HYPERAESTHESIAAND HEAD INJURY LISHMAN,W. A. (1988) Physiogenesis and psychogenesis in the ‘¿ post-concussional syndrome'. British Journal of Psychiatry, 153, 460—469.
SAS (1985)Statistics(Version5 edn). Cary: SAS.
STEVENS,J. C. & STEVENS,S. S. (1963) Brightness function: effects of adaptation. Journal of the Optical Society of America, 55,375-385. VERHAGE,R. (1964) Inteiigentie en leeftijd. PhD Dissertation.
Assen, The Netherlands.
WADDELL,P. A. & GRONWALL,D. M. A. (1984) Sensitivity to light and sound following minor head injury. Acta Neurologica
Scandinavica, 69, 270—276. WALSH,K. W. (1987) Neuropsychology: a Clinical Approach. New York: Livingston.
*N. Bohnen,
863
MD, PhD, Department
of Neuro
psychology & Psychobiology, University of Limburg, P0 Box 616, 62(X)MD Maastricht, The Netherlands; A. Twijnstra, MD,PhD, Department of Neurology,
University Hospitalof Maastricht; J.Kroeze,PhD, Psychophysicist, Laboratory of Psychology, Uni versity of Utrecht, The Netherlands; J. Jolles, PhD, Professor of Neuropsychology and Biopsychology, University of Limburg, Maastricht *Correspondence
Seasonal Affective Disorder in Adolescence CHRISTOPHER PAUL LUCAS Two adolescentgirls with seasonalaffective disorder (SAD) are described.It is suggestedthat the classic symptom
profile seen in adults is not characteristic
in
younger subjects. Although hypersomnia is prominent,
increased appetite and carbohydrate craving are rarely reported.
Local meteorological
data link the course of
The existence of SAD as a discrete clinical entity has been questioned by Eastwood et al (1988) who feel that it represents an uncommon con dition in a self-selected sample or something so mild as not ordinarily to come to the attention of doctors. The hypothesis that researchers are more likely to
the disorderin one case to the hoursof sunshineand recruit subjects who conform to their pre-existing ideas ambient temperature duringthe winter months. British Journal of Psychiatry (1991), 159, 863—865 about the clinical picture, and that this maybeaparticu
The first report of a patient with seasonal mood cycles and the treatment of these with bright-light therapy was by Lewy et al (1982). The description of the
lar problem when subjectsare contacted via media adver tisements, was tested by Thompson
(1989). In a well
designed study, no significant differences in clinical fea
tures were found whether patients entered the study via
referral from consultant psychiatrists or by self-referral in response to newspaper or television advertisements. In a two-stage survey, which looked at the extent affective disorder occurring in a particular season and severity of seasonally associated symptoms in (usually winter), on a regular basis, with relative the general population, almost half of the subjects absence of symptoms at other times. DSM—III—R questioned related feeling worst in the months of (American Psychiatric Association, 1987) requires January and/or February and this bore an apparent three episodes of major depression (two in consecutive relationship to ambient temperature and photoperiod years), and for the seasonal episodes to outnumber (Kasper et al, l989a). A quarter of those questioned non-seasonal ones by 3: 1. Clinic-based studies have felt that seasonal mood changes were a significant shown that one-fifth of patients with recurrent problem. The prevalence rate for SAD (as defined depression have a winter seasonal pattern to their in the study) was estimated at 4.5%. currently accepted syndrome of SAD was later made,
in a group of patients, by Rosenthal et al (1984). SAD is commonly defined as a clinically significant
disorder
(Garvey et al, 1988).
The clinical picture of depression which occurs primarily during the winter months has been shown to differ from non-seasonal recurrent depression (Garvey
et al, 1988). In most patients,
appetite
increases during the depressive period and many describe craving carbohydrate-rich foods. Hyper somnia is very common, with most subjects going
to sleep earlier and waking up later. Most patients report drowsiness throughout the day, with the late afternoon
being a time of especially low energy and
mood (e.g. Winton & Checkley, 1989).
