Rashmi Arasappa

Effect of yoga therapy on facial emotion recognition deficits, symptoms and functioning in patients with schizophrenia.

Behere RV, Arasappa R, Jagannathan A, Varambally S, Venkatasubramanian G, Thirthalli J, Subbakrishna DK, Nagendra HR, Gangadhar BN. Effect of yoga therapy on facial emotion recognition deficits, symptoms and functioning in patients with schizophrenia.

Neurohemodynamic correlates of 'OM' chanting: A pilot functional magnetic resonance imaging study.

Background: A sensation of vibration is experienced during audible ‘OM’ chanting. This has the potential for vagus nerve stimulation through its auricular branches and the effects on the brain thereof. The neurohemodynamic correlates of ‘OM’ chanting are yet to be explored. Materials and Methods: Using functional Magnetic Resonance Imaging (fMRI), the neurohemodynamic correlates of audible ‘OM’ chanting were examined in right-handed healthy volunteers (n=12; nine men). The ‘OM’ chanting condition was compared with pronunciation of “ssss” as well as a rest state. fMRI analysis was done using Statistical Parametric Mapping 5 (SPM5). Results: In this study, significant deactivation was observed bilaterally during ‘OM’ chanting in comparison to the resting brain state in bilateral orbitofrontal, anterior cingulate, parahippocampal gyri, thalami and hippocampi. The right amygdala too demonstrated significant deactivation. No significant activation was observed during ‘OM’ chanting. In contrast, neither activation nor deactivation occurred in these brain regions during the comparative task – namely the ‘ssss’ pronunciation condition. Conclusion: The neurohemodynamic correlates of ‘OM’ chanting indicate limbic deactivation. As similar observations have been recorded with vagus nerve stimulation treatment used in depression and epilepsy, the study findings argue for a potential role of this ‘OM’ chanting in clinical practice.

Effect of risperidone on emotion recognition deficits in antipsychotic-naïve schizophrenia: A short-term follow-up study

BACKGROUND Facial emotion recognition deficits [FERD] have been consistently demonstrated in treated schizophrenia patients. FERD in treatment-naïve patients and the effect of antipsychotics are yet to be explored. AIMS To examine for FERD in antipsychotic-naïve schizophrenia patients and the effect of short-term atypical antipsychotic treatment on FERD. METHODS Twenty-five antipsychotic-naïve schizophrenia [DSM-IV] patients and 30 age-, sex-, and education-matched healthy control subjects were assessed for FERD using the Tool for Recognition of Emotions in Neuropsychiatric DisorderS [TRENDS] - a culturally sensitive and valid tool. Psychopathology was assessed using SAPS and SANS. Performance of patients on TRENDS and psychopathology was re-assessed after short-term exposure to risperidone. RESULTS At baseline, the patients made significantly greater errors in recognition of negative emotions of fear and disgust which improved on follow-up. This improvement was influenced by severity of baseline negative symptoms. CONCLUSION Risperidone treatment can improve disgust recognition deficits in patients with schizophrenia.

Effect of yoga therapy on plasma oxytocin and facial emotion recognition deficits in patients of schizophrenia

Context: Yoga therapy has been demonstrated to be useful in treatment of negative symptoms and improving the socio-occupational functioning and emotion recognition deficits in antipsychotic-stabilized schizophrenia patients. Oxytocin has been recently implicated in social cognition deficits in schizophrenia. The effect of yoga therapy on oxytocin levels in schizophrenia has not been studied. Aims: This study aimed to assess the effect of yoga therapy on symptoms, socio-occupational functioning, facial emotion recognition deficits and plasma oxytocin levels in antipsychotic stabilized schizophrenia patients. Settings and Design: Randomized controlled study on 43 consenting, medication stabilized patients with schizophrenia in a tertiary psychiatric center using yoga intervention and waitlisted groups. Materials and Methods: A total of 43 schizophrenia patients were randomized to yoga group (n=15) or waitlist group (n=28). Patients in the yoga group received training in a specific yoga therapy module for schizophrenia. Patients in both groups were continued on stable antipsychotic medication. Assessments included scale for assessment of positive symptoms, scale for assessment of negative symptoms, socio-occupational functioning scale and tool for recognition of emotions in neuropsychiatric disorders (TRENDS) and plasma oxytocin levels; performed at baseline and at the end of 1 month. Results: A total of 15 patients in the yoga group and 12 in waitlist group completed the study. The yoga therapy group showed a significant improvement in socio-occupational functioning, performance on TRENDS (P<0.001) and plasma increase in oxytocin levels (P=0.01) as compared with the waitlist group. Conclusion: The study supported the role of add-on yoga therapy in management of schizophrenia and demonstrated an improvement in endogenous plasma oxytocin levels in schizophrenia patients receiving yoga therapy.

