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Download Full Text (Pdf) DEGREE PROJECT IN ARCHITECTURE, SECOND CYCLE, 15 CREDITS STOCKHOLM, SWEDEN 2021 The Right Light at the Right Time for Bipolar Patients An exploratory study of light environments for patients with bipolar disease in behavioral health clinics MIRA SVANBERG KTH ROYAL INSTITUTE OF TECHNOLOGY SCHOOL OF ARCHITECTURE AND THE BUILT ENVIRONMENT TRITA TRITA-ABE-MBT-21138 www.kth.se Title The Right Light at the Right Time for Bipolar Patients An exploratory study of light environments for patients with bipolar disease in behavioral health clinics Author Mira Svanberg Tutor Arne Lowden KTH School of Architecture - Architectural Lighting Design Course code AF270X Examiner Dr. Ute Besenecker Year 2021 TRITA-ABE-MBT-21138 KTH, 2021 Architectural lighting design Mira Svanberg The Right Light at the Right Time for Bipolar Patients An exploratory study of light environments for patients with bipolar disease in behavioral health clinics Author Mira Svanberg Tutor Arne Lowden Year: 2021 2 | Page KTH, 2021 Architectural lighting design Mira Svanberg Contents 7.4 Measurements ...................................... 18 1. Abstract......................................................... 4 7.5 Evaluation of patient rooms .............. 20 2. Introduction and objective of thesis .... 5 8. Improved design for patient rooms ... 20 3. Background ................................................. 5 8.1 Light intensity and direction of color 3.1 Bipolar disorder ....................................... 6 ........................................................................... 21 3.2 Circadian system ..................................... 6 8.2 Suggested luminaires ......................... 23 3.3 V/P- theory ............................................... 7 8.3 Light program ........................................ 28 4. Method .......................................................... 7 8.4 The improved patient room design visualized ........................................................ 35 5. Results of literature review ..................... 8 9. Discussion ................................................. 36 5.1 The biological effect of light ................ 8 9.1 Delimitations .......................................... 36 5.2 Light and bipolar disorder .................... 8 9.2 The improved design .......................... 36 5.3 Depressive episodes .............................. 9 9.3 Sun-like design ..................................... 37 5.4 Manic episodes ................................. 9 10.4 Light program ..................................... 37 5.5 Behavior health light design ................ 9 9.5 Depression ............................................. 38 6. Standards and Recommendations ....10 9.6 Manic state light effects .................... 39 6.1 Patient rooms recommendation from Lighting guide 2: Lighting for healthcare 9.7 Luminaires in the field study and the premises..........................................................10 TLM ................................................................. 39 6.2 Manchester Recommendations .......11 10. Conclusion ............................................ 40 6.3 Temporal Light Modulation ...............11 11. Further development ......................... 41 7. Field study .................................................13 12. Bibliography .............................................. 41 7.1 Patient room 1 .......................................13 13. Appendix ............................................... 45 7.2 Patient room 2 .......................................15 7.3 V/P-theory of the light situation in both patient rooms ......................................17 3 | Page KTH, 2021 Architectural lighting design Mira Svanberg 1. Abstract Research has showed that different light scenarios have a profound effect on hospitalized bipolar patients. Different light situations decrease the hospital stay for patients during both manic and depressive episodes. Nevertheless, a field study carried out during this thesis work of two arbitrary patient rooms in Swedish behavioral health clinics showed no incorporation of this knowledge in the light design of the rooms. Both patient rooms had insufficient light levels both in terms of circadian recommendations and perceived brightness. Hence this thesis suggests an improved light design for patient rooms housing bipolar patients. The basis of the improved design is to incorporate a dynamic, circadian lighting that varies depending on the patient's need and diagnosed episode. CIE International Commission on Illumination CRI Color Render Index IEEEE Institute of Electrical and Electronics Engineers ipRGC Intrinsically photosensitive Retinal Ganglion Cell K Kelvin M-EDI Melanopic Equivalent Daylight Illuminance SPD Spectral