APNA 29th Annua l Co nfe re nc e Se ssio n 3015.2: Oc to b e r 30, - - PDF document

APNA 29th Annua l Co nfe re nc e Se ssio n 3015.2: Oc to b e r 30, 2015 K e nd a ll 1

Ro b e rt K e nda ll, RN, MSN; Pa tric ia F e do rka , PhD, RNC-OB, C-E F M, CNE

APNA Na tio na l Co nfe re nc e 2015 Se ssio n 3015.2:

Intr

• duc ing L

ight T he r apy for T r e atme nt of De pr e ssive Symptoms in the In-Patie nt Se tting at the VA Pittsbur gh Hospital Syste m

 E

xpla in ho w the use o f lig ht the ra py c a n b e use d to tre a t pa tie nts with de pre ssive sympto ms in in-pa tie nt se tting s.

 De sc rib e the c o st b e ne fit a nd e ffe c tive ne ss o f

using lig ht the ra py a s tre a tme nt fo r pa tie nts with de pre ssive sympto ms in the in-pa tie nt se tting s.

 T

he spe a ke rs ha ve no c o nflic t o f inte re st to disc lo se

Ob je c tive s a nd Disc lo sure s

L ig ht T he ra py fo r T re a tme nt o f De pre ssive Sympto ms

Why? Whe re ? Who ? Ho w?

APNA 29th Annua l Co nfe re nc e Se ssio n 3015.2: Oc to b e r 30, 2015 K e nd a ll 2

 Pre va le nc e o f de pre ssive sympto ms a c ro ss dia g no se s

• PT

SD

• Bipo la r diso rde rs
• Ma jo r de pre ssive diso rde rs
• Po st pa rtum de pre ssio n

 Study re sults c o mpa ra b le to pha rma c o lo g ic a l tre a tme nt

• DSM-V re c o mme nda tio ns

 Adva nta g e s o ve r pha rma c o lo g ic a l tre a tme nt

• De c re a se d c o sts
• De c re a se d side e ffe c ts
• Ra pid e ffe c t
• I

nc re a se d c o mplia nc e

• De c re a se d risks in c o mb ining with o the r tre a tme nt mo da litie s

Why L ig ht T he ra py? F luo xe tine

$24 pe r mo nth Co st fo r o ne ye a r SAD tre a tme nt: $120 Co st fo r two ye a rs: $240 Co st fo r five ye a rs: $600

L ig ht T he ra py

$200 lig ht b o x $5 ma inte na nc e pe r ye a r Co st fo r o ne ye a r SAD tre a tme nt: $205 Co st fo r two ye a rs: $210 Co st fo r five ye a rs: $225

Co st Co mpa riso n

(Che ung , e t a l., 2012)

 Che ung , e t a l.

• Ca na dia n study
• SAD- 5 mo nths o f tre a tme nt pe r ye a r
• Outpa tie nt- o ne lig ht b o x pe r pa tie nt

 E

xtra po la te

• Using study pe r unit c o sts
• No nse a so na l de pre ssio n- 12 mo nths pe r ye a r
• Inpa tie nt- lig ht b o xe s use d b y multiple pa tie nts

Co st Co mpa riso n

APNA 29th Annua l Co nfe re nc e Se ssio n 3015.2: Oc to b e r 30, 2015 K e nd a ll 3

F luo xe tine

Co st pe r mo nth: $24 Co st fo r 1 pa tie nt fo r ye a r: $288 Co st fo r 10 pa tie nts fo r 1 ye a r: $2880 Co st fo r 10 pa tie nts fo r 5 ye a rs: $14,400

L ig ht T he ra py

L ig ht b o x: $200 Ma inte na nc e pe r ye a r: $5 Co st fo r 1 pa tie nt fo r 1 ye a r: $205 Co st fo r 10 pa tie nts fo r 1 ye a r: $205 Co st fo r 10 pa tie nts fo r 5 ye a rs: $225

E xtra po la te d Co st Co mpa riso n

 Me ta a na lysis sho ws b rig ht lig ht tre a tme nt re sulting

in sig nific a nt re duc tio n o f no nse a so na l de pre ssio n sympto m se ve rity in 15 se pa ra te ra ndo mize d, c o ntro lle d tria ls (E ve n, e t a l., 2008)

 E

ffe c tive a s so le tre a tme nt a nd in c o njunc tio n with pha rma c o lo g ic a l tre a tme nts (E ve n, e t a l., 2008)

 I

mpro ve d Ha milto n Sc a le sc o re s in e lde rly pa tie nts with no nse a so na l ma jo r de pre ssio n (L ie ve rse , e t a l., 2011)

