier, patients with a seasonal pattern improved significantly more than patients with a non-seasonal pattern of depression, and no significant differences were found between the treatment efficacy of morning compared to evening light. A cosinor analysis showed that the cortisol batyphase was significantly advanced by morning light, but was not delayed by evening light. A delay in batyphase cortisol showed a weak significant correlation with a decrease in the absolute and relative sum of scores. The batyphase of cortisol occurred approximately 3 h earlier than the acrophase of melatonin. Of the changes in the melatonin acrophase 43% were reflected in a change of cortisol batyphase, indicating a hierarchical relationship with melatonin as the co-ordinating hormone transducing part of the information of the external light to the phase position of cortisol. No significant differences between patients with a seasonal or a non-seasonal pattern were seen in mesor, amplitude or batyphase of cortisol before treatment, and no significant changes in mesor or amplitude were seen as a result of light treatment.

Season of birth as predictor of atopic manifestations.

The relation between month of birth, sensitisation, and manifestations of atopy was assessed in 209 children who were followed from birth to 12-15 years. Children born during the tree pollen season were less likely to develop allergic rhinoconjunctivitis, IgE antibodies to pollen, or a positive screening test for IgE antibodies (odds ratio 0.28, 0.41, 0.35, respectively) than children born during the rest of the year. The prevalence of IgE antibodies to food and animal dander at 9 months and to atopic disease was higher in children born in the autumn and winter, that is, September to February, compared to the spring and summer (egg 20% v 6%; milk 10% v 2%). Thus sensitisation to pollen and allergic rhinoconjunctivitis is least common in children born in the spring, while birth in September to February is associated with an increased incidence of sensitisation to food and of atopic disease.

Melatonin in light treatment of patients with seasonal and nonseasonal depression.

Melatonin as a marker of circadian rhythm and the effect of bright light on melatonin were studied in 63 depressed patients, 42 with a seasonal pattern and 21 with a nonseasonal pattern. The patients were matched for age, time of treatment and severity of depression. Before light treatment, blood was sampled for melatonin and depression was clinically rated with the Comprehensive Psychopathological Rating Scale and Hamilton Depression Rating Scale. Two hours of light treatment, 350 cd/m2, was given daily for 10 days 0600 to 0800 or 1800 to 2000. Of the 42 patients with seasonal depression, 26 were treated with morning light and, 16 with evening light. The melatonin amplitude was significantly decreased by light, and the melatonin phase position was advanced by morning light and delayed by evening light. All patients except for 3 in each group changed in the expected direction. Although the patients with seasonal pattern had a more favorable outcome than patients with nonseasonal pattern, there was no difference in therapeutic outcome related to the baseline melatonin phase position. The hypothesis that the short term clinical effects of light therapy either in the morning or evening are related to pretreatment melatonin levels or alteration of melatonin amplitude or phase position was not supported in the study. There was also no significant difference between the seasonal and nonseasonal patients related to the degree of light suppression of melatonin and the rebound effect of serum melatonin levels following bright level exposure between 2200 and 2300 before regular light treatment.

Light treatment in seasonal and nonseasonal depression.

Ninety patients with major depressive disorder were classified according to seasonal (n = 68, 50 women) or nonseasonal (n = 22, 17 women) pattern according to DSM-III-R. They were also clinically evaluated and rated before and after morning (0600-0800) or evening (1800-2000) light treatment for 10 days in a room with a luminance of 350 cd/m2 (approximately 1500 lx) at eye level. Mood ratings were performed using both the Comprehensive Psychopathological Rating Scale and the Hamilton Depression Rating Scale. Depressed patients with seasonal pattern improved significantly more than those with a nonseasonal pattern suggesting a specific nonplacebo effect of light treatment in depressed patients with seasonal pattern. There were no significant differences in outcome when light treatment was given in the morning or in the evening, and not between patients with and without atypical symptoms such as carbohydrate craving or increased appetite.

Appearance of atopic disease in relation to serum IgE antibodies in children followed up from birth for 4 to 15 years.

