Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-10T16:14:20.909Z Has data issue: false hasContentIssue false
  • English
  • Français

Protocol to evaluate the impact of yoga supplementation on cognitive function in schizophrenia: a randomised controlled trial

Published online by Cambridge University Press:  30 April 2014

Triptish Bhatia ,
Sati Mazumdar ,
Nagendra Narayan Mishra ,
Raquel E. Gur ,
Ruben C. Gur ,
Vishwajit Laxmikant Nimgaonkar  and
Smita Neelkanth Deshpande
Triptish Bhatia*
Affiliation:
Department of Psychiatry, Post-Graduate Institute of Medical Education and Research – Dr. Ram Manohar Lohia Hospital, New Delhi, India
Sati Mazumdar
Affiliation:
Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
Nagendra Narayan Mishra
Affiliation:
Department of Psychiatry, Post-Graduate Institute of Medical Education and Research – Dr. Ram Manohar Lohia Hospital, New Delhi, India
Raquel E. Gur
Affiliation:
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
Ruben C. Gur
Affiliation:
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
Vishwajit Laxmikant Nimgaonkar
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA
Smita Neelkanth Deshpande
Affiliation:
Department of Psychiatry, Post-Graduate Institute of Medical Education and Research – Dr. Ram Manohar Lohia Hospital, New Delhi, India
*
Triptish Bhatia, GRIP-NIH Project, Room# 30, Department of Psychiatry, Park Street, Post-Graduate Institute of Medical Education and Research – Dr. Ram Manohar Lohia Hospital, New Delhi-110001, India. Tel: +91 11 23404363; Fax: +91 11 23342122; E-mail: bhatiatriptish@yahoo.co.in
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Schizophrenia (SZ) is a chronic illness that is treated symptomatically. Cognitive dysfunction is a core feature of SZ that is relatively intractable to pharmacotherapy. Yoga can improve cognitive function among healthy individuals. A recent open trial indicated significant benefits of yoga training (YT) in conjunction with conventional pharmacotherapy among patients with SZ.

Aims

To describe the protocol for an ongoing randomised controlled trial designed to test whether the reported beneficial effects of YT on cognitive function among SZ patients can be replicated. Secondarily, the effects of YT on daily functioning living skills are evaluated.

Methods

Consenting patients with SZ receive routine clinical treatment and are randomised to adjunctive YT, adjunctive physical exercise (PE) or treatment as usual (proposed N = 234 total, N = 78 in each group). The trial involves YT or PE 5 days a week and lasts 3 weeks. Participants are evaluated thrice over 6 months. Cognitive functions measured by Trail Making Test, University of Pennsylvania Neurocognitive Computerised Battery were primary outcome measures while clinical severity and daily functioning measured by Independent Living Skills Survey were secondary outcome measures.

Results

A total of 309 participants have been randomised as of 31 August 2013, which exceeded beyond 294 proposed after attrition. Once participants begin YT or PE they generally complete the protocol. No injuries have been reported.

Conclusions

Short term YT is feasible and acceptable to Indian SZ patients. If beneficial effects of YT are detected, it will provide a novel adjunctive cognitive remediation strategy for SZ patients.

