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Self-Reported Benefits and Risks of Yoga in Individuals with Bipolar Disorder
Abstract
Background:
Although hatha yoga has frequently been recommended for patients with bipolar disorder (BD) and there is preliminary evidence that it alleviates depression, there are no published data on the benefits-and potential risks-of yoga for patients with BD. Thus, the goal of this study was to assess the risks and benefits of yoga in individuals with BD.
Methods:
We recruited self-identified yoga practitioners with BD (N=109) to complete an Internet survey that included measures of demographic and clinical information and open-ended questions about yoga practice and the impact of yoga.
Results:
86 respondents provided sufficient information for analysis, 70 of whom met positive screening criteria for a lifetime history of mania or hypomania. The most common styles of yoga preferred were hatha and vinyasa. When asked what impact yoga had on their life, participants responded most commonly with positive emotional effects, particularly reduced anxiety, positive cognitive effects (e.g., acceptance, focus, or "a break from my thoughts"), or positive physical effects (e.g., weight loss, increased energy). Some respondents considered yoga to be significantly life changing. The most common negative effect of yoga was physical injury or pain. Five respondents gave examples of specific instances or a yoga practice that they believed increased agitation or manic symptoms; five respondents gave examples of times that yoga increased depression or lethargy.
Conclusions:
Many individuals who self-identify as having BD believe that yoga has benefits for mental health. However, yoga is not without potential risks. It is possible that yoga could serve as a useful adjunctive treatment for BD.
... In an internet survey, patients diagnosed with bipolar disorder provided information about the risks and benefits associated with yoga practices. 23 The most frequently used styles were Hatha and vinyasa, and participants reported positive emotional effects, with reduced anxiety, beneficial cognitive effects, increased energy, and weight loss. Reported adverse events were physical injury and pain. ...
... Reported adverse events were physical injury and pain. 23 A Canadian randomized, single-blind, crossover study found that Yoga with psychoeducation, as an add-on therapy, may improve residual symptoms of unipolar and bipolar depression. 24 ...
... Online Yoga has ameliorated post-traumatic stress symptoms in women who have experienced stillbirth. 23 ...
Yoga is a 5000-year-old practice from India that originated as a spiritual practice. The term “yoga” is derived from the Sanskrit word “Yuj,” meaning union.1 Yoga is done by stretching and forming positions with one’s body while achieving self-realization and reducing bodily and mental suffering. Yoga aims to unite an individual’s soul with absolute reality and is rapidly gaining popularity. It has become a well-known lifestyle intervention for most psychiatric illnesses.
... They were effective in attracting their targeted demographic (i.e., individuals with bipolar I or bipolar II disorder who practice a type of Hatha yoga). For some persons with bipolar disease, Hatha yoga may be a strong and effective positive practice; nonetheless, it is not without hazards and should be utilized cautiously, like many other therapies for BD [15]. ...
... This is critical since depression, with its associated lack of desire and withdrawal, is often a primary symptom of BD. In addition to the recognized weight gain associated with some mood stabilizers and antipsychotic medicines, many patients who practiced yoga did so because it is a physical exercise [15]. There was some disagreement among yoga participants regarding whether yoga helped prevent or moderate symptoms, thus it is best used as a supplementary intervention. ...
... However, some studies have identified risks associated with yoga therapy, particularly for those suffering from bipolar illness [15]. Individuals with BD may be particularly affected by extreme activities, such as fast breathing, warm surroundings, or very slow and contemplative techniques. ...
Bipolar disorder (BD) is a mood disorder characterized by severe mood swings and or periods of depression. This study examined the role that practicing yoga has on the symptoms of BD. One of the main goals was to identify if patients with BD believe that yoga is a viable treatment option. Six research databases were searched using the keywords "yoga" AND "therapy" AND "BD" AND "bipolar depression." Articles published in 2005 and later were included in the search. After duplicates were removed, and inclusion and exclusion criteria were applied, five articles were analyzed and included in this literature review. Results of this review indicate that yoga has been shown to be associated with both benefits and risks for the treatment of BD. Studies have shown that yoga might relieve some symptoms of BD and depression. However, due to the lack of research on the impact of yoga on BD and the small number of studies included in this review, results should be approached with caution. Overall, yoga was well-tolerated in the studies reviewed in this article. Yoga may relieve the symptoms of depression. Future research should analyze the long-term impact of yoga on bipolar depression. Yoga instructional standards should also be considered.
