Хронофизиологические механизмы, опосредующие действие яркого света на активность и настроение человека тема диссертации и автореферата по ВАК РФ 14.00.17, доктор биологических наук Путилов, Аркадий Александрович

• Путилов, Аркадий Александрович
• доктор биологических наук
• 1998

Оглавление диссертации доктор биологических наук Путилов, Аркадий Александрович

ВВЕДЕНИЕ

Глава 1. АНАЛИТИЧЕСКИЙ ОБЗОР ЛИТЕРАТУРЫ

1.1. ВЛИЯНИЕ ФОТОПЕРИОДА НА АКТИВНОСТЬ И НАСТРОЕНИЕ ЧЕЛОВЕКА

1.1.1. ОПРЕДЕЛЕНИЕ, СИМПТОМЫ И РАСПРОСТРАНЕННОСТЬ ЗИМНЕЙ ДЕПРЕССИИ

1.1.2. СВЕТ КАК СРЕДСТВО КОРРЕКЦИИ СПАДОВ АКТИВНОСТИ И НАСТРОЕНИЯ

1.2. БИОЛОГИЧЕСКИЕ МЕХАНИЗМЫ ДЕЙСТВИЯ СВЕТА НА АКТИВНОСТЬ И НАСТРОЕНИЕ ЧЕЛОВЕКА

1.2.1. ФОТОПЕРИОДИЧЕСКАЯ ГИПОТЕЗА

1.2.2. СОМНОСТАТИЧЕСКАЯ ГИПОТЕЗА

1.2.3. ЦИРКАДИАННЫЕ ГИПОТЕЗЫ

1.2.4. МЕЛАТОНИНОВЫЕ ГИПОТЕЗЫ

1.2.5. НЕХРОНОБИОЛОГИЧЕСКИЕ ГИПОТЕЗЫ

1.2.6. ИТОГИ ТЕОРЕТИЧЕСКОГО ОСМЫСЛЕНИЯ МЕХАНИЗМОВ ДЕЙСТВИЯ ЯРКОГО СВЕТА

Глава 2. МАТЕРИАЛ И МЕТОДЫ ИССЛЕДОВАНИЙ

2.1. МЕТОДИКА ЭКСПЕРИМЕНТАЛЬНОГО ИССЛЕДОВАНИЯ

ДЕЙСТВИЯ ЯРКОГО СВЕТА

2.1.1. ОБЪЕМ ЭКСПЕРИМЕНТАЛЬНОГО ИССЛЕДОВАНИЯ

2.1.2. ПРОЦЕДУРА ВОЗДЕЙСТВИЯ ЯРКИМ СВЕТОМ

2.1.3. ОЦЕНКА ДЕЙСТВИЯ СВЕТА НА АКТИВНОСТЬ И НАСТРОЕНИЕ

2.2. ФИЗИОЛОГИЧЕСКИЕ МЕТОДИКИ

2.2.1 ИССЛЕДОВАНИЕ ДЕЙСТВИЯ СВЕТА НА РЕГУЛЯЦИЮ

2.2.2. ИССЛЕДОВАНИЕ ДЕЙСТВИЯ СВЕТА НА СУТОЧНЫЕ

РИТМЫ

2.2.3. ИССЛЕДОВАНИЕ ДЕЙСТВИЯ СВЕТА НА СКОРОСТЬ ОБЩЕГО ОБМЕНА И СИМПАТИЧЕСКУЮ РЕАКТИВНОСТЬ

2.2.4. МЕТОДИКА КОМПЛЕКСНОЙ ОЦЕНКИ ФИЗИОЛОГИЧЕСКИХ ЭФФЕКТОВ ЯРКОГО СВЕТА

2.3. ХРОНОБИОЛОГИЧЕСКИЕ ОПРОСЫ

2.3.1. ИССЛЕДОВАНИЕ ЦИКЛА СОН-БОДРСТВОВАНИЕ

2.3.2. ИССЛЕДОВАНИЕ СЕЗОННЫХ КОЛЕБАНИЙ ВЕГЕТАТИВНЫХ СИМПТОМОВ ЗИМНЕЙ ДЕПРЕССИИ

2.4. СТАТИСТИЧЕСКИЕ МЕТОДЫ ОБРАБОТКИ ДАННЫХ

2.5. ДОПОЛНИТЕЛЬНЫЕ ИСЛЛЕДОВАНИЯ

Глава 3. РЕЗУЛЬТАТЫ ИССЛЕДОВАНИЙ

3.1. ДЕЙСТВИЕ СВЕТА НА АКТИВНОСТЬ И НАСТРОЕНИЕ

ЧЕЛОВЕКА

3.1.1. ДЕЙСТВИЕ ЯРКОГО СВЕТА НА АКТИВНОСТЬ И

НАСТРОЕНИЕ ЛЮДЕЙ С И БЕЗ СИМПТОМОВ ДЕПРЕССИИ

3.1.2. ЭФФЕКТИВНОСТЬ ДЕЙСТВИЯ СВЕТА НА АФФЕКТИВНЫЕ И ВЕГЕТАТИВНЫЕ СИМПТОМЫ ЗИМНЕЙ ДЕПРЕССИИ

3.2. ДЕЙСТВИЕ СВЕТА НА ФИЗИОЛОГИЮ ЧЕЛОВЕКА

3.2.1. ФИЗИОЛОГИЧЕСКИЕ ЭФФЕКТЫ ЯРКОГО СВЕТА

3.2.2. СВЯЗИ МЕЖДУ ФИЗИОЛОГИЧЕСКИМИ И ЛЕЧЕБНЫМИ ПОКАЗАТЕЛЯМИ

3.2.3. СВЯЗИ МЕЖДУ ФИЗИОЛОГИЧЕСКИМИ ЭФФЕКТАМИ И СУММАРНАЯ ОЦЕНКА ФИЗИОЛОГИЧЕСКОГО ЭФФЕКТА

3.2.4. СВЯЗЬ МЕЖДУ СУММАРНЫМИ ОЦЕНКАМИ ФИЗИОЛОГИЧЕСКОГО И ЛЕЧЕБНОГО ЭФФЕКТА

3.3. РЕЗУЛЬТАТЫ ХРОНОБИОЛОГИЧЕСКИХ ОПРОСОВ

3.3.1. СВЯЗЬ МЕЖДУ РЕЗУЛЬТАТАМИ ИЗУЧЕНИЯ СУБЪЕКТИВНЫХ И ОБЪЕКТИВНЫХ ПОКАЗАТЕЛЕЙ

3.3.2. СВЯЗИ МЕЖДУ ФОТОПЕРИОДОМ И ЧАСТОТОЙ ВЕГЕТАТИВНЫХ СИМПТОМОВ СЕЗОННОЙ ДЕПРЕССИИ