Keywords

cognitionrandomised controlled trialschizophreniayoga
Type
Original Articles
Information
Acta Neuropsychiatrica , Volume 26 , Issue 5 , October 2014 , pp. 280 - 290
Copyright
Copyright © Scandinavian College of Neuropsychopharmacology 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Kitchen, H, Rofail, D, Heron, L, Sacco, P. Cognitive impairment associated with schizophrenia: a review of the humanistic burden. Adv Ther 2012;29:148–162.CrossRefGoogle ScholarPubMed
2.Heinrichs, RW, Zakzanis, KK. Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 1998;12:426–445.Google Scholar
3.Goldberg, T, Green, M. Neurocognitive functioning inpatients with schizophrenia: an overview. Philadelphia, PA: Lippincott: Williams & Wilkins, 2002.Google Scholar
4.Nuechterlein, KH, Barch, DM, Gold, JM, Goldberg, TE, Green, MF, Heaton, RK. Identification of separable cognitive factors in schizophrenia. Schizophr Res 2004;72:29–39.Google Scholar
5.Keefe, RS, Harvey, PD. Cognitive impairment in schizophrenia. Handb Exp Pharmacol 2012;213:11–37.Google Scholar
6.Twamley, EW, Jeste, DV, Bellack, AS. A review of cognitive training in schizophrenia. Schizophr Bull 2003;29:359–382.Google Scholar
7.Kurtz, MM, Moberg, PJ, Gur, RC, Gur, RE. Approaches to cognitive remediation of neuropsychological deficits in schizophrenia: a review and meta-analysis. Neuropsychol Rev 2001;11:197–210.Google Scholar
8.Vinogradov, S, Fisher, M, Nagarajan, S. Cognitive training in schizophrenia: golden age or Wild West? Biol Psychiatry 2013;73:935–937.CrossRefGoogle ScholarPubMed
9.Wexler, BE, Hawkins, KA, Rounsaville, B, Anderson, M, Sernyak, MJ, Green, MF. Normal neurocognitive performance after extended practice in patients with schizophrenia. Schizophr Res 1997;26:173–180.CrossRefGoogle ScholarPubMed
10.Bell, M, Bryson, G, Greig, T, Corcoran, C, Wexler, BE. Neurocognitive enhancement therapy with work therapy: effects on neuropsychological test performance. Arch Gen Psychiatry 2001;58:763–768.Google Scholar
11.Wykes, T, Reeder, C, Corner, J, Williams, C, Everitt, B. The effects of neurocognitive remediation on executive processing in patients with schizophrenia. Schizophr Bull 1999;25:291–307.Google Scholar
12.Hogarty, GE, Flesher, S, Ulrich, Ret al. Cognitive enhancement therapy for schizophrenia: effects of a 2-year randomized trial on cognition and behavior. Arch Gen Psychiatry 2004;61:866–876.CrossRefGoogle ScholarPubMed
13.McGurk, SR, Mueser, KT. Cognitive functioning, symptoms, and work in supported employment: a review and heuristic model. Schizophr Res 2004;70:147–173.Google Scholar
14.Kurtz, MM, Seltzer, JC, Shagan, DS, Thime, WR, Wexler, BE. Computer-assisted cognitive remediation in schizophrenia: what is the active ingredient? Schizophr Res 2007;89:251–260.CrossRefGoogle ScholarPubMed
15.Kern, RP, Libkuman, TM, Otani, H, Holmes, K. Emotional stimuli, divided attention, and memory. Emotion 2005;5:408–417.Google Scholar
16. Substance Abuse and Mental Health Services Administration. Results from the 2006 national survey on drug use and health: national findings, Substance Abuse and Mental Health Services Administration. Rockville, MD, 2006.Google Scholar
17.Zang, R. Do you Suffer from Headaches, Fatigue, Insomnia or Unexplained Aches and Pains? Mesa Lifestyle Magazine 2008;2.Google Scholar
18. Wailana. Wai Lana Yoga: Beginners Workout, On Wai Lana Yoga: Fun Challenge Series, 2005.Google Scholar
19.Ross, A, Thomas, S. The health benefits of yoga and exercise: a review of comparison studies. J Altern Complement Med 2010;16:3–12.Google Scholar
20.Sengupta, P. Health impacts of yoga and pranayama: a state-of-the-art review. Int J Prev Med 2012;3:444–458.Google Scholar
21.Innes, KE, Bourguignon, C, Taylor, AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: a systematic Review. J Am Board Fam Pract 2005;18:491–519.Google Scholar
22.Bowman, AJ, Clayton, RH, Murray, A, Reed, JW, Subhan, MM, Ford, GA. Effects of aerobic exercise training and yoga on the baroreflex in healthy elderly persons. Eur J Clin Invest 1997;27:443–449.Google Scholar