Full-spectrum (bright-light) therapy has been found to have a specific effect on the characteristic
symptoms of SAD (Yerevanian et al, 1986). In
placebo-controlled
trials,
marked
reduction
in scores
on a modified Hamilton observer rating scale (which included observer ratings of the atypical depressive symptoms of SAD and self-rating scales) have been demonstrated
(e.g. Rosenthal
et al, 1989). Studies
have also shown that light therapy has a significant effect on symptoms in patients with only mild moderate impairment, the so-called ‘¿ sub-syndromal seasonal affective disorder' (Kasper et al, 1989b).
864
LUCAS
Seasonal affective disorder in childi@n and adolescents
Case 2
There have only been two reported studies of SAD in children and adolescents despite the fact that in the
Referral of this 13-year-old girl was first made to a paediatric clinic in November 1985,at the age of nine. There was a history of hypersomma and fatigue during the winter months, first evident by the age of two, but more marked
original series of 29 adult patients (Rosenthal et al, 1984), three subjects related an onset in childhood
and, in one third of cases, seasonal mood swings started before the age of nineteen.
As part of their work with adult sufferers, Rosenthal and his co-workers (1986) gathered a series
of seven cases who were under the age of 18. It is unclear what the absolute symptom frequency was
in this sample, but as a whole the parents ranked their
children's symptoms in the following order of severity: irritability, fatigue, school difficulties, sadness,
after starting school at five. It was noted that each year, after the clocks went forward in October, she would have difficulties adjusting to the darker evenings and start to go to bed at an earlier hour. This would be at its worst in
January and February, with a gradual recovery occurring by April. At the age of 12 she was referred to a child psychiatrist, as during the episodes of fatigue and hypersomnia it was noticed that she was depressed. The patient described marked sadness, feeling that things easily got on top of her, not wanting to see her friends or participate in pleasurable
hypersoinnia, headaches, changes in appetite, ‘¿ carboactivities, hydrate craving', decreased activity, crying spells, anxiety, social withdrawal, and temper tantrums.
Sonis et al (1987) found that the central symptoms
reported by a group of five children and adolescents with SAD were sleep changes (both hyper and hypo somnia), irritability and anergia. Secondary symptoms were listed as sadness, crying and loss of pleasure.
There was no mention of characteristic appetite changes or ‘¿ carbohydrate craving' in this sample. In a double-blind crossover study, using relaxation treat ment as the alternative therapy, a significant response to light was seen in the group with SAD as compared with non-seasonal
major depressive disorder.
Case reports
together with marked anergia. This was in marked
contrast to her usual gregarious self during the summer. Appetite was decreased, with no evidence of carbohydrate craving. After a gradual worsening in severity of episodes, the next winter (1988—89)showed an improvement, with reduced hypersomnia and less intense affective symptoms. This winter (1989—90) she has been almost symptom free. Meteorological data Case 1 had a relative absence of symptoms during the winter of 1988—89,after a very stable cyclical pattern had
previously been established, with very severe symptoms in the previous winter. As the photoperiod (hours of daylight) will not change from year to year, figures from the
Meteorological Office in Leeds were examined to see if there were any differences in hours of sunshine (Fig. 1(a)) or
ambient
temperatures
(Fig. 1(b)) during these particular
winters. In 1988—89 (the symptom-free winter) there were more
Case 1 This 15-year-old girl was referred in January 1983, at the age of seven, to a paediatric clinic with a two-year history of lethargy and weariness in the winter months. She was
the second born of dizygotic twins, with considerably lower birth weight, and who since birth was noticed generally to have less energy than her co-twin. The winter of 1984
marked the onset of a clearly defined cyclical pattern. For the next four years, each January, she would commence
with one week of low mood, loss of pleasure, excessive worry about small matters and a marked loss of appetite. This would be followed in a predictable fashion by the rapid
onset of increasing lethargy, fatigue, hypersomnia and loss
of weight. Recoveryto full health occurred by the spring.
hours of sunshine in total (1672 hours) than would be expected (1505), based on the five-year average of the years 1986—90.This trend was particularly marked during the months of November to February,when therewere 329
hours of sunshine (5-year average, 264 hours). As would be expected, mean monthly temperatures were also higher than average during this very mild winter, although the discrepancy was seen slightly later (December to March).
A markedcontrastcanbe seenby examiningthedata from
1987—88(the worst winter) when total hours of sunshine were only 1369 (254 during November to February). Ambient
temperatures did not differ greatly from those expected.
