Mukund G. Rao

Urban growth trend analysis using GIS techniques—a case study of the Bombay metropolitan region

Abstract Towns and cities in India are facing complex problems regarding the provision and maintenance of services and infrastructure in the face of the rapid growth of pupulation, caused both by natural increase and migration. In order to meet such challenges a planner needs to have fairly accurate and up-to-date information, especially about physical structures and related land parameters. A study of their trends generally helps in the understanding of the emerging growth pattern and in formulating policies to guide or redirect it. Recent advances in the field of remote sensing technology and computer based Geographical Information Systems (GIS) provide very useful tools in undertaking such analysis. The results from a study about growth trends of the urban areas in the Bombay Metropolitan Region using multi-date remote sensing data and ARC/INFO GIS package are described here. The period under consideration is from 1968 to 1989. It should be noted that the major growth in the region is confined to Great...

Positive therapeutic and neurotropic effects of yoga in depression: A comparative study

Context: Therapeutic effect of yoga in depression is recognized. Neuroplastic effects of antidepressant therapies are inferred by elevations in brain-derived neurotrophic factor (BDNF). Role of yoga in both these effects has not been studied. Materials and Methods: Non-suicidal, consecutive out-patients of depression were offered yoga either alone or with antidepressants. The depression severity was rated on Hamilton Depression Rating Scale (HDRS) before and at 3 months. Serum BDNF levels were measured at the same time points. Repeated-measures analysis of variance was performed to look at change across groups with respect to HDRS scores and BDNF levels over 3 months of follow-up. Relationship between change in serum BDNF levels and change in HDRS scores was assessed using the Pearsons correlation coefficient. Results: Both yoga groups were better than drugs-only group with respect to reduction in HDRS scores. Serum BDNF rose in the total sample in the 3-month period. This was not, however, different across treatment groups. There was a significant positive correlation between fall in HDRS and rise in serum BDNF levels in yoga-only group (r=0.702; P=0.001), but not in those receiving yoga and antidepressants or antidepressants-alone. Conclusions: Neuroplastic mechanisms may be related to the therapeutic mechanisms of yoga in depression.

Cortisol and antidepressant effects of yoga

Context: Hypercortisolemia is well-known in depression and yoga has been demonstrated earlier to reduce the parameters of stress, including cortisol levels. Aim: We aimed to find the role of yoga as an antidepressant as well as its action on lowering the serum cortisol levels. Settings and Design: An open-labeled study consisting of three groups (yoga alone, yoga along with antidepressant medication and antidepressant medication alone) was conducted at a tertiary care psychiatry hospital. Methodology: Out-patient depressives who were not suicidal were offered yoga as a possible antidepressant therapy. A validated yoga module was used as therapy taught over a month and to be practiced at home daily. Patients were free to choose the drugs if their psychiatrist advised. Patients (n=54) were rated on Hamilton Depression Rating Scale (HDRS) with serum cortisol measurements at baseline and after 3 months. In 54 patients, assessments and blood test results were both available. 19 each received yoga alone or with drugs and 16 received drugs only. Healthy comparison subjects (n=18) too underwent morning cortisol measurements once. Results: Serum cortisol was higher in depressives compared with controls. In the total sample, the cortisol level dropped significantly at the end of treatment. More patients in the yoga groups had a drop in cortisol levels as compared to drug-only group. In the yoga-only group, the cortisol drop correlated with the drop in HDRS score (antidepressant effect). Conclusion: The findings support that yoga may act at the level of the hypothalamus by its ‘anti-stress’ effects (reducing the cortisol), to bring about relief in depression.

Serum cortisol and BDNF in patients with major depression—effect of yoga

Abstract Depression is associated with low serum Brain Derived Neurotrophic Factor (BDNF) and elevated levels of serum cortisol. Yoga practices have been associated with antidepressant effects, increase in serum BDNF, and reduction in serum cortisol. This study examined the association between serum BDNF and cortisol levels in drug-naïve patients with depression treated with antidepressants, yoga therapy, and both. Fifty-four drug-naïve consenting adult outpatients with Major Depression (32 males) received antidepressants only (n = 16), yoga therapy only (n = 19), or yoga with antidepressants (n = 19). Serum BDNF andcortisol levels were obtained before and after 3 months using a sandwich ELISA method. One-way ANOVA, Chi-square test, and Pearson’s correlation tests were used for analysis. The groups were comparable at baseline on most parameters. Significant improvement in depression scores and serum BDNF levels, and reduction in serum cortisol in the yoga groups, have been described in previous reports. A significant negative correlation was observed between change in BDNF (pre–post) and cortisol (pre–post) levels in the yoga-only group (r = −0.59, p = 0.008). In conclusion, yoga may facilitate neuroplasticity through stress reduction in depressed patients. Further studies are needed to confirm the findings and delineate the pathways for these effects.

Low serum brain derived neurotrophic factor in non-suicidal out-patients with depression: Relation to depression scores.