23.Gordon, LA, Morrison, EY, McGrowder, DAet al. Effect of exercise therapy on lipid profile and oxidative stress indicators in patients with type 2 diabetes. BMC Complement Altern Med 2008;8:21.Google Scholar
24.Sathyaprabha, TN, Satishchandra, P, Pradhan, Cet al. Modulation of cardiac autonomic balance with adjuvant yoga therapy in patients with refractory epilepsy. Epilepsy Behav 2008;12:245–252.Google Scholar
25.Yurtkuran, M, Alp, A, Dilek, K. A modified yoga-based exercise program in hemodialysis patients: a randomized controlled study. Complement Ther Med 2007;15:164–171.Google Scholar
26.Sterling, P. ed. Principles of Allostasis: Optimal Design, Predictive Regulation, Pathophysiology, and Rational Therapeutics. Cambridge: Cambridge University Press, 2004.Google Scholar
27.Hagins, M, Moore, W, Rundle, A. Does practicing hatha yoga satisfy recommendations for intensity of physical activity which improves and maintains health and cardiovascular fitness? BMC Complement Altern Med 2007;7:40.Google Scholar
28.Ross, A, Friedmann, E, Bevans, M, Thomas, S. Frequency of yoga practice predicts health: results of a national survey of yoga practitioners. Evid Based Complement Alternat Med 2012;2012:983258.Google Scholar
29.Uma, K, Nagendra, HR, Nagarathna, R, Vaidehi, S, Seethalakshmi, R. The integrated approach of yoga: a therapeutic tool for mentally retarded children: a one-year controlled study. J Ment Defic Res 1989;33:415–421.Google Scholar
30.Vani, PR, Nagarathna, R, Nagendra, HR, Telles, S. Progressive increase in critical flicker fusion frequency following yoga training. Indian J Physiol Pharmacol 1997;41:71–74.Google Scholar
31.Manjunath, NK, Telles, S. Improved performance in the Tower of London test following yoga. Indian J Physiol Pharmacol 2001;45:351–354.Google Scholar
32.Chattha, R, Nagarathna, R, Padmalatha, V, Nagendra, HR. Effect of yoga on cognitive functions in climacteric syndrome: a randomised control study. Bjog 2008;115:991–1000.CrossRefGoogle ScholarPubMed
33.Sharma, P, Das, SK, Deshpande, SN. An estimate of the monthly cost of two major mental disorders in an Indian metropolis. Indian J Psychiatry 2006;48:143–148.Google Scholar
34.Uebelacker, LA, Tremont, G, Epstein-Lubow, Get al. Open trial of Vinyasa yoga for persistently depressed individuals: evidence of feasibility and acceptability. Behav Modif 2010;34:247–264.Google Scholar
35.Saeed, SA, Antonacci, DJ, Bloch, RM. Exercise, yoga, and meditation for depressive and anxiety disorders. Am Fam Physician 2010;81:981–986.Google Scholar
36.Kirkwood, G, Rampes, H, Tuffrey, V, Richardson, J, Pilkington, K. Yoga for anxiety: a systematic review of the research evidence. Br J Sports Med 2005;39:884–891; Discussion 891.Google Scholar
37.Langle, G, Renner, G, Gunthner, A, Buchkremer, G. Community psychiatric management of severely ill schizophrenic patients. An exemplary case study. Nervenarzt 2000;71:915–918.Google Scholar
38.Cramer, C, Lauche, R, Langhorst, J, Dobos, G. Yoga for depression: a systematic review and meta-analysis. Depress Anxiety 2013;30:1068–1083.Google Scholar
39.Gangadhar, BN, Varambally, S. Author's reply. Int J Yoga 2013;6:134–135.Google Scholar
40.Vancampfort, D, Vansteelandt, K, Scheewe, Tet al. Yoga in schizophrenia: a systematic review of randomised controlled trials. Acta Psychiatr Scand 2012;126:12–20.CrossRefGoogle ScholarPubMed
41.Balasubramaniam, M, Telles, S, Doraiswamy, PM. Yoga on our minds: a systematic review of yoga for neuropsychiatric disorders. Front Psychiatry 2012;3:117.Google Scholar
42.Cramer, C, Lauche, R, Klose, P, Langhorst, J, Dobos, G. Yoga for schizophrenia: a systematic review and meta-analysis. BMC Psychiatry 2013;13:32–443.Google Scholar
43.Bhatia, T, Agarwal, A, Shah, Get al. Adjunctive cognitive remediation for schizophrenia using yoga: an open, non-randomized trial. Acta Neuropsychiatr 2012;24:91–100.CrossRefGoogle ScholarPubMed
44.Gur, RC, Ragland, JD, Moberg, PJet al. Computerized neurocognitive scanning: II. The profile of schizophrenia. Neuropsychopharmacology 2001;25:777–788.Google Scholar