During January and February of 1988, her symptoms Discussion were at their worst, although the following winter (1988—89) was atypical in that she was quite well throughout. In SAD in adults has been shown to have a different October 1989, she had a further attack of low mood, intense
fatigue, generalised weakness and hypersomnia (sleeping non-stop for 72 hours). Her appetite was very poor and she lost 7 lb in weight during the month. By the end of November she had made a full recovery. Referral to the child psychiatry clinic was made in January 1990. In February
1990, there was a mild attack which lasted only
one week, in which her appetite was relativelypreserved.
clinical pattern to non-seasonal recurrent depression. It is less clear, however, whether children and adolescents with seasonal mood changes have the same constellation of symptoms. While hypersomnia is a prominent
increased
absent.
feature
appetite
of both
cases reported
and carbohydrate
craving
here,
are
865
SAD IN ADOLESCENCE @30O
(a)
.@25O @200 @“¿ 150 @
light therapy has been shown to have amarked and speci fic effect
on the symptoms
11:
(b)
6@ 16 14
I wish to thank Dr D. Holman and Dr 0. Tagg for permission to
report these cases, and the two patients who agreed that their stories
could be told. I am indebted to the staff at the Meteorological Office, Leeds for assistance in extracting the relevant weather information.
References
Eli
I—
and
Acknowledgements
@18
.@
of SAD in children
adolescents (Sonis et a!, 1987). Failure to consider this diagnosis may lead to unnecessary impairment of per sonal, academic and social functioning at acritical age.
I@hI1IIflIfiIT@ AMERICAN Pn'cw.'@mic
ASSOCIATION (1987) Diagnostic
and Statistical
Manual ofMenial Disorders (3rd edn, revised) (DSM—III—R). Washington, DC: APA.
Jul AugSepOetNovDecJanFebMarAprMayJun
Fig. 1 Mean monthly (a) hours of sunshine and (1,)temperatures in Leeds in 1987—88 (U), 1988—89 ( D ) and five-year average ( !l).
EASTWOOD, M. R. & PETER, A. M. (1988) Epidemiology and seasonal affective disorder. PsychologicalMedicine, 18, 799-806. GARVEY, M. J., WESNER, R. & GODES, M. (1988)
Comparison
of
seasonaland nonseasonalaffectivedisorders.AmericanJournal ofPsychiatry,
145, 100—102.
It has previously been shown that the length of the photoperiod has a clear effect on the frequency and intensity with which depressive symptoms in winter are experienced, whether via seasonal or geographical changes. The influence of the weather on affective disorder has been discussed by Myers
KASPER, S., WEHR, T. A.,
of mania during the summer months and that admission rates for mania correlated closely with the number of hours of sunshine and mean temperature during the month of admission. Although ‘¿ cloudy-day dysphoria' is a well recog nised complaint in SAD this is the first report linking details of the local weather picture to the course of
MYERS, D. H. & DAVIES, P. (1978) The seasonal
temperature, as well as the photoperiod, must be taken into account when assessing the likelihood of disorder in any given year. This obviously requires further study, in a prospective fashion, before any
therapy: The NIMH experience. In Seasonal Affective Disorder (eds C. Thompson & T. Silverstone) pp. 145-158. London: CNS (Clinical Neuroscience) Publishers. SONIS,W. A., ABSALOM,M. Y., GARF1NKEL,B. D., et al (1987) The antidepressant effect of light in seasonal affectivedisorderof child
& Davies (1978). They found an increased incidence
illness in an individual. The implication is that hours of sunshine and mean
firm
conclusions
can
be drawn
and
from this monthly
the
relative
contribution of temperature and sunlight discerned. Children and adolescents with chronic anergia and hypersomnia are commonly referred to a paediatrician, whose differential diagnosis will include anaemia, myalgic encephalomyelitis (ME), school refusal, Klein—Levin syndrome, etc. The two cases reported here were extensively investigated, while
never being asked directly about their mood or other
affective symptoms. As it is well recognised that parents are relatively insensitive to their children's depressive symptoms, relying on parental reports
alone may lead to cases of affective disorder (seasonal and non-seasonal at
a late
stage.
alike) being missed or diagnosed This
is important
since
bright
BARTKO, J. J., et al (1989a)
Epidemio
logical findings of seasonalchangesin mood and behaviour. Archives of General Psychiatry, 46, 823—833. ,
ROGERS,
S.,
YANcEY,
A.,
et
al
(1989b)
Phototherapy
in
those individuals with and without subsyndromal seasonal
affective
disorder.