... Numerous studies have documented impacted sleep quality as a result of traditional MBIs, including multiple case reports [59][60][61] and mixed-methods research [62,63]. Additionally, research has linked MBPs to lack of appetite [55,59,64], lethargy [64], and body discomfort [65,66]. Despite the significant body of research focused on this theme, apps have a limited capability of addressing physical ailments (i.e., no in-person diagnosis). ...
... Mindfulness practices call on individuals to actively become aware of the present moment, observing their thoughts and sensations, which can sometimes induce fear, anxiety, negative thinking, and stress, among others [72]. Previous research examining the experiences of practitioners of mindfulness have shown that these sensations and "distress" are a normal part of the meditation process [58,65]. However, researchers have pointed out that practitioners are usually made aware of this through their teachers or reading texts [57,58,65]. ...
... Previous research examining the experiences of practitioners of mindfulness have shown that these sensations and "distress" are a normal part of the meditation process [58,65]. However, researchers have pointed out that practitioners are usually made aware of this through their teachers or reading texts [57,58,65]. ...
Mindfulness-based interventions (MBIs) and practices (MBPs) can promote better health outcomes. Although MBIs and MBPs were developed to be delivered in-person, mobile health (mHealth) tools such as apps have made these more accessible. Mindfulness apps (MAs) are popular among emerging adults (EAs) who have the highest ownership of smartphones and who are also at risk for distress. While adverse effects have been observed with MBIs/MBPs, this has not been examined when mindfulness is practiced using apps. We interviewed EAs (n = 22) to capture their motivations for using these apps and identified health-inhibiting and enhancing experiences. Data were thematically analyzed using the constant comparative method. Motivations for app use included accessibility, convenience, and stress/health management. EAs described health-enhancing outcomes (reduced distress, improved physical symptoms, increased focus) and health-inhibiting outcomes (worsened distress, performance uncertainty, dependency development, worsened physical health). They provided suggestions for improving apps (e.g., feedback option). These findings illustrate benefits and risks that EAs may encounter when practicing mindfulness using apps, which can inform the best practices for app design.
... 15 Finally, nine observational studies including a total of 9129 yoga practitioners and 9903 non-yoga practitioners were included in the qualitative synthesis ( Fig. 1). [16][17][18][19][20][21][22][23][24] All articles were published in English. ...
... Four studies did not report the time point of assessment, however one of those had received approval from the institutional review board in 2014 and was thus most likely conducted in 2014 or later (Table 1). 18 The studies were based on US, 17,18,21,23 European, 20 Asian, 19,24 and Australian 16,22 samples. The targeted underlying population included all self-identified current and/or prior yoga practitioners 16,17,21,22,24 ; practitioners that had just attended a yoga class 19 ; those that were practicing a specific yoga style, Ashtanga Vinyasa yoga, 20 or hot yoga 18 ; or yoga practitioners who were diagnosed with bipolar disorder. ...
... The targeted underlying population included all self-identified current and/or prior yoga practitioners 16,17,21,22,24 ; practitioners that had just attended a yoga class 19 ; those that were practicing a specific yoga style, Ashtanga Vinyasa yoga, 20 or hot yoga 18 ; or yoga practitioners who were diagnosed with bipolar disorder. 23 Where reported, the mean age of included participants ranged from 33.0 to 58.5 years (median: 43.1 years); between 71.8 and 100.0% (median: 91.1%) of participants were female. ...
Objectives:
To systematically assess the prevalence of yoga-associated injuries and other adverse events in epidemiological studies.
