背景:重度抑郁症患者表现出睡眠和情绪的昼夜节律紊乱,当他们从住院病房出院时,这种疾病有复发的危险.我们开发了昼夜节律强化疗法(CRT)干预措施,以促进这些患者从住院病房到家庭的过渡。CRT专注于通过社会接触增加昼夜节律时钟的时代精神,身体活动,饮食,日光照射,和睡眠时间。
目的:在本研究中,我们的目的是通过使用CRT来防止出院后抑郁症的恶化,由电子自我监控系统支持,促进和稳定睡眠,改善情绪。主要结果,这是由盲人评估者评估的,是汉密尔顿抑郁量表评分从基线到终点的变化。
方法:在住院病房中与参与者联系,并以1:1的比例随机分配到CRT或常规治疗(TAU)组。四个星期,两组参与者都以电子方式自我监测他们的日常情绪,身体活动,睡眠,和药物使用MonsensoDaybuilder(MDB)系统。MDB允许研究者和参与者同时查看注册的图形显示。一名调查员每周给所有参与者打电话,共同检查数据输入。在CRT组中,如果在日常检查期间观察到特定的预定义的情绪和睡眠触发点,则参与者在预定的通话之间再打电话.纳入后立即为CRT组的参与者提供专门的CRT心理教育课程,重点是增加对昼夜节律系统的zeitgeber输入;介绍了PowerPoint演示文稿;与参与者一起审查了纸质信息材料和传单;在所有电话咨询中都使用了CRT原则。在TAU组中,电话呼叫侧重于MDB系统中的数据输入。出院时,所有患者均在专门的情感障碍服务机构接受治疗.
结果:总体而言,包括103名参与者。与TAU组相比,CRT组的参与者的汉密尔顿抑郁量表评分降低幅度明显更大(P=.04)。自我监测的MDB数据显示夜间情绪(P=.02)和睡眠质量(P=.04)显着改善,较早的睡眠发作(P=.009),与TAU组相比,CRT组的睡眠持续时间更长(P=0.005)。日常和晚上情绪的日常变化,睡眠偏移,睡眠发作,CRT组睡眠质量明显低于TAU组(均P<.001)。用户对CRT方法和MDB系统的评价是肯定的。
结论:我们发现,与TAU组相比,CRT组的抑郁水平明显降低,睡眠质量改善。我们还发现日常睡眠的日常变异性显着降低,情绪参数,和活动参数在CRT组比在TAU组。应进一步完善和测试CRT干预的交付。
背景:ClinicalTrials.govNCT02679768;https://clinicaltrials.gov/study/NCT02679768。
■RR2-10.1186/s12888-019-2101-z。
BACKGROUND: Patients with major depression exhibit circadian disturbance of sleep and mood, and when they are discharged from inpatient wards, this disturbance poses a risk of relapse. We developed a circadian reinforcement therapy (CRT) intervention to facilitate the transition from the inpatient ward to the home for these patients. CRT focuses on increasing the zeitgeber strength for the circadian clock through social contact, physical activity, diet, daylight exposure, and sleep timing.
OBJECTIVE: In this
study, we aimed to prevent the worsening of depression after discharge by using CRT, supported by an electronic self-monitoring system, to advance and stabilize sleep and improve mood. The primary outcome, which was assessed by a blinded rater, was the change in the Hamilton Depression Rating Scale scores from baseline to the end point.
METHODS: Participants were contacted while in the inpatient ward and randomized 1:1 to the CRT or the treatment-as-usual (TAU) group. For 4 weeks, participants in both groups electronically self-monitored their daily mood, physical activity, sleep, and medication using the Monsenso Daybuilder (MDB) system. The MDB allowed investigators and participants to simultaneously view a graphical display of registrations. An investigator phoned all participants weekly to coinspect data entry. In the CRT group, participants were additionally phoned between the scheduled calls if specific predefined trigger points for mood and sleep were observed during the daily inspection. Participants in the CRT group were provided with specialized CRT psychoeducation sessions immediately after inclusion, focusing on increasing the zeitgeber input to the circadian system; a PowerPoint presentation was presented; paper-based informative materials and leaflets were reviewed with the participants; and the CRT principles were used during all telephone consultations. In the TAU group, phone calls focused on data entry in the MDB system. When discharged, all patients were treated at a specialized affective disorders service.
RESULTS: Overall, 103 participants were included. Participants in the CRT group had a significantly larger reduction in Hamilton Depression Scale score (P=.04) than those in the TAU group. The self-monitored MDB data showed significantly improved evening mood (P=.02) and sleep quality (P=.04), earlier sleep onset (P=.009), and longer sleep duration (P=.005) in the CRT group than in the TAU group. The day-to-day variability of the daily and evening mood, sleep offset, sleep onset, and sleep quality were significantly lower in the CRT group (all P<.001) than in the TAU group. The user evaluation was positive for the CRT method and the MDB system.
CONCLUSIONS: We found significantly lower depression levels and improved sleep quality in the CRT group than in the TAU group. We also found significantly lower day-to-day variability in daily sleep, mood parameters, and activity parameters in the CRT group than in the TAU group. The delivery of the CRT intervention should be further refined and tested.
BACKGROUND: ClinicalTrials.gov NCT02679768; https://clinicaltrials.gov/
study/NCT02679768.
UNASSIGNED: RR2-10.1186/s12888-019-2101-z.