Clinical correlates of thalamus volume deficits in anti-psychotic-naïve schizophrenia patients: A 3-Tesla MRI study

Background: Thalamus, the sensory and motor gateway to the cortex, plays an important role in cognitive and perceptual disturbances in schizophrenia. Studies examining the volume of the thalamus in schizophrenia have reported conflicting findings due to the presence of potential confounding factors such as low-resolution imaging and anti-psychotics. The thalamus volume in anti-psychotic-naïve patients determined using high-resolution 3-Tesla magnetic resonance imaging (MRI) has not yet been examined. Materials and Methods: Using 3-Tesla MRI, this study for the first time examined anti-psychotic-naïve schizophrenia patients (n=18; M:F:11:7) in comparison with healthy controls (n=19;M:F:9:10) group-matched for age, sex, handedness, education, and socioeconomic status. The volume of the thalamus was measured using a three-dimensional, interactive, semi-automated analysis with good inter-rater and intra-rater reliability. Psychopathology was assessed using the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS). Results: Right, left, and total thalamus volumes of patients were significantly smaller than those of controls after controlling for the potential confounding effect of intracranial volume. Thalamus volumes had significant positive correlation with positive symptoms score (SAPS) and significant negative correlation with negative symptoms score (SANS). Conclusions: Thalamus volume deficits in anti-psychotic-naïve schizophrenia patients support a neurodevelopmental pathogenesis. The contrasting correlation of thalamus volume deficits with psychopathology scores suggests that contrasting pruning aberrations underlie symptom genesis in schizophrenia.

Digit ratio (2D:4D) asymmetry and Schneiderian first rank symptoms: Implications for cerebral lateralisation theories of schizophrenia

Schneiderian first rank symptoms (FRS) in schizophrenia have been hypothesised to be secondary to aberrant cerebral lateralisation over the course of human evolution. The ratio of length of second digit to fourth digit (2D:4D) has been put forward as a potential indicator of cerebral lateralisation. This study examined 2D:4D and its asymmetry in antipsychotic-naïve schizophrenia patients (N=79) in comparison with healthy controls (N=75). Psychopathology was assessed using Scales for Assessment of Positive and Negative Symptoms. FRS assessment was performed as per established descriptions. The digit lengths (2D & 4D) were measured using a digital vernier caliper with good inter-rater reliability. Female schizophrenia patients showed significantly lower 2D:4D than female healthy controls. Mean 2D:4D asymmetry index was significantly lower in male schizophrenia patients than male healthy controls. FRS status had significant effect on left 2D:4D as well as 2D:4D asymmetry index, the patients with FRS having the lowest values. Our study findings support association between Schneiderian FRS and low 2D:4D as well as low 2D:4D asymmetry index. Since 2D:4D is linked with limbic asymmetry, our study findings offer further support to the cerebral lateralisation theories of schizophrenia.

First rank symptoms & facial emotion recognition deficits in antipsychotic naïve schizophrenia: Implications for social threat perception model

Facial emotion recognition deficits (FERD) have been consistently demonstrated in schizophrenia. However the relation between psychopathology and FERD remains inconclusive. This could possibly be due to the wide heterogeneity in the psychopathology of schizophrenia. First Rank Symptoms (FRS) of schizophrenia is associated with heightened sense of paranoia and rapid processing of threatful emotional stimuli. We studied differences in patterns of FERD between homogenous sub-groups of antipsychotic naïve schizophrenia patients (n=63); namely those experiencing FRS (FRS+ group n=26) and those who did not (FRS- group n=37), in comparison to age-, sex-, education matched healthy controls (n=45). FERD was assessed using TRENDS - (Tool for Recognition of Emotions in Neuropsychiatric DisorderS), a culturally sensitive and ecologically valid (consisting of both static and dynamic emotional stimuli) tool. The total number of images of non threatful emotions (sad, happy, neutral) which were identified as any of the threatful emotions (fear, anger, disgust) and vice versa were calculated and termed TRENDS Over-identification and Under-identification score respectively. The patient group made significantly greater errors in emotion recognition as compared to healthy controls. On post hoc analysis (Tukey HSD) the patients in FRS+ group made significantly greater errors in Over-identification as compared to the FRS- group. This study supports that FERD is one of the important deficits in schizophrenia. There is a differential pattern of impairment in FERD, which supports the role of heightened threat perception in the evolution of psychopathology in schizophrenia patients.