Design:
Systematic review of observational studies.
Methods:
Medline/PubMed, Scopus, the Cochrane Library, and IndMed were searched through October 2016 for epidemiological studies assessing the prevalence of adverse events of yoga practice or comparing the risk of any adverse events between yoga practitioners and non-yoga practitioners.
Results:
Nine observational studies with a total 9129 yoga practitioners and 9903 non-yoga practitioners were included. Incidence proportion of adverse events during a yoga class was 22.7% (95% confidence interval [CI]=21.1%-24.3%); 12-months prevalence was 4.6% (95%CI=3.8%-5.4%), and lifetime prevalence ranged from 21.3% (95%CI=19.7%-22.9%) to 61.8% (95%CI=52.8%-70.8%) of yoga practitioners. Serious adverse events occurred in 1.9% (95%CI=1.4%-2.4%). The most common adverse events related to the musculoskeletal system; the most common injuries were sprains and strains. Compared to non-yoga practitioners, yoga practitioners had a comparable risk of falls (odds ratio [OR]=0.90; 95%CI=0.76-1.08), and falls-related injuries (OR=1.04; 95%CI=0.83-1.29), and higher risk of meniscus injuries (OR=1.72; 95%CI=1.23-2.41).
Conclusions:
A considerable proportion of yoga practitioners experienced injuries or other adverse events; however most were mild and transient and risks were comparable to those of non-yoga practitioners. There is no need to discourage yoga practice for healthy people. People with serious acute or chronic illnesses should seek medical advice before practicing yoga.
... In numerous scientific studies, it has been indicated that yoga is used as part of physiotherapeutic rehabilitation in disorders related to various systems 4,[9][10][11][12][13][14][15][16] . After a 12-week yoga programme, reduction in pain and improvement in knee joint mobility was noted among patients with osteoarthritis 13 . ...
... Participants in the survey reported both positive and negative effects. The listed effects of yoga on the subjects include reducing anxiety levels, increasing the ability to focus attention and reducing body mass 16 . ...
Introduction: Yoga is a popular form of physical activity used by healthy people and patients with various ailments. There is evidence of both positive and negative effects of practicing yoga on both physical and psychological aspects. There is a lack of extensive knowledge about the factors that increase the risk of injury in yoga practitioners.Objectives: The aim of the study was to determine the occurrence and characteristics of motor organ overload associated with practicing yoga among people undertaking this form of physical activity on the basis of a literature review, including answering the following questions: 1. What are the health benefits of practicing yoga?; 2. What are the risk factors for an injury in the yoga training?Material and methods: The current professional literature was analysed based on a review of Internet databases from last 10 years, including Pubmed. The yoga, injury, adverse events, musculoskeletal system, physiotherapy keywords were used.Results: From the abovementioned Internet databases, 32 items of the current professional literature on the analysed variables were identified, 8 articles were included in the analysis of the beneficial effects of yoga and 7 articles were comprised on the detailed list of musculoskeletal overloads.Conclusions: The benefits of practicing yoga include pain reduction, increasing range of motion in the joints, improving the performance of daily activities and the quality of life in physical and mental spheres. The risk factors of experiencing the injury mentioned in the literature concerned old age, yoga practice, and the presence of chronic diseases.
... Many subjects with bipolar depression reported that ongoing yoga practice assisted their focus and sense of acceptance [21]. Often linked to cognitive benefits, another study showed that six weeks of hatha yoga enhanced the capacity of memory and attention-switching ability in older adults [22]. ...
... Paroxysmal gamma (PG) was observed during the Bhramari Pranayama (BhP) [34]. High frequencies in beta (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and gamma (¿ 30 Hz) and enhanced theta intensity with complex Morlet wavelets were observed with Fourier analysis. Since, epilepsy also exhibits similar spiky shape and EEG patterns in the temporal lobe, as seen in BhPr, it may reflect the epileptic activity. ...
