Light therapy

it will help to understand more about the importance of light therapy

1. Light therapy Presented to: M r . Bharat Pareek Associate Professor mental Health Nursing Saraswati nursing institute Presented by: Astha M. sc nursing 1 st year

2. introduction It is sometimes called as phototherapy. It involves exposure to intense light under specific conditions. It consists of fluorescent bulbs installed in a box with plastic diffusing screen and setup on a table at which one can sit for treatment Faroese physician Niels Finsen is believed to be the father of modern phototherapy. He developed the first artificial light source for this purpose, and used his invention to treat lupus vulgaris . He received the Nobel Prize in Physiology or Medicine in 1903.

3. Process of light therapy It includes simply sitting close to light box with light on and eyes open. in this one is free to eat meals, writing, reading. In this body and head should be oriented to lights concentrating on light surface not only lights themselves. Session last for 15 min to 2 hours but it can be separated into sessions depends upon need of person. In it amount of light and its duration should be adjusted.

4. Mechanism of light therapy Activity get delayed when stimulated by light. These physiological changes are based on the therapeutic level of illumination and has physiological effects, but mechanism is still unclear. Blood levels of hormone melatonin i.e is abnormally high many times in a day and gets reduce with light therapy. With bright light internal clock of body which controls daily activities, sleep, body activities therapeutic response

5. Uses of light therapy Patient of seasonal affective disorder experience feeling down, having less energy, having difficulty in getting up in morning. When person become less productive and thinks life has gone in extreme patient has increased appetite, weight gain. Women report worsening of postmenstrual symptoms. SAD(seasonal affective disorder) people improve with light therapy. Research shows marked improvement in 4 to 5 days at medical centres in US, CANADA, AUSTRALIA.

6. Treatment Mood and sleep related Light boxes The brightness and color temperature of light from a light box are quite similar to daylight. The production of the hormone melatonin, a sleep regulator, is inhibited by light and permitted by darkness as registered by photosensitive ganglion cells in the retina. To some degree, the reverse is true for serotonin, which has been linked to mood disorders. Hence, for the purpose of manipulating melatonin levels or timing, light boxes providing very specific types of artificial illumination to the retina of the eye are effective.

7. Cont.. Light therapy either uses a light box which emits up to 10,000 lux of light, much brighter than a customary incandescent lamp, or a lower intensity of specific wavelengths of light from the blue (470 nm) to the green (525 nm) areas of the visible spectrum. Newer light therapy devices use LED technology, making them much smaller and more convenient for users.

8. Brightness values Candle light at 20 cm- 10-15 lux Street light- 10-20 lux Normal living room lightening- 100 lux Office fluorescent light- 300-500 lux Halogen lamp- 750 lux Sunlight 1 hr before sunset- 1000 lux Daylight, cloudy sky- 5000 lux Daylight clear sky- 10,000 lux Bright sunlight- less than 20,000 lux

9. Seasonal affective disorder While full sunlight is preferred for seasonal affective disorder (SAD) light boxes may be effective for the treatment of the condition. Light boxes for seasonal affective disorder are designed to filter out most UV light, which can cause eye and skin damage. The U.S. Food and Drug Administration have not approved the use of light boxes to treat SAD due to unclear results in clinical trials, but light therapy is still seen as the main form of treatment for SAD.

10. Cont.. Direct sunlight, reflected into the windows of a home or office by a computer-controlled mirror device called a heliostat, has also been used as a type of light therapy for the treatment of SAD. It is possible that response to light therapy for SAD could be season dependent.

11. Non-seasonal depression Light therapy has also been suggested in the treatment of non-seasonal depression and other psychiatric disturbances, including major depressive disorder, bipolar disorder and postpartum depression. A meta-analysis by the Cochrane Collaboration concluded that "For patients suffering from non-seasonal depression, light therapy offers modest though promising anti depressive efficacy."

12. Circadian rhythm sleep disorders Chronic CRSD In the management of circadian rhythm disorders such as delayed sleep phase syndrome (DSPS), the timing of light exposure is critical. For DSPS, the light must be provided to the retina as soon after spontaneous awakening as possible to achieve the desired effect, as shown by the phase response curve for light in humans. Some users have reported success with lights that turn on shortly before awakening (dawn simulation).

13. Cont… Morning use may also be effective for non-24-hour sleep-wake syndrome, while evening use is recommended for advanced sleep phase syndrome. Situational CRSD Light therapy has been tested for individuals on shift work, and for jet lag.

14. Time to use light therapy Light can be used for several purposes, including winter depression, which is one version of seasonal affective disorder -- SAD, what an acronym. It can also be used for moving your sleep timing, even if you don't have depression. Here we'll focus on SAD. For winter depressions, research has so far focused on using light therapy in the morning. Most studies have shown this to be more effective than evening light, when one timing is compared against the other and no further information is gathered about the patients participating.

15. Benefits Normal results for mainstream light treatments are clearing of the skin disorder or a lifting of depressed mood. Normal results for alternative light therapies include a sense of heightened energy and relief from negative thoughts or preoccupations. Antidepressant and light therapy combined are more effective for SAD disorder.

16. Side effects It has minimal side effects but some are- Eye irritation, Redness alleviated by sitting farther to light Nausea or agitation in beginning of treatment, But passes off quickly as one accommodates to high intensity light. Headache

17. Contraindications Glaucoma Cataract Use of photosensitizing medicines.

18. Precautions Patients with eye disorders, patients sometimes experience headaches, Dry eyes, Mild sunburn, or fatigue. These problems can usually be relieved by adjusting the length of time for light treatments and by using a sunscreen and nose or eye drops.

19.   After care No aftercare is necessary for mainstream light treatments. Practitioners of alternative light therapies recommend that patients sit or rest quietly for a few minutes after the treatment rather than returning abruptly to their daily routines. This brief rest is thought to maximize the benefits of the treatment.

20. Role of nurse Assess need of patient for doing any activity Ask what he wants to do Assess the mood or activity level Activity should be like that it should improve the condition Encourage the client to participate in activities Teaches about how to do that activity which he wishes to do The environment for any therapy should be perfect

21. Client education : Advice client to use relaxation techniques. Advice client to do therapies as regular basis. Educate the client about techniques of therapies. Educate them to learn and practice those techniques. Teach about the therapies to have control over specific psychiatric problems.

22. Research input A meta analysis exploring light therapy for depression found that a large effect size for seasonal affective disorder. Light therapy has a lower side effect profile than antidepressant medications and may reduce the time of antidepressant response. Evidence is less established for the light therapy as a single therapy for non seasonal depression, but it may be effective as an adjunct to antidepressant medications.

23. Bibliography Shreevani R. A guide to mental health and psychiatric nursing, 3 rd edition. Pub- Jaypee . p.p-131. Staurt W. Gail. principle and practice of psychiatric nursing, 10 th edition. Pub-Elsevier. P.p-610.