Shivarama Varambally

Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment: A randomized controlled trial

OBJECTIVES This study compares the anxiolytic effects of a yoga program and supportive therapy in breast cancer outpatients undergoing conventional treatment at a cancer centre. METHODS Ninety-eight stage II and III breast cancer outpatients were randomly assigned to receive yoga (n=45) or brief supportive therapy (n=53) prior to their primary treatment i.e., surgery. Only those subjects who received surgery followed by adjuvant radiotherapy and six cycles of chemotherapy were chosen for analysis following intervention (yoga, n=18, control, n=20). Intervention consisted of yoga sessions lasting 60min daily while the control group was imparted supportive therapy during their hospital visits as a part of routine care. Assessments included Speilbergers State Trait Anxiety Inventory and symptom checklist. Assessments were done at baseline, after surgery, before, during, and after radiotherapy and chemotherapy. RESULTS A GLM-repeated measures ANOVA showed overall decrease in both self-reported state anxiety (p<0.001) and trait anxiety (p=0.005) in yoga group as compared to controls. There was a positive correlation between anxiety states and traits with symptom severity and distress during conventional treatment intervals. CONCLUSION The results suggest that yoga can be used for managing treatment-related symptoms and anxiety in breast cancer outpatients.

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.

Therapeutic efficacy of add-on yogasana intervention in stabilized outpatient schizophrenia: Randomized controlled comparison with exercise and waitlist.

Background: Schizophrenia is a highly disabling illness. Previous studies have shown yoga to be a feasible add-on therapy in schizophrenia. Aims: The current study aimed to test the efficacy of yoga as an add-on treatment in outpatients with schizophrenia. Settings and Design: The study done at a tertiary psychiatry center used a single blind randomized controlled design with active control and waitlist groups. Materials and Methods: Consenting patients with schizophrenia were randomized into yoga, exercise, or waitlist group. They continued to receive pharmacological therapy that was unchanged during the study. Patients in the yoga or exercise group were offered supervised daily procedures for one month. All patients were assessed by a blind rater at the start of the intervention and at the end of 4 months. Results: Kendall tau, a nonparametric statistical test, showed that significantly more patients in the yoga group improved in Positive and Negative Syndrome Scale (PANSS) negative and total PANSS scores as well as social functioning scores compared with the exercise and waitlist group. Odds ratio analysis showed that the likelihood of improvement in yoga group in terms of negative symptoms was about five times greater than either the exercise or waitlist groups. Conclusion: In schizophrenia patients with several years of illness and on stabilized pharmacological therapy, one-month training followed by three months of home practices of yoga as an add-on treatment offered significant advantage over exercise or treatment as usual. Yoga holds promise as a complementary intervention in the management of schizophrenia.

Cerebellar and other neurological soft signs in antipsychotic-naïve schizophrenia

Objective:  Cerebellar neurological abnormalities in schizophrenia have been associated with severe negative symptoms, cognitive deficits, and smaller cerebellar volume. This study assessed the comparative discriminant validity between Cerebellar Soft Signs (CSS) vs. other neurological soft signs (ONSS) [in discriminating between schizophrenia patients and healthy controls] as well as the relationship between the soft signs and psychopathology.

Yoga: A spiritual practice with therapeutic value in psychiatry

UNLABELLED Yoga is one of the spiritual practices derived from the orthodox school of Hindu philosophy. The practices were codified by Patanjali under the title of Ashtanga Yoga. Although Yoga was traditionally seen as a practice meant for achieving self-realization, in recent years there has been significant attention given to the effects of yoga practices on physical and mental health. Yoga as a therapy has proven to be effective as a sole or additional intervention in several psychiatric disorders. CONCLUSIONS The literature suggests that yoga can lead to significant symptomatic improvements in psychiatric disorders, along with neurobiological effects which may underlie these changes. This suggests that mental health professionals should be open to the potential benefits of spiritual practices for their patients, either as complementary interventions to modern treatments or as sole treatment in some disorders.

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.

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.

Effects of yoga intervention on sleep and quality-of-life in elderly: A randomized controlled trial.