Objectives
The present investigation is to study the impact of yoga and meditation on Brain waves concerning physical and mental health. There are mainly three stages (steps) in the brain wave classification:(i) preprocessing, ii) feature extraction, and iii) classification. This work provides a review of interpretation methods of Brain signals (Electroencephalogram (EEG)) EEG during yoga and meditation. Past research has revealed significant mental and physical advantages with yoga and meditation (1).
Methods
The research topic reviewed focused on the machine learning strategies applied for the interpretation of brain waves. In addressing the research questions highlighted earlier in the general introduction, we conducted a systematic search of articles from targeted scientific and journal online databases that included PubMed, Web of Science, IEEE Xplore Digital Library (IEEE), and Arxiv databases based on their relevance to the research questions and domain topic. The survey topic is relatively nascent, and therefore, the scope of the search period was limited to the 20-year timeline that was deemed representative of the research topic under investigation. The literature search was based on the keywords “EEG”, “yoga*” and “meditation*”. The key phrases were concatenated using Boolean expressions and applied to search through the selected online databases yielding a total of 120 articles. The online databases were selected based on the relevancy of content with the research title, research questions, and the domain application. The literature review search, process, and classification were carefully conducted guided by two defined measures; 1.) Inclusion criteria; and 2.) Exclusion criteria. These measures define the criteria for searching and extracting relevant articles relating to the research title and domain of interest.
Results
Our literature search and review indicate a broad spectrum of neural mechanics under a variety of meditation styles have been investigated. A detailed analysis of various mental states using Zen, CHAN, mindfulness, TM, Rajayoga, Kundalini, Yoga, and other meditation styles have been described by means of EEG bands. Classification of mental states using KNN, SVM, Random forest, Fuzzy logic, neural networks, Convolutional Neural Networks has been described. Superior research is still required to classify the EEG signatures corresponding to different mental states.
Conclusions
Yoga practice may be an effective adjunctive treatment for a clinical and aging population. Advanced research can examine the effects of specific branches of yoga on a designated clinical grouping. Yoga and meditation increased overall healthy brain activity (2).
... Reducing manic symptoms and restoring patients' sleeping rhythms are primary goals in treatment, yet suitable medication comprising a combination of lithium, valproate, antipsychotics, and benzodiazepines may not always be sufficient in the acute phase of mania. Previous studies suggest that physical activity and relaxation techniques can reduce manic symptoms in patients with bipolar disorder [8][9][10]. Further, studies have shown promising results on reducing self-reported level of arousal in inpatient psychiatric units by sensory modulation [11,12]. ...
... To a lesser extent, patients were also offered 'other' physical therapy interventions, comprising stretching exercise and yoga-like exercises, with an effect comparable to arousal-reducing interventions. Taken together, our findings are consistent with previous studies finding an effect of yoga and mindfulness meditation in reducing anxiety in patients with bipolar disorder [8][9][10]. ...
Background: From 2003 to 2013 the number of patients exposed to mechanical restraint in Danish psychiatric hospitals was increased. Since, a great effort has been done to reduce mechanical restraint.
The aim of this study was to assess whether physical therapy could lower the level of
arousal and reduce mechanical restraint among patients with mania.
Methods: 170 patients admitted with mania at Aarhus University Hospital were offered physical therapy during the study period from 2017 to 2018. Patients reported their experienced level of arousal before and after physical therapy, rating feelings of tension, ability to be at rest, and feelings of irritability/aggression on Visual Analog Scales. Further, the number of manic patients exposed to mechanical restraint in this period was compared with the two previous years and with patients with other diagnoses.
Results: Patients’ level of arousal was significantly reduced after receiving physical therapy. Further, the study showed a significant reduction in mechanical restraint among patients with mania from2015 to 2017.
Conclusion: The results indicate that physical therapy lowers the level of arousal and it is possible that physical therapy contributed to a reduction in mechanical restraint among manic patients.However, the study-design does not allow for confirming this causality.