Archives
ofGeneralPsychialry,
46, 837-844.
LEwy, A. J., KERN,H. E., RosENm@au,N. E., etal(1982)Brightarti
ficial light treatment of a manic-depressive patient with a seasonal mood cycle. American Journal of Psychiatry, 139, 1496—1498. incidence
of mania
and its relationship to climatic variables. Psychological Medicine,
8, 433—440.
ROSENTHAL, N. E., SACK, D. A. & GILLIN, J. C. (1984)
Seasonal
affective disorder: a description of the syndrome and preliminary findings
72—80.
with light therapy.
Archives
of General
Psychiatry,
41,
CARPENTER,C. J., JAMES, S. P., et al (1986) Seasonal affective disorder in children and adolescents. American Journal
of Psychiatry, 143, 356—358. SKEWERER, R. G.,
JACOBSEN, F. M.,
et al (1989)
Photo
hood and adolescence.Psychopharmacology Bulletin, 23, 360-363.
THOMPSON, C. (1989)
The syndrome
of seasonal
affective
disorder.
In Seasonal Affective Disorder (eds C. Thompson & T. Silverstone) pp. 37-57. London: CNS (Clinical Neuroscience) Publishers.
WINTON,
F. & CHECKLEY, S. A. (1989)
Clinical
characteristics
of
patients with seasonal affective disorder. In Seasonal Affective Disorder (eds C. Thompson & T. Silverstone) pp. 59-67. London: CNS (Clinical Neuroscience) Publishers.
YEREVANIAN, S., ANDERSON,J., Gitoi@, L., et a! (1986) Effects of
bright incandescent light on seasonal and nonseasonal major
depressive disorder. Psychiatry Research, 18, 355—364.
Christopher Paul Lucas, MB,ChB.MMedSc,MRCPsych, formerlySeniorRegistrar inChildandAdolescent Psy chiatry, University of Leeds, currently SeniorLecturer in Childand AdolescentPsychiatry, University of Nottingham,Thomeywood ChildandAdolescent Psy chiatric Unit,PorchesterRoad, NottinghamNG3 6LF
SAS (1985)Statistics(Version5 edn). Cary: SAS.
STEVENS,J. C. & STEVENS,S. S. (1963) Brightness function: effects of adaptation. Journal of the Optical Society of America, 55,375-385. VERHAGE,R. (1964) Inteiigentie en leeftijd. PhD Dissertation.
Assen, The Netherlands.
WADDELL,P. A. & GRONWALL,D. M. A. (1984) Sensitivity to light and sound following minor head injury. Acta Neurologica
Scandinavica, 69, 270—276. WALSH,K. W. (1987) Neuropsychology: a Clinical Approach. New York: Livingston.
*N. Bohnen,
863
MD, PhD, Department
of Neuro
psychology & Psychobiology, University of Limburg, P0 Box 616, 62(X)MD Maastricht, The Netherlands; A. Twijnstra, MD,PhD, Department of Neurology,
University Hospitalof Maastricht; J.Kroeze,PhD, Psychophysicist, Laboratory of Psychology, Uni versity of Utrecht, The Netherlands; J. Jolles, PhD, Professor of Neuropsychology and Biopsychology, University of Limburg, Maastricht *Correspondence
Seasonal Affective Disorder in Adolescence CHRISTOPHER PAUL LUCAS Two adolescentgirls with seasonalaffective disorder (SAD) are described.It is suggestedthat the classic symptom
profile seen in adults is not characteristic
in
younger subjects. Although hypersomnia is prominent,
increased appetite and carbohydrate craving are rarely reported.
