主編的話：睡眠、晝夜節奏與社會節奏

Editorial Remarks: Sleep, Circadian Rhythm, and Social Rhythm

10.6847/TJPMHN.201906_14(1).00

林靜蘭(Esther Ching-Lan Lin)

精神衛生護理雜誌

14卷1期（2019 / 06 / 01）

i - i

繁體中文;英文

長久以來，睡眠一向是值得關注的健康問題，近年來亦有許多研究者開始關注與睡眠相關的問題，如：晝夜節奏與社會節奏。晝夜節奏（circadian rhythm），又稱生理時鐘，是一種存於所有生物體內自然的生理週期，大約24小時，通常會調節個體的睡醒及飲食週期，此週期亦會受到環境因素之影響，例如：光線、溫度或生活事件；而社會節奏（social rhythm）則指個體所經歷的外在生活事件，會改變其生活步調及人際互動，進而影響晝夜節奏，導致壓力或情緒變化，甚至造成精神疾病（Ehlers et al., 1988），回顧性研究指出—生理及社會節奏的內外在改變，會影響雙相症譜系疾患之發病及病程（Abreu& Braganca, 2015; Alloy et al., 2017）。從此看來，睡眠、晝夜節奏及社會節奏對於健康、疾病與臨床症狀的影響，實不容忽視，而如何測量睡眠與評估晝夜節奏，也成了熱門話題，各種「生理測量手環」也因運而生。本期「精神科急性住院病人主客觀睡眠品質、精神症狀與暴力風險之相關性：前驅研究」，讓我們初探精神科急性住院病人主客觀睡眠品質、精神症狀與暴力風險之相關性，這個問題也許所有精神科護理人員都認為有想當然耳的答案，然而，卻少有人以實證研究回答，研究結果似乎也讓我們再次思量護理人員查房紀錄病患睡眠這項護理常規的精確性，期待未來臨床同仁納入更大樣本進行實證與轉譯研究，以影響臨床照護實務，並促進照護品質。而「運用人際社會節奏治療於一位反覆發作躁鬱症個案之護理經驗」，讓我們一窺社會節奏的紊亂，對情緒疾患病人之影響，該文敘述精神科護理人員如何評估病人之社會節奏，進而運用人際社會節奏治療增進其社會節奏之穩定性，期待此拋磚引玉讓臨床護理師可以更加關注病人之社會節奏問題。此外，以質性方法探究台灣精神科護理教學融入翻轉教室經驗之研究稿，讓我們看到當前精神衛生護理教育之前景及所需改變。臨床同仁們也分享如何運用「動機式晤談法」於一位酒精成癮病人，以及精神科日間照護中心病人口腔健康維護能力之改善方案，均值得各位悉心一讀。

Sleep has been always a critical healthy issue, and related topics about circadian rhythm and social rhythm have also drawn lots of attention. Circadian rhythm often referred to as the "bodily clock existing in living beings is a natural, internal process that regulates the sleep-wake and eating cycle and repeats roughly every 24 hours". It can be affected by environmental factors, like sunlight and temperature. Social rhythm proposes that life events can cause disruptions in a person's external social routines and, their circadian rhythm, and in turn, trigger stressors, mood symptoms, and even mental disorders (Ehlers et al., 1988). Two reviewed articles concluded that both endogenous irregularities in the biological clock and external disruptions in circadian and social rhythms are associated with the onset and course of the BD spectrum (Abreu &Braganca, 2015; Alloy et al. 2017). Therefore, it's worthy to notice the impact of sleep, circadian rhythm, and social rhythm upon health, illness, and clinical symptoms. A variety of physiological assessment tools, such as Actigraphy watch or Actiwatch, have been used to assess the sleep and circadian rhythm. In this issue, you shall read the research on examining the association between sleep quality, psychiatric symptoms, and violent risk in acute psychiatric patients. That makes us re-think the precision of the routine practice on patients' sleep recorded by nursing staff. A case report of applying interpersonal and social rhythms therapy to a patient who suffered from bipolar disorder provides you a best vivid example to assess a patient's social rhythm by using a self-reported social rhythm metric. Another qualitative research explored current teaching experiences integrating with the flipping classroom in psychiatric nursing, which leads us to look forward to the future and its necessary changes. Two experiences shared by nursing staff also deserve your attention, including a case report about using the motivational interview in a patient with alcoholism, and a successful improvement project for oral maintenance ability of patients in a psychiatric daycare center.

1. Abreu, T.,Braganca, M.(2015).The bipolarity of light and dark: A review on bipolar disorder and circadian cycles.Journal of Affective Disorders,185,219-229.
2. Alloy, L. B.,Ng, T. H.,Titone, M. K.,Boland, E. M.(2017).Circadian rhythm dysregulation in bipolar spectrum disorders.Current Psychiatry Report,19(4),21.
3. Ehlers, C. L.,Frank, E.,Kupfer, D. J.(1988).Social zeitgebers and biological rhythms.Archives of General Psychiatry,45,948-952.

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