... 82 Epidemiological studies reported a lifetime prevalence of yoga-associated adverse events ranging from 21.3% to 27.4%; with more severe adverse events being far less prevalent. [83][84][85] Only for patients with bipolar disorder, the risk of adverse events in psychiatric patients has been investigated in more depth and only few reported symptom aggravation due to yoga practice. 85 Whether these findings can also be applied to eating disorders remains to be investigated in future studies. ...
... [83][84][85] Only for patients with bipolar disorder, the risk of adverse events in psychiatric patients has been investigated in more depth and only few reported symptom aggravation due to yoga practice. 85 Whether these findings can also be applied to eating disorders remains to be investigated in future studies. ...
Background:
The question of whether yoga practice ameliorates or even aggravates eating disorders is currently under debate. The aim of this review was to systematically assess and the effectiveness and safety of yoga in patients with eating disorders.
Methods:
Medline/PubMed, PsycINFO, and the Psychological and Behavioral Science Collection were screened through July 2018 for randomized controlled trials, non-randomized controlled trials and longitudinal observational studies on yoga for patients with eating disorders and other individuals with disordered eating and/or body dissatisfaction. Risk of bias was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa Quality Assessment Scale.
Results:
Eight randomized trials and four uncontrolled trials involving a total of 495 participants were included. Risk of bias was mixed. Comparing yoga to untreated control groups, effect sizes ranged from negligible effects of d = 0.02 to very large effects of d = 2.15. However, most effects were small to moderately sized and in most cases not significant. No safety-related data were reported.
Conclusions:
There is limited evidence on the effectiveness and safety of yoga in patients with eating disorders. Yoga can be preliminarily considered as an additional treatment option in multimodal psychiatric treatment programs.
... Yoga has demonstrated significant improvement in depression as an adjuvant to antidepressants in several trials. [24,32,33,[46][47][48][49][50] Other demonstrated advantages of yoga in depression are improvement in anxiety, [32,50] behavioral activation, and nonjudging facet of mindfulness. [47] Shahidi et al. have established significant improvement in depression and life satisfaction in elderly depressed women as compared to the TAU control group but not against the PE group. ...
... However, the duration of the intervention in the included studies ranged from 5 weeks [52] to 9 months. [48] A study with a waitlist control group and the yoga group receiving interventions by trained professionals with at least two supervised sessions per week and ensuring home-based continuation of the yoga sessions during rest of the days in a week has clearly demonstrated benefit of yoga as an add-on treatment for depression. [50] Therefore, future studies of yoga intervention could have two or more weekly sessions of personal instruction from a trained yoga therapist. ...
Background
Yoga has its origin from the ancient times. It is an integration of mind, body, and soul. Besides, mindfulness emphasizes focused awareness and accepting the internal experiences without being judgemental. These techniques offer a trending new dimension of treatment in various psychiatric disorders.
Aims
We aimed to review the studies on the efficacy of yoga and mindfulness as a treatment modality in severe mental illnesses (SMIs). SMI includes schizophrenia, major depressive disorder (MDD), and bipolar disorder (BD).
Methods
We conducted a literature search using PubMed, Google Scholar, and Cochrane Library with the search terms “yoga,” “meditation,” “breathing exercises,” “mindfulness,” “schizophrenia spectrum and other psychotic disorders,” “depressive disorder,” and “bipolar disorder” for the last 10-year period. We also included relevant articles from the cross-references.
Results
We found that asanas and pranayama are the most commonly studied forms of yoga for schizophrenia. These studies found a reduction in general psychopathology ratings and an improvement in cognition and functioning. Some studies also found modest benefits in negative and positive symptoms. Mindfulness has not been extensively tried, but the available evidence has shown benefits in improving psychotic symptoms, improving level of functioning, and affect regulation. In MDD, both yoga and mindfulness have demonstrated significant benefit in reducing the severity of depressive symptoms. There is very sparse data with respect to BD.
Conclusion
Both yoga and mindfulness interventions appear to be useful as an adjunct in the treatment of SMI. Studies have shown improvement in the psychopathology, anxiety, cognition, and functioning of patients with schizophrenia. Similarly, both the techniques have been established as an effective adjuvant in MDD. However, more rigorously designed and larger trials may be necessary, specifically for BD.