Local meteorological
data link the course of
The existence of SAD as a discrete clinical entity has been questioned by Eastwood et al (1988) who feel that it represents an uncommon con dition in a self-selected sample or something so mild as not ordinarily to come to the attention of doctors. The hypothesis that researchers are more likely to
the disorderin one case to the hoursof sunshineand recruit subjects who conform to their pre-existing ideas ambient temperature duringthe winter months. British Journal of Psychiatry (1991), 159, 863—865 about the clinical picture, and that this maybeaparticu
The first report of a patient with seasonal mood cycles and the treatment of these with bright-light therapy was by Lewy et al (1982). The description of the
lar problem when subjectsare contacted via media adver tisements, was tested by Thompson
(1989). In a well
designed study, no significant differences in clinical fea
tures were found whether patients entered the study via
referral from consultant psychiatrists or by self-referral in response to newspaper or television advertisements. In a two-stage survey, which looked at the extent affective disorder occurring in a particular season and severity of seasonally associated symptoms in (usually winter), on a regular basis, with relative the general population, almost half of the subjects absence of symptoms at other times. DSM—III—R questioned related feeling worst in the months of (American Psychiatric Association, 1987) requires January and/or February and this bore an apparent three episodes of major depression (two in consecutive relationship to ambient temperature and photoperiod years), and for the seasonal episodes to outnumber (Kasper et al, l989a). A quarter of those questioned non-seasonal ones by 3: 1. Clinic-based studies have felt that seasonal mood changes were a significant shown that one-fifth of patients with recurrent problem. The prevalence rate for SAD (as defined depression have a winter seasonal pattern to their in the study) was estimated at 4.5%. currently accepted syndrome of SAD was later made,
in a group of patients, by Rosenthal et al (1984). SAD is commonly defined as a clinically significant
disorder
(Garvey et al, 1988).
The clinical picture of depression which occurs primarily during the winter months has been shown to differ from non-seasonal recurrent depression (Garvey
et al, 1988). In most patients,
appetite
increases during the depressive period and many describe craving carbohydrate-rich foods. Hyper somnia is very common, with most subjects going
to sleep earlier and waking up later. Most patients report drowsiness throughout the day, with the late afternoon
being a time of especially low energy and
mood (e.g. Winton & Checkley, 1989).
Full-spectrum (bright-light) therapy has been found to have a specific effect on the characteristic
symptoms of SAD (Yerevanian et al, 1986). In
placebo-controlled
trials,
marked
reduction
in scores
on a modified Hamilton observer rating scale (which included observer ratings of the atypical depressive symptoms of SAD and self-rating scales) have been demonstrated
(e.g. Rosenthal
et al, 1989). Studies
have also shown that light therapy has a significant effect on symptoms in patients with only mild moderate impairment, the so-called ‘¿ sub-syndromal seasonal affective disorder' (Kasper et al, 1989b).
864
LUCAS
Seasonal affective disorder in childi@n and adolescents
Case 2
There have only been two reported studies of SAD in children and adolescents despite the fact that in the
Referral of this 13-year-old girl was first made to a paediatric clinic in November 1985,at the age of nine. There was a history of hypersomma and fatigue during the winter months, first evident by the age of two, but more marked
original series of 29 adult patients (Rosenthal et al, 1984), three subjects related an onset in childhood
and, in one third of cases, seasonal mood swings started before the age of nineteen.
As part of their work with adult sufferers, Rosenthal and his co-workers (1986) gathered a series
of seven cases who were under the age of 18. It is unclear what the absolute symptom frequency was
in this sample, but as a whole the parents ranked their
children's symptoms in the following order of severity: irritability, fatigue, school difficulties, sadness,
after starting school at five. It was noted that each year, after the clocks went forward in October, she would have difficulties adjusting to the darker evenings and start to go to bed at an earlier hour. This would be at its worst in
January and February, with a gradual recovery occurring by April. At the age of 12 she was referred to a child psychiatrist, as during the episodes of fatigue and hypersomnia it was noticed that she was depressed. The patient described marked sadness, feeling that things easily got on top of her, not wanting to see her friends or participate in pleasurable
hypersoinnia, headaches, changes in appetite, ‘¿ carboactivities, hydrate craving', decreased activity, crying spells, anxiety, social withdrawal, and temper tantrums.
Sonis et al (1987) found that the central symptoms
reported by a group of five children and adolescents with SAD were sleep changes (both hyper and hypo somnia), irritability and anergia. Secondary symptoms were listed as sadness, crying and loss of pleasure.
There was no mention of characteristic appetite changes or ‘¿ carbohydrate craving' in this sample. In a double-blind crossover study, using relaxation treat ment as the alternative therapy, a significant response to light was seen in the group with SAD as compared with non-seasonal
major depressive disorder.