BACKGROUND: Few studies have addressed the relationship between sensitization and the development of atopic disease over many years. OBJECTIVE: To study the temporal relationship between the appearance of IgE antibodies in serum and atopic disease, we studied 324 children from three different groups, who were followed up prospectively from birth for 4, 12, and 15 years, respectively. METHODS: Serum samples were obtained at various ages and analyzed for IgE antibodies against egg white, cow's milk, wheat, animal dander, house dust mite, birch and timothy with Phadebas RAST (Kabi Pharmacia Diagnostics AB, Uppsala, Sweden) or Pharmacia CAP system. In addition, a screening test for atopy, the Phadiatop Paediatric test (Kabi Pharmacia Diagnostics AB) was performed. Presence of atopic disease was assessed by means of clinical examination, interviews, and questionnaires. RESULTS: In 135 children IgE antibodies were detected at least once to at least one allergen. Antibodies to egg white appeared in 46 children before or at 2 years of age: in 57% of them IgE antibodies to inhalants developed within the next 2 years, and in 19 of 25 (76%) IgE antibodies to inhalants developed before or at 12 to 15 years. Antibodies to inhalant allergens appeared in 55 children during the first 4 years of life and in 64 before 12 to 15 years. Among the former 48% and among the latter 32% had previously detectable egg white antibodies. Atopic disease appeared before or at age 4 years in 80% of the 40 children with IgE antibodies against egg white up to 9 months of age and in 69% of the 58 children who had a positive Phadiatop Paediatric test result in infancy. CONCLUSIONS: IgE antibodies in children are usually associated with current or later topic disease. Sensitization to foods in infants is usually associated with appearance of IgE antibodies to inhalants later in life.

Effect of a 15 minute light pulse on nocturnal serum melatonin levels in human volunteers.

Monitoring the daily melatonin rhythm during the course of phototherapy for affective disorders may be beneficial in assessing the efficacy of such treatments. It is therefore of interest to study the effects of the timing, duration, and intensity of bright light pulses on melatonin levels in normal subjects. To examine the effects of a single exposure to a brief burst of bright light on serum melatonin, groups of healthy human volunteers of both sexes were treated with a 15 minute pulse of bright light (350 cd/m2) early in the evening during the winter months. Serial blood samples were collected from each person and the effect of the light pulse on serum melatonin and cortisol levels determined. Melatonin levels were significantly but only transiently suppressed by the light pulse, while cortisol levels were not affected. These results demonstrate that short duration bright light treatments can influence the melatonin rhythm generating system in humans.

Long-term changes in inhalant allergy in asthmatic children.

In a representative cohort of 55 asthmatic schoolchildren the progress of the allergy per se was followed up prospectively for 8 years. Judged by clinical data, skin prick tests and RAST, a large majority of the children retained their allergies to pollen and animal danders. These allergens were predominant, whereas allergy to mites and moulds was less frequent. Serum IgE levels showed a strong tendency to remain high. Positive RAST and skin prick tests were also found in a substantial number of children with normal serum IgE concentrations.

Kingella kingae infections: a review and a presentation of data from 10 Swedish cases.

Kingella kingae is a fastidious gram-negative rod related to the Neisseriae. Together with data from published cases of K. kingae infection, we report the clinical and laboratory findings from 10 cases in western Sweden; a specific serological reaction is also described. The diagnoses were osteomyelitis, septic arthritis, discitis, endocarditis, occult bacteraemia and phlegmon. The data from the Swedish cases, together with those from previous reports in the literature provided the basis for an analysis of a total of 33 cases, ranging from self-limiting to potentially fatal infections. In orthopaedic infections (n = 19), including 3 cases of discitis, the course was usually protracted but subacute and benign, although the full-blown, acute septic arthritis was also encountered. Endocarditis (n = 10) was characterized by a stormy clinical course and the development of significant sequelae. The majority of the patients were previously healthy children. 42% of them had a current or recent upper respiratory tract infection. After start of antibiotic treatment patients were afebrile within a few days. Betalactam antibiotics should be regarded as the drugs of choice for coping with K. kingae. We stress the insidious course of skeletal infections in children and urge the importance of early puncture of a suspected focus to establish a correct diagnosis without delay. The clinical data suggest that K. kingae should be regarded as a significant pathogen.

Atopic disease and pediatric ambulatory care.

This prospective study, concerning ambulatory pediatric care in a Swedish county during a 1-year period shows that 24% of all visits to pediatric reception centres were due to atopic diseases. Atopy answered for a large proportion of the visits to all of the five pediatric centres whether they were located at a hospital or at a health centre. Hyposensitization answered for 59% of the visits for atopy, asthma for 39% and allergic rhinoconjunctivitis for 50%. The geographical accessibility of the pediatric reception centre influenced the frequency of visits due to diseases other than atopy but not visits due to atopy. Whether the children lived in a community with a pediatric centre or not made little difference to frequency of attendance. This is probably due to intensive information about atopic diseases in children addressed to the parents in the county. The balance between centralization and decentralization of an organization for ambulatory care of atopic children is discussed.

Congenital generalized lipodystrophy. Report on one case, with special reference to postmortem findings.

Generalized lipodystrophy (Berardinelli-Seip's syndrome) was diagnosied in a boy at the age of 8-1/2 months. Ten months later he died because of aspiration of food. Necropsy with special reference to the CNS revealed hypothalamic lesions, probably of a malformative or hamartomatous nature. The findings lend additional support to the view that hypothalamic dysfunction is responsible for the signs and symptoms of generalized lipodystrophy.