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   2013| July  | Volume 55 | Issue 7  
    Online since August 8, 2013

 
 
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ORIGINAL ARTICLES
Designing, validation and feasibility of a yoga-based intervention for elderly
VR Hariprasad, S Varambally, PT Varambally, J Thirthalli, IV Basavaraddi, BN Gangadhar
July 2013, 55(7):344-349
DOI:10.4103/0019-5545.116302  PMID:24049197
Context: Ageing is an unavoidable facet of life. Yogic practices have been reported to promote healthy aging. Previous studies have used either yoga therapy interventions derived from a particular school of yoga or have tested specific yogic practices like meditation. Aims: This study reports the development, validation and feasibility of a yoga-based intervention for elderly with or without mild cognitive impairment. Settings and Design: The study was conducted at the Advanced Centre for Yoga, National Institute for Mental Health and Neurosciences, Bangalore. The module was developed, validated, and then pilot-tested on volunteers. Materials and Methods: The first part of the study consisted of designing of a yoga module based on traditional and contemporary yogic literature. This yoga module along with the three case vignettes of elderly with cognitive impairment were sent to 10 yoga experts to help develop the intended yoga-based intervention. In the second part, the feasibility of the developed yoga-based intervention was tested. Results: Experts (n=10) opined the yoga-based intervention will be useful in improving cognition in elderly, but with some modifications. Frequent supervised yoga sessions, regular follow-ups, addition/deletion/modifications of yoga postures were some of the suggestions. Ten elderly consented and eight completed the pilot testing of the intervention. All of them were able to perform most of the Sukṣmavyayāma, Prāṇāyāma and Nādānusaṇdhāna (meditation) technique without difficulty. Some of the participants ( n=3) experienced difficulty in performing postures seated on the ground. Most of the older adults experienced difficulty in remembering and completing entire sequence of yoga-based intervention independently. Conclusions: The yoga based intervention is feasible in the elderly with cognitive impairment. Testing with a larger sample of older adults is warranted.
  4 2,545 349
Development and feasibility of yoga therapy module for out-patients with depression in India
GH Naveen, MG Rao, V Vishal, J Thirthalli, S Varambally, BN Gangadhar
July 2013, 55(7):350-356
DOI:10.4103/0019-5545.116305  PMID:24049198
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.
  4 2,398 328
Randomized clinical trial of yoga-based intervention in residents from elderly homes: Effects on cognitive function
VR Hariprasad, V Koparde, PT Sivakumar, S Varambally, J Thirthalli, M Varghese, IV Basavaraddi, BN Gangadhar
July 2013, 55(7):357-363
DOI:10.4103/0019-5545.116308  PMID:24049199
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 3 rd month and encouraged to continue unsupervised until 6 months. They were assessed on Rey's Auditory Verbal Learning Test (RAVLT), Rey's complex figure test (CFT), Wechsler's 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 6 th 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.
  2 4,467 510
Effects of yoga intervention on sleep and quality-of-life in elderly: A randomized controlled trial
VR Hariprasad, PT Sivakumar, V Koparde, S Varambally, J Thirthalli, M Varghese, IV Basavaraddi, BN Gangadhar
July 2013, 55(7):364-368
DOI:10.4103/0019-5545.116310  PMID:24049200
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.
  2 5,305 631
Efficacy of yoga as an add-on treatment for in-patients with functional psychotic disorder
RB Manjunath, S Varambally, J Thirthalli, IV Basavaraddi, BN Gangadhar
July 2013, 55(7):374-378
DOI:10.4103/0019-5545.116314  PMID:24049202
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.
  2 2,676 318
Yoga and epilepsy: What do patients perceive?
GH Naveen, S Sinha, N Girish, AB Taly, S Varambally, BN Gangadhar
July 2013, 55(7):390-393
DOI:10.4103/0019-5545.116306  PMID:24049205
Context: Benefit of yoga therapy in the management of epilepsy is emerging. However, there is no data available about the knowledge, attitude and practice (KAP) of yoga amongst people living with epilepsy (PLWE). Aims: This study was designed to explore the KAP about yoga among PLWE. Settings and Design: The study was conducted on 300 PLWE attending the neurology out-patient services of a tertiary care hospital. Methodology: Three hundred PLWE (male:female=173:127; age: 31.6±12.4 years) attending the neurology out-patient services of a neuropsychiatry hospital were administered a pre-tested KAP questionnaire. Results: About 87.4% were on regular anti-epileptic drugs and half (50.3%) on monotherapy. Use of complementary and alternative medicine by the respondents included: Ayurveda (26.7%), yoga (25.6%) and homeopathy (16.3%) or folk medicine (29.1%). Nearly 33.7% of the respondents reported that yoga is beneficial in managing epilepsy. More than half the respondents (54.8%) were willing to practice yoga. Those who practiced yoga opined that regular practice of yoga might reduce dosage of medication (62.8%), their side effects (51.3%) and frequency of seizures (54.5%). Majority of the patients were willing to practice yoga, if yoga services were offered. Conclusion: The gaps in KAP identified in this study point to the need for more systematic effort to bring about awareness of yoga in patients with epilepsy.
  2 2,209 205
Low serum brain derived neurotrophic factor in non-suicidal out-patients with depression: Relation to depression scores
S Varambally, GH Naveen, MG Rao, J Thirthalli, R Sharma, R Christopher, BN Gangadhar
July 2013, 55(7):397-399
DOI:10.4103/0019-5545.116311  PMID:24049207
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. Pearson's 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.