Case reports
together with marked anergia. This was in marked
contrast to her usual gregarious self during the summer. Appetite was decreased, with no evidence of carbohydrate craving. After a gradual worsening in severity of episodes, the next winter (1988—89)showed an improvement, with reduced hypersomnia and less intense affective symptoms. This winter (1989—90) she has been almost symptom free. Meteorological data Case 1 had a relative absence of symptoms during the winter of 1988—89,after a very stable cyclical pattern had
previously been established, with very severe symptoms in the previous winter. As the photoperiod (hours of daylight) will not change from year to year, figures from the
Meteorological Office in Leeds were examined to see if there were any differences in hours of sunshine (Fig. 1(a)) or
ambient
temperatures
(Fig. 1(b)) during these particular
winters. In 1988—89 (the symptom-free winter) there were more
Case 1 This 15-year-old girl was referred in January 1983, at the age of seven, to a paediatric clinic with a two-year history of lethargy and weariness in the winter months. She was
the second born of dizygotic twins, with considerably lower birth weight, and who since birth was noticed generally to have less energy than her co-twin. The winter of 1984
marked the onset of a clearly defined cyclical pattern. For the next four years, each January, she would commence
with one week of low mood, loss of pleasure, excessive worry about small matters and a marked loss of appetite. This would be followed in a predictable fashion by the rapid
onset of increasing lethargy, fatigue, hypersomnia and loss
of weight. Recoveryto full health occurred by the spring.
hours of sunshine in total (1672 hours) than would be expected (1505), based on the five-year average of the years 1986—90.This trend was particularly marked during the months of November to February,when therewere 329
hours of sunshine (5-year average, 264 hours). As would be expected, mean monthly temperatures were also higher than average during this very mild winter, although the discrepancy was seen slightly later (December to March).
A markedcontrastcanbe seenby examiningthedata from
1987—88(the worst winter) when total hours of sunshine were only 1369 (254 during November to February). Ambient
temperatures did not differ greatly from those expected.
During January and February of 1988, her symptoms Discussion were at their worst, although the following winter (1988—89) was atypical in that she was quite well throughout. In SAD in adults has been shown to have a different October 1989, she had a further attack of low mood, intense
fatigue, generalised weakness and hypersomnia (sleeping non-stop for 72 hours). Her appetite was very poor and she lost 7 lb in weight during the month. By the end of November she had made a full recovery. Referral to the child psychiatry clinic was made in January 1990. In February
1990, there was a mild attack which lasted only
one week, in which her appetite was relativelypreserved.
clinical pattern to non-seasonal recurrent depression. It is less clear, however, whether children and adolescents with seasonal mood changes have the same constellation of symptoms. While hypersomnia is a prominent
increased
absent.
feature
appetite
of both
cases reported
and carbohydrate
craving
here,
are
865
SAD IN ADOLESCENCE @30O
(a)
.@25O @200 @“¿ 150 @
light therapy has been shown to have amarked and speci fic effect
on the symptoms
11:
(b)
6@ 16 14
I wish to thank Dr D. Holman and Dr 0. Tagg for permission to
report these cases, and the two patients who agreed that their stories
could be told. I am indebted to the staff at the Meteorological Office, Leeds for assistance in extracting the relevant weather information.
References
Eli
I—
and
Acknowledgements
@18
.@
of SAD in children
adolescents (Sonis et a!, 1987). Failure to consider this diagnosis may lead to unnecessary impairment of per sonal, academic and social functioning at acritical age.
I@hI1IIflIfiIT@ AMERICAN Pn'cw.'@mic
ASSOCIATION (1987) Diagnostic
and Statistical
Manual ofMenial Disorders (3rd edn, revised) (DSM—III—R). Washington, DC: APA.
Jul AugSepOetNovDecJanFebMarAprMayJun
Fig. 1 Mean monthly (a) hours of sunshine and (1,)temperatures in Leeds in 1987—88 (U), 1988—89 ( D ) and five-year average ( !l).
EASTWOOD, M. R. & PETER, A. M. (1988) Epidemiology and seasonal affective disorder. PsychologicalMedicine, 18, 799-806. GARVEY, M. J., WESNER, R. & GODES, M. (1988)
Comparison
of
seasonaland nonseasonalaffectivedisorders.AmericanJournal ofPsychiatry,
145, 100—102.