3.3.3. СХОДСТВО И РАЗЛИЧИЕ ВЫБОРОК

ЭКСПЕРИМЕНТАЛЬНОГО И АНКЕТНОГО ИССЛЕДОВАНИЙ

Глава 4. ОБСУЖДЕНИЕ РЕЗУЛЬТАТОВ

4.1. КОМПЛЕКСНАЯ ФИЗИОЛОГИЧЕСКАЯ РЕАКЦИЯ НА ЯРКИЙ СВЕТ

4.1.1. ОСНОВНОЙ РЕЗУЛЬТАТ ИССЛЕДОВАНИЯ

4.1.2. ЛЕЧЕБНЫЕ ЭФФЕКТЫ

4.2. МЕХАНИЗМЫ ОТДЕЛЬНЫХ ФИЗИОЛОГИЧЕСКИХ РЕАКЦИЙ

4.2.1. СОМНОСТАТИЧЕСКАЯ РЕАКЦИЯ

4.2.2. РЕАКЦИЯ ЦИРКАДИАННЫХ РИТМОВ

4.2.3. НЕХРОНОБИОЛОГИЧЕСКИЕ РЕАКЦИИ

ВЫВОДЫ

Введение диссертации (часть автореферата) на тему «Хронофизиологические механизмы, опосредующие действие яркого света на активность и настроение человека»

Актуальность проблемы. Спад активности и настроения в зимнее время года наблюдается у миллионов людей, проживающих в умеренных и высоких широтах Земли. Его крайняя форма - зимняя депрессия, которую также называют сезонным аффективным расстройством (САР) зимнего типа, успешно лечится ярким светом в течение недели (Rosenthal et al., 1984). Яркий свет также оказался эффективным средством коррекции спадов активности и настроения при субклинической форме зимней депрессии - субсиндроме САР (С-САР) (Kasper et al., 1989). Зимняя депрессия и светолечение уникальны тем, что были открыты не благодаря медицинской практике, а в результате фундаментальных исследований в области биоритмологии (Kripke, 1981; Lewy et al., 1982). Однако, первоначальные предположения о лежащих в их основе биологических механизмах не были подтверждены экспериментально (Wehr et al., 1986). До сих пор физиологический базис нормализующего эффекта яркого света на активность и настроение человека остается недостаточно изученным. В общем предполагается, что в основе свойственных зимней депрессии изменений психических и нейровегетативных функций лежат пока еще до конца неизвестные физиологические процессы, направленные на приспособление организма человека к укорочению длины дня и обусловленному им светодефициту (Wehr, 1990). Можно провести аналогию между нейровегетативными симптомами зимней депрессии (гиперсомния, утренний спад активности, гиперфагия, набор лишнего веса, дневная сонливость, апатия, заторможенность и усталость) и рядом физиологических дисфункций (нарушения гомеостаза сна, синхронизации суточных ритмов, обмена веществ и симпато-парасимпатического баланса). Однако, ни одно из объяснений биологических основ зимней депрессии и ее лечения, пока не получило удовлетворительной экспериментальной поддержки. По общепринятому среди специалистов в этой области мнению, механизм действия яркого света остается наиболее спорным и интригующим вопросом (Blehar, Rosenthal, 1989; Lam et al., 1996).