45.Berger, BG, Owen, DR. Mood alteration with yoga and swimming: aerobic exercise may not be necessary. Percept Mot Skills 1992;75:1331–1343.Google Scholar
46.Gorczynski, P, Faulkner, G. Exercise therapy for schizophrenia. Schizophr Bull 2010;36:665–666.Google Scholar
47.Nurnberger, JI JrBlehar, MC, Kaufmann, CAet al. Diagnostic interview for genetic studies. Rationale, unique features, and training. NIMH Genetics Initiative. Arch Gen Psychiatry 1994;51:849–859; Discussion 863–864.CrossRefGoogle ScholarPubMed
48.Deshpande, SN, Mathur, MN, Das, SK, Bhatia, T, Sharma, S, Nimgaonkar, VL. A Hindi version of the diagnostic interview for genetic studies. Schizophr Bull 1998;24:489–493.Google Scholar
49.Duraiswamy, G, Thirthalli, J, Nagendra, HR, Gangadhar, BN. Yoga therapy as an add-on treatment in the management of patients with schizophrenia – a randomized controlled trial. Acta Psychiatr Scand 2007;116:226–232.Google Scholar
50.Horton, AM JrRoberts, C. Sex, ethnicity, age and education effects on the trail making test in a sample of cocaine abusers. Int J Neurosci 2001;108:281–290.Google Scholar
51.Bhatia, T, Shriharsh, V, Adlakha, SBisht, V, Garg, K, Deshpande, SN. The trail making test in India. Indian J Psychiatry 2007;49(2),113–116.Google Scholar
52.Pershad, D, Verma, SK. Information Subtest of Verbal Intelligence Scale in Handbook of PGI Battery of Brain Dysfunction. Agra: National Psychological Corporation, 1990.Google Scholar
53.Gur, RC, Ragland, JD, Moberg, PJet al. Computerized neurocognitive scanning: I. Methodology and validation in healthy people. Neuropsychopharmacology 2001;25:766–776.Google Scholar
54.Gur, RC, Richard, J, Hughett, Pet al. A cognitive neuroscience-based computerized battery for efficient measurement of individual differences: standardization and initial construct validation. J Neurosci Methods 2010;187:254–262.Google Scholar
55.Gur, RC, Richard, J, Calkins, MEet al. Age group and sex differences in performance on a computerized neurocognitive battery in children age 8-21. Neuropsychology 2012;26:251–265.Google Scholar
56.Thomas, P, Chandra, A, Bhatia, Tet al. Clinical and genetic correlates of severity in schizophrenia in India: an ordinal logistic regression approach. Psychiatry Res 2011;189:321–323.Google Scholar
57.Gur, RE, Nimgaonkar, VL, Almasy, Let al. Neurocognitive endophenotypes in a multiplex multigenerational family study of schizophrenia. Am J Psychiatry 2007;164:813–819.Google Scholar
58.Hochberg, A. Sharper Bonferroni procedure for multiple tests of significance. Biometrika 1988;75:800–802.Google Scholar
59.Wallace, CJ, Liberman, RP, Tauber, R, Wallace, J. The independent living skills survey: a comprehensive measure of the community functioning of severely and persistently mentally ill individuals. Schizophr Bull 2000;26:631–658.Google Scholar
60.Endicott, J, Spitzer, RL, Fleiss, JL, Cohen, J. The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1976;33:766–771.Google Scholar
61.Andreasen, NC. Scale for the Assessment of Positive Symptoms (SAPS). Iowa City: University of Iowa, 1984.Google Scholar
62.Andreasen, NC. Scale for the Assessment of Negative Symptoms (SANS). Iowa City: University of Iowa, 1984.Google Scholar
63.Mazumdar, S, Tang, G, Houck, PRet al. Statistical analysis of longitudinal psychiatric data with dropouts. J Psychiatr Res 2007;41:1032–1041.Google Scholar
64.Blakesley, RE, Mazumdar, S, Dew, MAet al. Comparisons of methods for multiple hypothesis testing in neuropsychological research. Neuropsychology 2009;23:255–264.Google Scholar
65.Dang, Q, Mazumdar, S, Anderson, SJ, Houck, PR, Reynolds, CF. Using trajectories from a bivariate growth curve as predictors in a Cox regression model. Stat Med 2007;26:800–811.Google Scholar
66.Faul, F, Erdfelder, E, Lang, AG, Buchner, A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39:175–191.CrossRefGoogle ScholarPubMed
67.Chuang, LH, Soares, MO, Tilbrook, Het al. A pragmatic multicentered randomized controlled trial of yoga for chronic low back pain: economic evaluation. Spine 2012;37:1593–1601.Google Scholar