Power Distribution TLA Temporal Light Artifact TLM Temporal Light Modulation 4 | Page KTH, 2021 Architectural lighting design Mira Svanberg 2. Introduction and objective of thesis The purpose of a behavioral health clinic with compulsory care is to heal and protect. Hence, the light design for such a premise should support that purpose. Unfortunately, many hospitals provide stressful environments for their occupants, contradicting their healing intent (Andrade & Devlin, 2021). Patients who are suffering from bipolar disorder, a severe mental disease which afflict 1-4% of the world population (Geoffroy et al., 2016), is one group which occupies behavioral health clinics. The number of Swedish hospitalized bipolar patients has increased rapidly since 1998 (Socialstyrelsen, 2020). This increase motivates the objective of the thesis, which is to investigate how light design can be implemented to possibly improve the well-being of hospitalized bipolar patients. The long, dark winter season in Sweden results in a dependency on artificial light. Therefore, the focus will be only on the impact of this ubiquitous artificial light. 3. Background Florence Nightingale stated already in 1860 "Without going into any scientific exposition, we must admit that light has quite as real and tangible effects upon the human body." (Nightingale, 2005) Light has been clinically applied as a form of therapy worldwide since the 1980s (Brainard, 2021). It has been in use as a treatment for seasonal affective disorder, non-seasonal affective disorder, and in many other health care areas (Lucas et al. 2014). Trials of dynamic circadian light in geriatric care facilities are relatively common (Chromaviso, 2021). Several research projects in Scandinavia have conducted pilot studies incorporating circadian light design in psychiatric clinics, with positive results, such as shortened hospital stays (Chromaviso, 2021). Although there is ongoing work in the field, the Swedish Agency for Health Technology Assessment and Assessment of Social Services concluded in 2007 that the evidence value of light therapy was insufficient (SBU, 2007). They did not entirely reject it but asked for more proper evidence-based research. As a result of this, the use of light therapy decreased, and in 2015 only seven of 21 5 | Page KTH, 2021 Architectural lighting design Mira Svanberg regions used light as a therapeutic tool (SR, 2015). Could the increasing knowledge of the biological impact of light perhaps provide a second chance for light as part of therapy for bipolar patients? 3.1 Bipolar disorder Bipolar disease is a severe brain disorder with a palpable risk of suicide, as evident by the 34% prevalence of suicidal attempts during a patient’s lifetime (American Psychiatric Association, 2021). It is defined by a depressive, low mood state and an elevated mood state, mania (Gold & Sylvia, 2016). There are three different subclasses of bipolar disorder, but the sleep disturbances are common for all of them; hence bipolar will be referred to as one disease in this thesis. The diagnosis of bipolar disorder 1, based on the DSM 5-criteria for depression, partly includes: intense sadness or despair, frequent thoughts of death or suicide, feelings of worthlessness or guilt, fatigue, increased or decreased sleep, insomnia, or hypersomnia (American Psychiatric Association, 2021). For manic episodes, DSM-5 criteria include increased or faster speech, Decreased need for sleep (e.g., feeling energetic despite significantly less sleep than usual), uncontrollable racing thoughts or quickly changing ideas or topics when speaking, distractibility, and increased activity and risky behavior (American Psychiatric Association, 2021). As shown by the criteria in bold, sleep disturbances occur in all stages of bipolar disease in the shape of hypersomnia, insomnia, or experienced decreased need for sleep. 25% of patients experience hypersomnia or insomnia in an episode (Kaplan, 2020). Also, in inter-episodes, there seems to be a dysfunction in sleep-wake time (Bradley et al., 2017). Sleep is crucial for the healing and recovery of the body in all humans and impacts several factors, such as immune function, hormone production and motivation, attention, and emotional reactivity (Aulsebrook, Jones, & et al., 2019). Sleep deprivation is harmful by its negative impact on learning and memory capacity (Aulsebrook, Jones, & et al., 2019). Some hypotheses even suggest sleep disturbances to be the root of the bipolar disease (Gold & Sylvia, 2016). 3.2 Circadian system Human beings have evolved under Earth’s celestial environment, where the movement of the sun affects our behavior. Today, even though most people inhabit electrified houses, the body is still somewhat in synch with its ancestral rhythms (Brainard,
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