  2 1,502 166
Positive therapeutic and neurotropic effects of yoga in depression: A comparative study
GH Naveen, J Thirthalli, MG Rao, S Varambally, R Christopher, BN Gangadhar
July 2013, 55(7):400-404
DOI:10.4103/0019-5545.116313  PMID:24049208
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 Pearson's 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.
  2 4,410 396
Cortisol and antidepressant effects of yoga
J Thirthalli, GH Naveen, MG Rao, S Varambally, R Christopher, BN Gangadhar
July 2013, 55(7):405-408
DOI:10.4103/0019-5545.116315  PMID:24049209
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.
  2 4,158 392
Effect of yoga therapy on plasma oxytocin and facial emotion recognition deficits in patients of schizophrenia
N Jayaram, S Varambally, RV Behere, G Venkatasubramanian, R Arasappa, R Christopher, BN Gangadhar
July 2013, 55(7):409-413
DOI:10.4103/0019-5545.116318  PMID:24049210
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.
  1 30,904 402
Yoga increases the volume of the hippocampus in elderly subjects
VR Hariprasad, S Varambally, V Shivakumar, SV Kalmady, G Venkatasubramanian, BN Gangadhar
July 2013, 55(7):394-396
DOI:10.4103/0019-5545.116309  PMID:24049206
Context: The neurobiological effect of yoga on the cortical structures in the elderly is as yet unknown. Materials and Methods: Seven healthy elderly subjects received yoga intervention as an add-on life-style practice. Magnetic resonance imaging scans were obtained before and 6 months later. Voxel-based-morphometric analyses compared the brains before and after the yoga. Results: Yoga group was found to have increases in hippocampal, but not in occipital gray matter. Conclusion: Yoga has potential to reduce neuro-senescence. Small sample size and absence of the control group prevent generalization of the findings limiting its translational value.
  1 3,007 265
Feasibility and efficacy of yoga as an add-on intervention in attention deficit-hyperactivity disorder: An exploratory study
VR Hariprasad, R Arasappa, S Varambally, S Srinath, BN Gangadhar
July 2013, 55(7):379-384
DOI:10.4103/0019-5545.116317  PMID:24049203
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 1 st , 2 nd and 3 rd 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.
  1 5,377 499
Effect of yoga therapy on anxiety and depressive symptoms and quality-of-life among caregivers of in-patients with neurological disorders at a tertiary care center in India: A randomized controlled trial
P Umadevi, S Ramachandra, S Varambally, M Philip, BN Gangadhar
July 2013, 55(7):385-389
DOI:10.4103/0019-5545.116304  PMID:24049204
Context: The concerns of caregivers of patients with neurological disorders have been a felt need for a long time, with many of them experiencing significant psychiatric morbidity. Aims: This study aimed to find the effect of yoga in reducing anxiety and depression, as well as improving quality-of-life in caregivers of patients with neurological disorders. Settings and Design: The study was conducted using a randomized controlled design, with yoga intervention and waitlisted controls. Methodology: Sixty consenting caregivers of inpatients in neurology wards were randomized into two groups: Yoga and control. Demographic variables except years of education and length of caretaking were comparable in the two groups, as also baseline scores of anxiety, depression and quality-of-life. A specific yoga module comprising yogāsanas, prāṇāyāma, and chanting was taught to the participants in the yoga group by the researcher. At follow-up 43 patients (yoga n=20 and control group n=23) were available. Two-way repeated measures analysis of variance was used to test the change from pre-test to post-test scores within and between groups. Analysis of covariance was performed to compare the post-test scores between the groups adjusting for education and length of caretaking. Results: Following one month intervention of yoga therapy, there was a significant ( P<0.001) decrease in anxiety and depression scores, as well as improved quality-of-life among the participants in the yoga group as compared with the control group. Conclusion: This study highlights the usefulness of a yoga intervention for caregivers of inpatients with neurological problems. The small sample size and lack of blinding were some of the limitations of this study.
  1 4,243 423
COMMENTARIES
Yoga for Psychiatry and Mental Health: An Ancient Practice with Modern Relevance
Sat Bir Singh Khalsa
July 2013, 55(7):334-336
PMID:24049194
  - 2,050 1,978
Integrated Yoga Therapy for mental Illness
HR Nagendra
July 2013, 55(7):337-339
PMID:24049195
  - 2,627 353
Yogic intervention for mental disorders
KK Deepak
July 2013, 55(7):340-343
PMID:24049196
  - 1,357 270
EDITORIAL
Yoga and mental health: Promising road ahead, but proceed with caution
MS Keshavan, NP Rao, T.S.S. Rao
July 2013, 55(7):329-331
DOI:10.4103/0019-5545.116295  PMID:24049192
  - 2,112 4,577
MESSAGE
Yoga and Neurobehavioral Sciences: Indian Perspective
P Satishchandra
July 2013, 55(7):332-333
PMID:24049193
  - 1,043 2,169
ORIGINAL ARTICLES
Positive antidepressant effects of generic yoga in depressive out-patients: A comparative study
BN Gangadhar, GH Naveen, MG Rao, J Thirthalli, S Varambally
July 2013, 55(7):369-373
DOI:10.4103/0019-5545.116312  PMID:24049201
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.
  - 2,618 303