 Re pe a te d sig nific a nt impro ve me nt in de pre ssive

sympto ms fro m the first we e k o f tre a tme nt (Pa il, e t a l., 2011) (Ca ma rde se , 2015)

De mo nstra te d E ffe c tive ne ss

 Outpe rfo rme d tra ditio na l pha rma c o lo g ic a l

tre a tme nt in pa tie nts with c hro nic de pre ssio n o f a t le a st 2 ye a rs (E ve n, e t a l., 2008)

 Sig nific a nt de c re a se in de pre ssive sympto ms fo r

b o th unipo la r a nd b ipo la r pa tie nts who we re re sista nt to pha rma c o lo g ic a l tre a tme nt (Ca ma rde se , e t a l., 2015)

 Ha s mo ve d b e yo nd b e ing e xpe rime nta l a nd is

no w c o nside re d a n a ffo rda b le a nd po we rful c linic a l inte rve ntio n fo r tre a tme nt o f de pre ssio n

De mo nstra te d E ffe c tive ne ss

APNA 29th Annua l Co nfe re nc e Se ssio n 3015.2: Oc to b e r 30, 2015 K e nd a ll 4

• We ig ht g a in
• Pa ra d o xa l e ffe c t
• Inso mnia
• Se xua l dysfunc tio n
• Na use a
• F

a tig ue a nd dro wsine ss

• Dry mo uth
• Blurre d visio n
• Co nstipa tio n
• Dizzine ss
• Ag ita tio n
• Irrita b ility
• Anxie ty

Pha rma c o lo g ic a l T re a tme nt

• E

me rg e nt hypo ma nia

• Auto no mic hype ra c tiva tio n

L ig ht T he ra py

Side E ffe c ts

Org a niza tio na l ine rtia L imite d pra c titio ne r kno wle dg e (Oldha m 2014) L a rg e numb e r o f sta ke ho lde rs L a c k o f insura nc e c o ve ra g e (Oldha m 2014) Ab se nc e in tre a tme nt a lg o rithms (Oldha m 2014) Initia l inve stme nt in purc ha sing lig ht b o xe s

Ba rrie rs to I mple me nta tio n Whe re to Use L ig ht T he ra py?

 L

ite ra ture a ll invo lve s o utpa tie nt e nviro nme nts

 Gre a t po te ntia l fo r inpa tie nt tre a tme nt

• L

ike ly inc re a se in e ffe c tive ne ss o ve r o utpa tie nt use

 I nc re a se d c o mplia nc e  Use in c o mb ina tio n with o the r the ra pie s  E sta b lishing g o o d ha b its b e fo re disc ha rg e

• Co nse rva tio n o f re so urc e s

 One a ppa ra tus c a n tre a t do ze ns o f pa tie nts  Pa tie nts c a n b e tre a te d b y the ro o mful  T re a tme nt time c a n simulta ne o usly b e use d fo r g ro up the ra py o r o the r inte rve ntio ns

APNA 29th Annua l Co nfe re nc e Se ssio n 3015.2: Oc to b e r 30, 2015 K e nd a ll 5

Who a re the Sta ke ho lde rs?

PMH Nurse Psyc hia trist Psyc ho lo g ist De pa rtme nt o f Ve te ra ns’ Affa irs Pa tie nt F a mily

Ho w to I mple me nt L ig ht T he ra py?

Suc c e ssful Imple me nta tio n E d uc a tio n Org a niza tio n Pro vid e rs PMH Nurse Pa tie nt F a mily Co mmunic a tio n Pro fe ssio na ls a nd

• rg a niza tio n

Pro fe ssio na ls a nd pa tie nt/ fa mily Da ta Co lle c tio n Ana lysis

30 minute s pe r die m E xpo sure a t 10,000 lux Auro ra o r No rthe rn L ig hts 10,000 mo de l lig ht Be twe e n 7 a nd 8a m I nc lude a s pa rt o f mo rning me d ro utine

Sug g e ste d Pro to c o l

APNA 29th Annua l Co nfe re nc e Se ssio n 3015.2: Oc to b e r 30, 2015 K e nd a ll 6

Ho w to Va lida te Re sults?

Se ve rity o f De pre ssive Sympto ms

Be fo re T re a tme nt PHQ9 Se lf Re po rt F

• llo wing

T re a tme nt Ha milto n De pre ssio n Ra ting Sc a le

Multiple me a suring po ints Multiple to o ls E sta b lishe d to o ls fo r me a suring de pre ssio n Co rre la tio n o f se lf-re po rt a nd pro fe ssio na lly-a dministe re d re sults

Ho w to Va lida te Re sults?