... Research regarding adverse events is essential to assist clinicians, researchers and policy makers to develop effective and safe interventions, but data is limited in this population. A qualitative internet survey on self-identified yoga practitioners with bipolar disorders (Uebelacker et al., 2014) reported that negative impacts of yoga practice included increased agitation or relapse into mania, increased lethargy or symptoms of depression, injury or increased pain, and opportunities for self-criticism. There is a need for more longitudinal and observational studies that systematically (a) report adverse events in supervised versus unsupervised physical activity in manic versus depressive versus remitted patients with bipolar disorder, and (b) target higher-risk patients with bipolar disorder. ...
... The efficacy and effectiveness of different physical activity types with similar physical activity volumes should also be investigated. In particular the increased interest in other types of physical activity such as yoga (Uebelacker et al., 2014) warrants additional studies. Time or duration can also be manipulated in intervention based physical activity studies. ...
Background
Research has only recently started to consider the importance and applicability of physical activity (PA) for people with bipolar disorder (BD). The aim of the current study is to highlight 10 pertinent PA research questions in people with BD.
Methods
The International Organization of Physical Therapy in Mental Health executed a consultation with all National organizations (n=13) to identify the most salient questions to guide future research on PA in BD.
Results
We identified the following 10 questions: (1) What are the benefits of PA for people with BD? (2) What are the most prominent safety issues for PA prescription in BD? (3) What is the optimal PA prescription for people with BD? (4) What are the key barriers to PA among people with BD? (5) What are the most effective motivational strategies for ensuring PA adoption and maintenance in BD? (6) How do we translate PA research into community practice? (7) If one treatment goal is increased physical activity, what type of professionals are needed as part of a multidisciplinary team? (8) How do we incorporate PA as a vital sign in clinical practice? (9) How can we prevent sedentary behavior in BD? (10) What is the most appropriate PA assessment method?
Limitations
We did not consult people with BD.
Conclusions
Addressing these questions is critical for developing evidence-based approaches for promoting and sustaining an active lifestyle in BD. Ultimately, achieving this will reduce the burden of cardiovascular disease and improve the quality of life of this population.
... 82 Epidemiological studies reported a lifetime prevalence of yoga-associated adverse events ranging from 21.3% to 27.4%; with more severe adverse events being far less prevalent. [83][84][85] Only for patients with bipolar disorder, the risk of adverse events in psychiatric patients has been investigated in more depth and only few reported symptom aggravation due to yoga practice. 85 Whether these findings can also be applied to eating disorders remains to be investigated in future studies. ...
... [83][84][85] Only for patients with bipolar disorder, the risk of adverse events in psychiatric patients has been investigated in more depth and only few reported symptom aggravation due to yoga practice. 85 Whether these findings can also be applied to eating disorders remains to be investigated in future studies. ...
... Prakash et al.'s (2018) case report on a male with no history of psychiatric illness found that he experienced mental distress (e.g., hallucinations) after a 6-day meditation retreat and was diagnosed with acute transient psychosis. Miller (1993) (1985) x Høye et al. (2020) x x x Miller (1993) x Paradkar and Chaturvedi (2010) x x Shapiro (1992) x Sharma et al. (2016) x Walsh and Roche (1979) x Mind-body practice Yost and Taylor (2013) x Cebolla et al. (2017) x x El-Khayat (2017) x Kim and Sammel (2020) x Lindahl (2017) x x x Park et al. (2016) x Telles et al. (2021) x Uebelacker et al. (2014) x Xu (1994) x Content courtesy of Springer Nature, terms of use apply. Rights reserved. ...
Objectives
Studies that use meditation-interventions (MIs) and mind–body practices (MBPs) typically highlight health-enhancing benefits whereas health-inhibiting adverse effects (AEs) have been largely underreported. The primary aim of this review was to identify articles outlining health-inhibiting AEs and synthesize the findings narratively. Randomized control trials were excluded because this design often underreports AEs or does not include measures for monitoring them.