It has previously been shown that the length of the photoperiod has a clear effect on the frequency and intensity with which depressive symptoms in winter are experienced, whether via seasonal or geographical changes. The influence of the weather on affective disorder has been discussed by Myers
KASPER, S., WEHR, T. A.,
of mania during the summer months and that admission rates for mania correlated closely with the number of hours of sunshine and mean temperature during the month of admission. Although ‘¿ cloudy-day dysphoria' is a well recog nised complaint in SAD this is the first report linking details of the local weather picture to the course of
MYERS, D. H. & DAVIES, P. (1978) The seasonal
temperature, as well as the photoperiod, must be taken into account when assessing the likelihood of disorder in any given year. This obviously requires further study, in a prospective fashion, before any
therapy: The NIMH experience. In Seasonal Affective Disorder (eds C. Thompson & T. Silverstone) pp. 145-158. London: CNS (Clinical Neuroscience) Publishers. SONIS,W. A., ABSALOM,M. Y., GARF1NKEL,B. D., et al (1987) The antidepressant effect of light in seasonal affectivedisorderof child
& Davies (1978). They found an increased incidence
illness in an individual. The implication is that hours of sunshine and mean
firm
conclusions
can
be drawn
and
from this monthly
the
relative
contribution of temperature and sunlight discerned. Children and adolescents with chronic anergia and hypersomnia are commonly referred to a paediatrician, whose differential diagnosis will include anaemia, myalgic encephalomyelitis (ME), school refusal, Klein—Levin syndrome, etc. The two cases reported here were extensively investigated, while
never being asked directly about their mood or other
affective symptoms. As it is well recognised that parents are relatively insensitive to their children's depressive symptoms, relying on parental reports
alone may lead to cases of affective disorder (seasonal and non-seasonal at
a late
stage.
alike) being missed or diagnosed This
is important
since
bright
BARTKO, J. J., et al (1989a)
Epidemio
logical findings of seasonalchangesin mood and behaviour. Archives of General Psychiatry, 46, 823—833. ,
ROGERS,
S.,
YANcEY,
A.,
et
al
(1989b)
Phototherapy
in
those individuals with and without subsyndromal seasonal
affective
disorder.
Archives
ofGeneralPsychialry,
46, 837-844.
LEwy, A. J., KERN,H. E., RosENm@au,N. E., etal(1982)Brightarti
ficial light treatment of a manic-depressive patient with a seasonal mood cycle. American Journal of Psychiatry, 139, 1496—1498. incidence
of mania
and its relationship to climatic variables. Psychological Medicine,
8, 433—440.
ROSENTHAL, N. E., SACK, D. A. & GILLIN, J. C. (1984)
Seasonal
affective disorder: a description of the syndrome and preliminary findings
72—80.
with light therapy.
Archives
of General
Psychiatry,
41,
CARPENTER,C. J., JAMES, S. P., et al (1986) Seasonal affective disorder in children and adolescents. American Journal
of Psychiatry, 143, 356—358. SKEWERER, R. G.,
JACOBSEN, F. M.,
et al (1989)
Photo
hood and adolescence.Psychopharmacology Bulletin, 23, 360-363.
THOMPSON, C. (1989)
The syndrome
of seasonal
affective
disorder.
In Seasonal Affective Disorder (eds C. Thompson & T. Silverstone) pp. 37-57. London: CNS (Clinical Neuroscience) Publishers.
WINTON,
F. & CHECKLEY, S. A. (1989)
Clinical
characteristics
of
patients with seasonal affective disorder. In Seasonal Affective Disorder (eds C. Thompson & T. Silverstone) pp. 59-67. London: CNS (Clinical Neuroscience) Publishers.
YEREVANIAN, S., ANDERSON,J., Gitoi@, L., et a! (1986) Effects of
bright incandescent light on seasonal and nonseasonal major
depressive disorder. Psychiatry Research, 18, 355—364.
Christopher Paul Lucas, MB,ChB.MMedSc,MRCPsych, formerlySeniorRegistrar inChildandAdolescent Psy chiatry, University of Leeds, currently SeniorLecturer in Childand AdolescentPsychiatry, University of Nottingham,Thomeywood ChildandAdolescent Psy chiatric Unit,PorchesterRoad, NottinghamNG3 6LF