I ntro duc ing lig ht the ra py fo r the tre a tme nt o f de pre ssive sympto ms in the inpa tie nt se tting will e na b le the PMH nurse to me e t the physic a l a nd me nta l ne e ds o f the po pula tio n a c ro ss the life spa n, a nd impro ve the po pula tio n’ s me nta l he a lth b y inc re a sing inte r- a nd intra -pro fe ssio na l sta ke ho lde r, e spe c ia lly pa tie nt, c o lla b o ra tio n in tre a tme nt.

Wha t is the Ultima te Go a l?

APNA 29th Annua l Co nfe re nc e Se ssio n 3015.2: Oc to b e r 30, 2015 K e nd a ll 7

• Inc re a se d pra c titio ne r kno wle dg e
• Disc ussio n b e twe e n va rio us sta ke ho ld e rs
• De ve lo pe d a pro to c o l suppo rte d b y re se a rc h find ing s

Addre sse d se ve ra l b a rrie rs to imple me nta tio n

• Org a niza tio na l ine rtia
• F

unding fre e ze s

• Po ssib le funding c uts

Still re so lving e xisting a nd e me rg ing b a rrie rs

Curre nt Pro je c t Sta tus

Co mpa ra b le e ffe c tive ne ss to pha rma c o lo g ic a l tre a tme nt

• f de pre ssive sympto ms
• Ra pid impro ve me nt
• De c re a se d c o sts
• De c re a se d side e ffe c ts
• I

nc re a se d pa tie nt c o mplia nc e Curre nt pro g re ss is slo w, b ut no t a re a so n to b e disc o ura g e d

• Pa ra dig m shift
• Ove rc o ming b a rrie rs ne e d
• nly b e do ne o nc e
• Co ntinue d suc c e ss o f lig ht

the ra py in o utpa tie nt e nviro nme nt ma ke s e ve ntua l inpa tie nt use ine vita b le

Co nc lusio n

 Ca ma rde se , G., L

e o ne , B., Se rra ni, R., Wa lstra , C., Di Nic o la , M., De lla Ma rc a , G., Bria , P., & Ja niri, L . (2015). Aug me nta tio n o f lig ht the ra py in diffic ult-to -tre a t de pre sse d pa tie nts: a n o pe n-la b e l tria l in b o th unipo la r a nd b ipo la r pa tie nts. Ne uro psyc hiatric Dise ase and T re atme nt, 2015(11): 2331-2338. do i: 10.2147/ NDT .S74861

 Che ung , A., De wa , C., Mic ha la k, E

. E ., Bro wne , G., L e vitt, A., L e vita n, R. D., E nns,

• M. W., Mo re ho use , R. L

., & L a m, R. W. (2012). Dire c t he a lth c a re c o sts o f tre a ting se a so na l a ffe c tive diso rde r: a c o mpa riso n o f lig ht the ra py a nd fluo xe tine . De pre ssio n Re se arc h and T re atme nt, 2012. do i: 10.1155/ 2012628434

 E

ve n, C., Sc hro de r, C. M., F rie dma n, S., & Ro uillo n, F . (2008). E ffic a c y o f lig ht the ra py in no nse a so na l de pre ssio n: a syste ma tic re vie w. J

• urnal o f Affe c tive

Diso rde rs, 108 (2008), 11-23.

 L

ie ve rse , R., Va n So me re n, E . J., Nie le n, M. M., Uitde ha a g , B. M., Smit, J. H., & Ho o g e ndijk, W. J. (2011). Brig ht lig ht tre a tme nt in e lde rly pa tie nts with no nse a so na l ma jo r de pre ssive diso rde r: a ra ndo mize d pla c e b o -c o ntro lle d tria l. Arc hive s o f Ge ne ral Psyc ho lo gy, 68(1): 61-70.

 Oldha m, M. A., & Do me nic , C. A. (2014). Brig ht lig ht the ra py fo r de pre ssio n: a

re vie w o f its e ffe c ts o n c hro no b io lo g y a nd the a uto no mic ne rvo us syste m. Chro no bio lo gy I nte rnatio nal, 2014: 31(3). do i: 10.3109/ 07420528.2013.833935

 Pa il, G., Huf, W., Pire k, E

., Winkle r, D., Wille it, M., Pra sc ha k-Rie de r, N., & K a spe r, S. (2011). Brig ht-lig ht the ra py in the tre a tme nt o f mo o d diso rde rs. Ne uro psyc ho bio lo gy, 2011(64): 152-162. do i: 10.1159/ 000328950

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