Methods
We conducted our search using four different databases (PubMed, PsychInfo, Psychology and Behavioral Sciences Collection, and Web of Science) from inception to March 2021. We used cited reference searching and conducted a gray literature search.
Results
A total of 1,826 articles were identified through search strategies. Sixty-one studies met all inclusion criteria, and were separated by intervention/practice, with MIs being used most frequently (n = 41). The total sample size was 8,620. AEs were separated into two categories: somatic and mental distress. Nearly all studies (n = 57) mentioned some form of mental distress such as anxiety, while fewer studies (n = 21) reported somatic distress such as sleep disturbance. Individuals primarily engaged with MIs and MBPs face-to-face (n = 59).
Conclusions
This review suggests that AEs appear more frequently in research using MIs, and that mental distress is more common than somatic. These effects were primarily identified in studies delivering MIs and MBPs face-to-face, suggesting that future studies should aim to evaluate emerging technologies (i.e., apps). Easy access to apps disseminating MIs and/or MBPs could be problematic for users, considering the lack of supervision associated with technology.
Systematic review registration: PROSPERO ID#CRD42020167263
... Injury prevalence values from national surveys in Australia (21.3%) (Penman et al., 2012) and the US (35.4%) (Park et al., 2016) were in the lower half of the reported range. A group of yoga practitioners with diagnosed bipolar disorder had an injury prevalence of 25.6% (Uebelacker et al., 2014). Higher injury prevalence was observed in hot yoga (52.2%) (Mace and Eggleston, 2016) and Ashtanga (61.8%) (Mikkonen et al., 2008) practices. ...
Background
Limited biomechanical data exist describing how yoga asanas (postures) load the limbs and joints, and little evidence-based recommendations for yoga injury prevention are available. This study aimed to establish joint loading metrics for an injury-prone, yet common yoga pose, the Triangle asana (Trikonasana) by identifying how stance width adjustments alter lower extremity loading.
Methods
Eighteen yoga practitioners underwent 3D motion analysis while performing Trikonasana with self-selected (SS) stance width and −30, −20, −10, +10, +20, and +30% of SS stance width. Ground reaction forces (GRFs), joint forces, and joint moments were calculated for the leading and trailing limb ankle, knee, and hip. One-way repeated-measures analysis of variance determined differences in loading due to stance width.
Results
GRFs, net joint forces, and net joint moments were significantly affected by stance width where increasing stance width increased leading limb loading but decreased trailing limb loading.
Conclusions
Altering stance width of Trikonasana influences lower extremity limb loading, and these loading responses were limb-dependent. Yoga practitioners and instructors can use this information to objectively support increasing or decreasing stance width to reduce or increase limb loading according to their goals or to make accommodations to groups such as beginners or at-risk populations for safer, more accessible yoga practices. Cuing a wider or narrower stance width will not have the same effect on both limbs.
... Yoga is also helpful in patients with PTSD (Gallegos et al., 2017), for treating and preventing addictive behaviors (Khanna & Greeson, 2013) and eating disorders (Borden & Cook-Cottone, 2020). Yoga can also be helpful in the acceptance of bipolar disorders (Uebelacker et al., 2014). ...