Цель исследований. Изучение хронофизиологических основ действия яркого света на активность и настроение человека.

В соответствии с этой целью решались следующие задачи:

1. Определить участвуют ли механизмы регуляции сна и суточных ритмов в механизме нормализации психических и нейровегетативных функций с помощью яркого света в утренние, либо вечерние часы.

2. Оценить вклад четырех физиологических систем (сомностатической, циркадианной, метаболической и симпато-адреналовой) в улучшение психических и нейровегетативных функций при действии яркого света.

3. Оценить возможность прогнозирования нормализующего действия яркого света на активность и настроение по физиологическим особенностям человека.

Научная новизна. Впервые на большой выборке (около ста человек), включающей людей с симптомами зимней депрессии и без симптомов, была обнаружена высоко достоверная связь между результатами действия яркого света на физиологические функции и на активность и настроение человека. Впервые выявлены конкретные физиологические механизмы коррекции зимних спадов активности и настроения (интенсификация медленного сна, опережающий сдвиг фазы суточного ритма, ускорение основного обмена веществ и активация симпато-адреналовой системы). Впервые определены физиологические отклонения от нормы, позволяющие прогнозировать насколько успешной будет коррекция уровней активности и настроения с помощью яркого света. Эти результаты объясняют, почему гипотезы и эксперименты по поиску физиологических механизмов действия яркого света на симптомы зимней депрессии часто оказываются неудачными. Как правило, исследователи на небольшой выборке анализируют сдвиги в одной-двух физиологических системах, в то время как, согласно представленным в работе данным, коррекция симптомов зимней депрессии ярким светом оказывается малоэффективной, если происходит лишь один из изученных физиологических сдвигов. Наилучший результат наблюдается тогда, когда обнаруживаются сразу несколько таких сдвигов (Putilov, 1998).

Практическое значение. Автор первым в России начал экспериментальное изучение и популяризацию научных знаний о зимней депрессии и благотворном действии яркого света на активность и настроение человека (Путилов A.A. и др. «Светолечение зимней депрессии». Новосибирск, 1990, 50 е.; Путилов A.A. «Совы, жаворонки и другие: О наших внутренних часах и о том как они влияют на здоровье и характер». Новосибирск: Изд-во Новосибирского ун-та; М.: Совершенство, 1997, 264 е.). Результаты исследования проливают свет на физиологический базис симптомов зимней депрессии и механизм их исчезновения при воздействии ярким светом. По сравнению с фармакологическими методами антидепрессантной терапии лечение ярким светом является более дешевым, менее вредным для здоровья человека и более эффективным (клинический эффект достигается в три раза быстрее). По инициативе автора методика светолечения была внедрена в клинике СО РАМН и уже была успешно использована для коррекции зимних спадов активности и настроения у нескольких сотен жителей Новосибирска, Якутии и других районов Сибири. Результаты данной работы стимулировали ряд других экспериментальных исследований, направленных на оптимизацию методов нефармакологического лечения сезонной и несезонной депрессии. Использованные в работе опросники и диагностические методы были применены для оценки распространенности симптомов зимней депрессии и особенностей их сезонной ритмики на Аляске, в Туркмении и в пяти регионах азиатской части России (опрошено более 3000 человек). Была также выявлена возможность объективной оценки эффективности воздействия светом на симптомы зимней депрессии с помощью набора достаточно простых физиологических методик. Кроме того, была доказана физиологическая валидность разработанных автором опросников и возможность их использования для прогноза эффективности светолечения и оценки хронофизиологических особенностей людей с симптомами зимней депрессии. Материалы исследования использованы в лекционных курсах автора (Путилов A.A. «Ритмы в обществе и природе», 22 с. и «Хронотипология личности», 22 с. Программы курсов. Новосибирск: НГЭУ, 1993) и в «Руководстве по хронобиологии и хрономедицине» (М: Медицина, 1989, гл. 10, с. 133-144).

Основные положения, выносимые на защиту.