Antithetical asymmetry in schizophrenia and bipolar affective disorder: a line bisection study

OBJECTIVE Evolutionary theories link the pathogenesis of psychosis with anomalous brain asymmetry. Research shows that aberrant lateralization is linked to schizophrenia with elevated rates of left-handedness and reversal of normal cerebral asymmetries. However, lateralization is underexamined in bipolar affective disorder (BPAD) and the available literature suggests the possibility of greater lateralization, which is diametrically opposite to what is observed in schizophrenia. For the first time, we report concurrent analyses of asymmetry in BPAD and schizophrenia using a line bisection task. METHODS We examined 164 subjects (31 patients with BPAD in remission, 30 patients with schizophrenia, and 103 healthy controls) using a two-hand line bisection task with established methodology. Raters with good inter-rater reliability (intraclass correlation coefficient > 0.8) measured deviation from the center. Task performance was compared using analysis of covariance with age, sex, and education as covariates. RESULTS Study groups did not differ significantly on age, sex, and handedness (p > 0.06). Patients (both schizophrenia and BPAD) had significantly more errors in identifying the center than controls (p < 0.001). Patients with schizophrenia bisected fewer lines at center than controls and BPAD subjects (p < 0.001). Using their right hand, schizophrenia patients had significant rightward deviation and BPAD patients had leftward deviation (p = 0.001). A significant interaction between diagnosis and direction of deviation (p = 0.01) was noted, with significant rightward deviation in schizophrenia and a trend toward leftward deviation in BPAD. CONCLUSIONS Study findings suggest attenuation of normal pseudoneglect in schizophrenia and accentuation of normal pseudoneglect in BPAD, indicating lesser lateralization in schizophrenia and possibly greater lateralization in BPAD. From an evolutionary perspective, schizophrenia and BPAD might have antithetical origins.

Feasibility and efficacy of yoga as an add-on intervention in attention deficit-hyperactivity disorder: An exploratory study

Context: Attention deficit-hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders. Stimulant medication is frequently used in management, with significant adverse effects. There is a growing interest in complementary treatments like yoga. Aims: To study the effects of yoga as a complementary therapy in children with moderate to severe ADHD. Settings and Design: The study was performed on children (consent was taken from parents) admitted in a child psychiatry unit using an open-label exploratory study. Materials and Methods: Children between 5 and 16 years of age diagnosed with ADHD and co-operative for yoga were included. Subjects with other serious psychiatric and medical illnesses were excluded. The participants were given yoga training daily during their in-patient stay. They were rated on Conners’ abbreviated rating scale – (CARS), ADHD-rating scale–IV (ADHD - RS IV) and clinical global impression (CGI)-Severity, at the beginning of study, at discharge and subsequently at the end of 1st, 2nd and 3rd month by a research associate not involved in yoga instruction. Paired t-test was employed to compare the means of scores between baseline and follow-ups. Results: A total of 9 children (8 males, 1 female) were recruited into the study. All, but one were on medications. An average of 8 yoga training sessions was given to subjects. They were able to learn yoga reasonably well. There was a significant improvement in the ADHD symptoms as assessed on CARS (P-0.014), ADHD-RS IV (P=0.021) and CGI- S scales (P=0.004) at the time of discharge.

Inferior parietal lobule volume and schneiderian first-rank symptoms in Antipsychotic-Naive schizophrenia: A 3-Tesla MRI study

Background: As per Friths neuro-cognitive model, inferior parietal lobule (IPL) is implicated in the pathogenesis of Schneiderian first-rank symptoms (FRS) in schizophrenia. The specific role of IPL structural abnormalities in the pathogenesis of FRS is yet to be ascertained. Materials and Methods: Using 3-tesla MRI scanner, this first-time study examined antipsychotic-naïve schizophrenia patients ( n = 28) (patients with FRS [FRS +]: N = 14, M: F = 7:7; and patients without FRS [FRS-]: N = 14, M: F = 7:7) in comparison with sex-, handedness-, education- and socioeconomic status-matched healthy controls (n = 14, M: F = 7:7). The volume of IPL was measured using a three-dimensional, interactive, semi-automated analysis, with good inter-rater reliability. Results: FRS + patients showed significant volume deficit in right IPL in comparison with healthy controls (F = 4.0; P=.028) after controlling for the potential confounding effects of age, sex and intracranial volume. Conclusions: Right IPL volume deficit in FRS+patients adds further support to the Friths model of FRS in schizophrenia.