A pragmatic effectiveness randomized controlled trial of duration of psychiatric hospitalization in a trans-diagnostic sample of patients with acute mental illness admitted to a ward with either blue depleted evening lighting or normal lighting conditions

Abstract

Introduction There is increasing recognition of the need to stabilize sleep-wake cycles in individuals with major mental disorders. As such, clinicians and researchers advocate for the use of interventions targeted at sleep and circadian dysrhythmias as an adjunct to the standard treatments offered for acute illness episodes of a broad range of diagnoses. To determine the trans-diagnostic generalizability of chronotherapy, we explore the benefits of admitting individuals with an acute illness episode to a psychiatric inpatient unit where changes in light exposure are integrated into the therapeutic environment. Methods A two-arm pragmatic effectiveness randomized controlled treatment trial, where individuals admitted for acute inpatient psychiatric care will be allocated to a ward with blue depleted evening light or to a ward with the same layout and facilities but lacking the new lighting technology. The trial will test whether the experimental lighting conditions offer any additional benefits beyond those associated with usual treatment in an acute psychiatric inpatient unit. The main objectives are to examine any differences between groups in the mean duration of hospitalization in days. Additional analyses will compare group differences in symptoms, functioning, medication usage, and side-effects and whether length of stay is associated with stability of sleep-wake cycles and circadian rhythms. Ancillary investigations will determine any benefits according to diagnostic subgroups and potential drawbacks such as any adverse effects on the well-being of professionals working across both wards. Discussion This unit offers a unique opportunity to explore how exposure to different lighting conditions may modify sleep-wake cycles and how any changes in sleep-wake cycle may impact on the clinical and functional outcomes of individuals experiencing an acute episode of a severe mental disorder that requires inpatient care. The findings could influence the future design of hospital units offering care to patients with mental or physical disorders. Trial registration Clinicaltrials.gov NCT03788993, retrospectively registered Dec 28th 2018. https://clinicaltrials.gov/ct2/show/NCT03788993.

Let there be blue-depleted light: in-patient dark therapy, circadian rhythms and length of stay

“…Finally, connections between ipRGCs and the limbic system, striatum and the brain-stem may affect mood state, while connections between the thalamus, SCN, retina, visual and other cortical/subcortical areas suggest that the thalamus acts as a major interface between alertness and cognition (Fernandez 2018). The effects of light on these systems and the subsequent impacts may be of specific interest to psychiatry research and practice (Scott 2019).…”

“…In contrast, chronic exposure to blue light (even as part of traditional 'white' light) directly before bedtime may affect sleep quality and circadian phase and/or cycle duration (Wahl 2019). Interestingly, research indicates that the absence of blue light (so-called virtual darkness) is equivalent to actual darkness from the perspective of the human brain and synchronisation of circadian rhythms (Castro 2011;Scott 2019).…”

“…For instance, sleep-wake cycle disruptions are criterion symptoms for diagnosing unipolar and bipolar disorders; sleep abnormalities may be prodromal symptoms heralding the onset of mood, psychotic and/or other major mental disorders; and emerging data identify that circadian dysrhythmias may exacerbate e.g. suicidal behaviours (Rumble 2018;Scott 2019). Also, research by our own group demonstrates that day-to-day variability in sleep-wake cycles is associated with frequency of aggression or violent acts in transdiagnostic populations admitted to psychiatric intensive care units (Langsrud 2016(Langsrud , 2018.…”

“…For example, an RCT of 89 patients admitted for cervical or lumbar spinal surgery found that the participants allocated to a brightly lit ward reported less distress or pain than those allocated to a dimly lit ward, and the former group needed 22% less analgesic medication per hour, which contributed to a significant reduction in the cost of care and treatment (Walch 2005). Nearly all the medical inpatient studies comment that the impact of light on the circadian system was an important mediator of the observed clinical outcomes (Scott 2019).…”

“…Growing empirical evidence of significant associations between light exposure, mood and well-being has raised awareness of the notion that, as natural light is a key component of any 'healing environment', it may be possible to manipulate light exposure during clinical treatment for patient benefit (e.g. Beauchemin 1996;Park 2018;Scott 2019). In psychiatry, interest in these issues was fostered by growing awareness of seasonal subtypes of affective disorders and evidence that interventions that act on the circadian rhythm and sleep-wake cycle (collectively labelled 'chronotherapies') can ARTICLE Jan Scott, MBBS, PhD, is a Professor of Psychiatry in the Institute of Neuroscience, University of Newcastle, UK, and the International Visiting Professor in Mental Health at the Norwegian University of Science and Technology (NTNU), Trondheim, Norway.…”