Context: Low brain-derived neurotrophic factor (BDNF) has been implicated in the pathophysiology of depression. The relation between BDNF and severity of depression has been investigated. Aims: In this study, we aimed to measured serum BDNF levels in never-treated non-suicidal out-patients with depression and relate this to the severity of depression. Settings and Design: This study was conducted in an out-patient setting in a tertiary care psychiatric hospital on consenting depressed patients. Materials and Methods: Forty three (19 females) antidepressant-naive out-patients with depression, aged between 18 and 55 years and 24 (13 females) age-matched healthy volunteers gave consent for the study. Serum BDNF levels were assayed by using the sandwich enzyme-linked immunosorbent assay method on morning serum samples before starting treatment. These were compared between patients and controls using independent sample t-test. Pearsons correlation coefficient was used to assess the association between baseline BDNF and Hamilton depression rating scale (HDRS). Results: Serum BDNF was significantly lower in patients with depression (mean±standard deviation (SD)=18.59±4.9 ng/ml) than in healthy volunteers (mean±SD=23.6±5.6 ng/ml; P=0.001). There was a significant negative correlation between the HDRS total scores and BDNF levels (P=0.04), indicating that more severely depressed patients had lower BDNF scores. Conclusions: Serum BDNF level is lower in non-suicidal out-patients with depression. The inverse correlation between ratings of depression and BDNF levels suggests possible relationship between depression, (role of illness on) BDNF levels and neuroplasticity thereof.

Development and feasibility of yoga therapy module for out-patients with depression in India

Context: Evidence suggests that certain yoga practices are useful in the management of depression. To the best of our knowledge, there has been no study that deals with the formulation of a yoga module for the particular clinical features of depression. Aim: The main aim of our study was to develop a comprehensive yoga therapy module targeting specific clinical features of depression. Settings and Design: Specific yoga practices were matched for clinical features of depression based on a thorough literature review. A yoga program was developed, which consisted of Sukṣmavyayāma, (loosening exercises), äsanas (postures), relaxation techniques, Prāṇāyāma (breathing exercises) and chanting meditation to be taught in a 2 week period. Materials and Methods: A structured questionnaire was developed for validation from nine experienced yoga professionals. The final version of yoga therapy module was pilot-tested on seven patients (five females) with depression recruited from outpatient service of National Institute of Mental Health and Neuro Sciences, Bangalore. Results: The final yoga therapy module had those practices that received a score of three or more (moderately/very much/extremely useful) from all responders. Six out of nine (>65%) experts suggested Sūkśmavyāyāma should be included. Five out of nine experts opined that training with 10 sessions (over 2 weeks) is rather short. All experts opined that the module is easy to teach, learn and practice. At the pilot stage, the five patients who completed the module reported more than 80% satisfaction about the yoga practices and how the yoga was taught. Severity of depression substantially reduced at both 1 and 3 months follow-up. Conclusion: The developed comprehensive yoga therapy module was validated by experts in the field and was found to be feasible and useful in patients with depression.

Positive antidepressant effects of generic yoga in depressive out-patients: A comparative study

Context: Therapeutic effects in depression of yoga adopted from different schools have been demonstrated. The efficacy of a generic module of yoga on depressed patients has not yet been tested in the literature. Aims: The study was aimed to compare the therapeutic effect of a generic yoga module with antidepressant drugs in non-suicidal out-patients of major depression attending a psychiatric hospital. Settings and Design: The study was outpatient-based using an open-labeled design. Materials and Methods: A total of 137 out-patients of depressive disorders received one of the three treatments as they chose – yoga-only, drugs-only or both. The yoga was taught by a trained yoga physician for over a month in spaced sessions totaling at least 12. Patients were assessed before treatment, after 1 and 3 months on depression and Clinical Global Impression Scales. Out of 137, 58 patients completed the study period with all assessments. Results: Patients in the three arms of treatment were comparable on demographic and clinical variables. Patients in all three arms of treatment obtained a reduction in depression scores as well as clinical severity. However, both yoga groups (with or without drugs) were significantly better than the drugs-only group. Higher proportion of patients remitted in the yoga groups compared with the drugs-only group. No untoward events were spontaneously reported in the yoga-treated patients. Conclusion: Within the limitations of this study, it can be concluded that the findings support a case for prescribing yoga as taught in the study in depressive non-suicidal out-patients.

Hyperthyroidism presenting as mixed affective state: a case report.

Thyroid disorders have long been associated with psychiatric illness, commonly mood disorders. In bipolar disorder, hypothyroidism is quite a common abnormality. Little is known about the association of thyroid disorders and mixed affective states. We present a case of hyperthyroidism presenting as a mixed affective state and the successful resolution of psychiatric symptoms with antithyroid medication along with a mood-stabilizing agent.

Late-onset clozapine-induced agranulocytosis in a patient with comorbid multiple sclerosis

The risk of clozapine-induced agranulocytosis is highest in the initial 6 months after onset of treatment. There have been very few reports of neutropenia and agranulocytosis after this period. We report a unique case of delayed clozapine-induced agranulocytosis in a patient with preexisting multiple sclerosis (MS) which was treated with granulocyte colony-stimulating factor. Both MS and clozapine-induced agranulocytosis have an underlying autoimmune immune mechanism. This case highlights the need for frequent blood count monitoring on clozapine even after the initial 6 months of starting treatment especially in patients with a past history of drop in white blood cell counts as well as with a comorbid autoimmune disorder.

Metacognitive training for delusion in treatment-resistant schizophrenia.

Metacognitive training for patients with schizophrenia (MCT) is a novel form of psychotherapy that aims to promote insight into the relationship between metacognitive deficits and psychotic symptoms, especially delusions. MCT has been found to be effective in reducing the delusional conviction and other positive symptoms in patients with schizophrenia. However, we are not aware of any research in which MCT has been used specifically to manage treatment-resistant schizophrenia patients. We report the case of a patient with treatment-resistant schizophrenia who responded to MCT. Her persecutory and referential delusions improved with a course of twelve sessions of therapy. Further, the improvement in delusions had a positive impact on her psychosocial functioning. A follow-up after two months of therapy revealed sustained improvement.