Context: Yoga as a life-style practice has demonstrated beneficial effects. The role of yoga in the elderly for such benefits merits investigation. Aims: The aim of this study is to examine the effects of yoga intervention on quality-of-life (QOL) and sleep quality in the elderly living in old age homes. Settings and Design: Single blind controlled study with block randomization of elderly homes. Materials and Methods: A total of 120 subjects from nine elderly homes were randomized in to yoga group (n=62) and waitlist group (n=58). Subjects in the yoga group were given yoga intervention daily for 1 month and weekly until 3 months and were encouraged to practice yoga without supervision until for 6 months. Subjects in waitlist group received no intervention during this period. Subjects were evaluated with World Health Organization Quality of Life (WHOQOL)-BREF for measuring QOL and Pittsburgh Sleep Quality Index for sleep quality in the baseline and after 6 months. Statistical Analysis: Independent t-test and repeated measures analysis of covariance respectively was used to measure the difference in outcome measures between the two groups at baseline and after the study period. Results: Subjects in the yoga group had significantly higher number of years of formal education. Subjects in the yoga group had significant improvement in all the domains of QOL and total sleep quality after controlling for the effect of baseline difference in education between the two groups. Conclusion: Yoga intervention appears to improve the QOL and sleep quality of elderly living in old age homes. There is a need for further studies overcoming the limitations in this study to confirm the benefits of yoga for elderly in QOL and sleep quality.

Efficacy of yoga as an add-on treatment for in-patients with functional psychotic disorder

Context: The efficacy of yoga as an intervention for in-patients with psychosis is as yet unknown; although, previous studies have shown efficacy in stabilized out-patients with schizophrenia. Aim: This study aimed to compare the effect of add-on yoga therapy or physical exercise along with standard pharmacotherapy in the treatment of in-patients with psychosis. Settings and Design: This study was performed in an in-patient setting using a randomized controlled single blind design. Materials and Methods: A total of 88 consenting in-patients with psychosis were randomized into yoga therapy group (n=44) and physical exercise group (n=44). Sixty patients completed the study period of 1½ months. Patients who completed in the yoga group (n=35) and in the exercise group (n=25) were similar on the demographic profile, illness parameters and psychopathology scores at baseline. Results: The two treatment groups were not different on the clinical syndrome scores at the end of 2 weeks. At the end of 6 weeks, patients in the yoga group however had lower mean scores on Clinical Global Impression Severity (CGIS), Positive and Negative Syndrome Scale (total and general psychopathology subscale) and Hamilton Depression Rating Scale (HDRS) (P<0.05). Repeated measure analysis of variance detected an advantage for yoga over exercise in reducing the clinical CGIS and HDRS scores. Conclusion: Adding yoga intervention to standard pharmacological treatment is feasible and may be beneficial even in the early and acute stage of psychosis.

Randomized clinical trial of yoga-based intervention in residents from elderly homes: Effects on cognitive function

Context: Elderly have increased risk for cognitive impairment and dementia. Yoga therapy may be helpful in elderly to improve cognitive function. Aims: We examined the benefits of yoga-based intervention compared with waitlist control group on cognitive function in the residents of elderly homes. Settings and Design: Single blind controlled study with block randomization of elderly homes. Materials and Methods: Study sample included yoga group (n=62) and waitlist group (n=58). A total of 87 subjects (yoga=44, waitlist=43) completed the study period of 6 months. Yoga group received daily yoga sessions for 1 month, weekly until 3rd month and encouraged to continue unsupervised until 6 months. They were assessed on Reys Auditory Verbal Learning Test (RAVLT), Reys complex figure test (CFT), Wechslers Memory Scale (WMS)-digit and spatial span, Controlled Oral Word Association (COWA) test, Stroop Color Word Interference Test and Trail Making Test A and B at baseline and at the end of 6th month. Statistical Analysis: Paired t-test and analysis of covariance (ANCOVA) to compare the difference in neuropsychological test scores. Results: Yoga group showed significant improvement in immediate and delayed recall of verbal (RAVLT) and visual memory (CFT), attention and working memory (WMS-spatial span), verbal fluency (COWA), executive function (Stroop interference) and processing speed (Trail Making Test-A) than waitlist group at the end of 6 months after correcting for corresponding baseline score and education. Conclusion: Yoga based-intervention appears beneficial to improve several domains of cognitive function in elderly living in residential care homes. Study findings need to be interpreted after considering methodological limitations like lack of active comparison group.