1. Дефицит медленноволнового сна, запаздывание фазы циркадианного ритма, замедление основного обмена веществ и пониженная симпато-адреналовая активность являются физиологическими особенностями людей с симптомами зимней депрессии и с хорошими результатами их коррекции ярким светом.

2. Состояние летней ремиссии и результат коррекции симптомов зимней депрессии ярким светом в утренние и вечерние часы положительно связаны с признаками интенсификации медленного сна, опережающего сдвига фаз суточных ритмов, ускорения основного обмена и активации симпато-адреналовой системы.

3. Любой из указанных физиологических сдвигов, взятый в отдельности, не является обязательным для нормализации активности и настроения человека, но нормализующий эффект тем значительнее, чем больше таких сдвигов.

Апробация работы. Материалы диссертации были доложены и обсуждены на симпозиуме «Зимние города как среда обитания» (Анкоридж, Аляска, 1989); 8-ом международном конгрессе по приполярной медицине (Уайтхорс, Канада, 1990), Семинаре по программе медицинского обмена Сибирь-Аляска в Университете Аляски (Анкоридж, Аляска, 1990), 7-й встрече Европейского хронобиологического общества (Марбург, Германия, 1991), совещании Проблемной комиссии АМН СССР по хронобиологии и хрономедицине (Свердловск, 1991), 7-й встрече Европейского психометрического общества (Трир, Германия, 1991), Сателитном симпозиуме 9-го международного конгресса по эндокринологии «Мелатонин и эпифиз» (Париж, Франция, 1992), конференции «Эндогенные депрессии: Клиника. Патогенез» (Иркутск, 1992), заседании Аляскинского отделения Нейронаучного общества «Как работает сомностат?» в Университете Аляски (Фэрбанкс, Аляска, 1993), 64-ой Гордоновской конференции по хронобиологии (Нью-Лондон, Нью-Гемпшир, 1993), семинаре «САР и бессонница в Сибири» в Отделе клинической психобиологии Национального института психического здоровья (Бетезда, Мерилэнд, 1993), 8-ой встрече Европейского психометрического общества (Барселона, Испания, 1993), 23-ей Международной этологической конференции (Торремолинос, Испания, 1993), Осенней школе «Нейронные механизмы, участвующие в психологическом и биологическом измерении времени» (Сан-Фелю де Гигсолз, Испания, 1993), 65-ой Гордоновской конференции по хронобиологии (Барга, Италия, 1995), 6-ой встрече Общества светолечения и биологических ритмов (Франкфурт на Майне, Германия, 1995), 3-ей Европейской конференции по психологическому оцениванию (Трир, Германия, 1995), семинаре: «Световая и несветовая синхронизация биологических ритмов» (Халле, Германия, 1997), 150-ой юбилейной конференции Американской психиатрической ассоциации (Сан-Диего, Калифорния, 1997), семинаре «Физиология светолечения» в отделе изучения циркадианного пейсмекера Калифорнийского университета в Сан-Диего (Ла Хойя, Калифорния, 1997) и Ганзейской эндокринологической конференции «Мелатонин спустя четыре десятилетия: оценка его потенциала» (Гамбург, Германия, 1998).

Публикации. Публикации по материалам диссертации включают 10 статей полного объема и 19 кратких публикаций в рецензируемых международных журналах. Кроме того, 4 статьи были опубликованы в отечественных журналах и 18 - в сборниках статей.

Заключение диссертации по теме «Нормальная физиология», Путилов, Аркадий Александрович

ВЫВОДЫ

1. Биологические механизмы, опосредующие эффекты искусственного яркого света и естественной смены сезона года на настроение и активность людей с симптомами зимней депрессии, включают реакции как минимум четырех систем физиологической регуляции (сомностатической, циркадианной, метаболической и симпато-адреналовой).

2. Для людей с симптомами зимней депрессии характерны такие физиологические отклонения как дефицит медленноволнового сна, запаздывание фаз циркадианных ритмов, замедление общего обмена веществ и гипоактивность симпато-адреналовой системы.

3. Чем больше указанных физиологических отклонений наблюдается до воздействия ярким светом, тем значительнее подъем настроения и активности после воздействия.

4. Исчезновение симптомов зимней депрессии связано с такими физиологическими реакциями как интенсификация медленного сна, опережающий сдвиг фаз циркадианных ритмов, ускорение общего обмена веществ и активация симпато-адреналовой системы.

5. Влияние всех четырех указанных физиологических регуляторных реакций на настроение и активность людей с симптомами зимней депрессии является положительным и аддитивным.

6. При наличии лишь одной из этих реакций полной нормализации настроения и активности не происходит; чем больше этих реакций, тем значительнее результат воздействия ярким светом на настроение и активность людей с симптомами зимней депрессии.

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