Physicians, psychiatrists and myself are unaware of the influence of light, colors, and environment on (psychiatric) patients. Especially patients with mood disorders. The same counts for the appearance of doctors. Would you rather be spoken to by an unshaven, ill mannered sloppy looking doctor or by a clear shaven fresh looking doc?
A recent clinical review got me interested in the subject: Chronotherapeutics in a Psychiatric Ward. Here are some highlights from this publication.
What is chronotherapeutics
Chronotherapeutics are controlled exposures to environmental stimuli that act on biological rythms in order to achieve therapeutic effects in psychiatric conditions.
Special interest arose when reading about depressed patients and exposure to sunlight. The use of sunlight can become an underestimated treatment for depression: in Canada depressed patients in sunny rooms had a mean shorter hospitalisation of 2.6 days,than patients in a dimly lit room.
In Italy bipolar depressed patients in rooms with windows at the east side of the building had a mean 3.7 days shorter hospital stay than patients in rooms with western windows, with maximal difference in summer and autumn and no difference in winter when morning subnlight is dimmer and later.
I was especialy interested in the implementation on psychiatric wards. Psychiatrists are usually not aware of the influence of simple measures such as light and exercise on mood and mood disorders. Six years ago we implemented running therapy on our unit for depressed inpatients. It is still a valuable form of therapy to our patients. We should consider using light as a therapeutic.
Usually chronotherapeutics have efficacy of short duration with early relapse.
More promising is the use of chronotherapeutics when combining different chronotherapeutics and adding them to conventional psychiatric treatments such as antidepresants leading to more long-lasting therapeutic effects.
The use of chronotherapeutics can be of additional value to other more conventional treatment for inpatients such as antidepressants, ECT and cognitive behavioral therapy.
What are chronotherapeutics?
- Sleep deprivation
- Light therapy
- Sleep phase advance
Another important practical point from this review is that chronotherapeutics best results are observed in bipolar depression. The side effect of going in to mania seems to be less than with antidepressants. It can be combined with mood stabilisers and antidepressants for speeding up response.
A very readable and clearly written review by a clinician. After a clear description of the origins and history of chronotherapeutics this review also discusses the similarities of action between chronotherapeutics and antidepressants. The article concludes with practical remarks and topics for future research.
Sleep Med Rev. 2007 Aug 2; [Epub ahead of print]
Chronotherapeutics in a psychiatric ward.
Benedetti F, Barbini B, Colombo C, Smeraldi E.
The Center of Health Design, evidence based design for hospitals