The incidence of cancer cases is rising steadily, while improved early detection and new cancer-specific therapies are reducing the mortality rate. In addition to curing cancer or prolonging life, increasing the quality of life is thus an important goal of oncology, which is why the burdens of cancer and treatment are becoming more important. A common side effect of cancer and its therapy is cancer-related fatigue, a tiredness that manifests itself on physical, emotional and cognitive levels and is not in proportion to previous physical efforts. Since the etiology of fatigue has not yet been fully clarified, symptom-oriented therapy is preferable to cause-specific therapy. In addition to activity management, sleep hygiene, and cognitive behavioral therapy, mind-body interventions such as yoga are recommended for reducing fatigue. Previous studies with small sample sizes were able to examine the efficacy of yoga regarding fatigue predominantly in patients with breast cancer. Long-term effects of yoga have rarely been studied and there have been no attempts to increase long-term effects through interventions such as reminder e-mails. This dissertation takes a closer look at these mentioned aspects of the study sample and long-term effects. An 8-week randomized controlled yoga intervention was conducted, including patients with different cancer types reporting mild to severe fatigue. Following the 8-week yoga therapy, a randomized group of participants received weekly reminder e-mails for 6 months for regular yoga practice, whereas the control group did not receive reminder e-mails. The first paper is a protocol article, which addresses the design and planned implementation of the research project this dissertation is based upon. This serves to ensure better replicability and comparability with other yoga studies. Due to a very low consent rate of patients in the pilot phase, it was necessary to deviate from the protocol article in the actual implementation and the planned inclusion criterion of fatigue >5 was reduced to fatigue >1. The second paper examines the efficacy of the eight-week yoga intervention. Patients in the intervention group who participated in the yoga classes seven times or more showed a significantly greater reduction in general and physical fatigue than those who participated less often. The efficacy of yoga was related to the number of attended yoga sessions. Women with breast cancer who participated in yoga reported greater reductions in fatigue than women with other cancer types. There was also an improvement for depression and quality of life after eight weeks of yoga therapy compared to no yoga therapy. These results imply that yoga is helpful in reducing depression and cancer-related fatigue, especially in terms of physical aspects and improving quality of life. The third paper focuses on the efficacy of reminder e-mails in terms of fatigue and practice frequency. Patients who received reminder e-mails reported greater reductions in general and emotional fatigue, as well as significant increases in practice frequency, compared to patients who did not receive reminder e-mails. Compared to fatigue scores before yoga, significantly lower fatigue and depression scores and higher quality of life were reported after yoga therapy and at follow-up six months later. Weekly e-mail reminders after yoga therapy may have positive effects on general and emotional fatigue and help cancer patients with fatigue establish a regular yoga practice at home. However, higher practice frequency did not lead to higher improvement in physical fatigue as found in Paper 2. This may indicate other factors that influence the efficacy of yoga practice on physical fatigue, such as mindfulness or side effects of therapy. This research project provides insight into the efficacy of yoga therapy for oncology patients with fatigue. It is important that such interventions be offered early, while fatigue symptoms are not too severe. Regular guided yoga practice can reduce physical fatigue, but subsequent yoga practice at home does not further reduce physical fatigue. Reminder emails after completed yoga therapy could only reduce patients' emotional fatigue. It may be that physical fatigue was reduced as much as possible by the previous yoga therapy and that there was a floor effect, or it may be that reminder emails are not suitable as an intervention to reduce physical fatigue at all. Further research is needed to examine the mechanisms of the different interventions in more detail and to find appropriate interventions that reduce all levels of fatigue equally.
... For example, panellists agreed on the usefulness of yoga as an adjunct therapy for mood disorders at a rate nearing consensus (82.35%), consistent with research in the field [45,46]. Notably, none of the experts made comments or direct reference to bipolar disorder in the present study, possibly reflecting a dearth of research in this area [47]. Lack of research may also explain why comments made by experts around yoga for anxiety reduction were also not met with panel consensus, despite recent meta-analytical evidence demonstrating small short-term effects of yoga on anxiety compared to no treatment [48]. ...
Background
There is preliminary evidence to suggest that yoga can be beneficial in reducing anxiety, depression and general eating disorder symptoms in people with Anorexia Nervosa (AN). It is unclear whether the therapeutic benefits of yoga are supported or utilised in the treatment of AN amongst clinical experts. The present study aimed to explore and synthesise expert opinion on the use of yoga as an adjunctive therapy in the management of anxiety, depression and over-exercise in individuals with AN.
Methods
A Delphi methodology was employed, with clinicians considered experts in the treatment of AN recruited internationally to form the panel ( n = 18). The first iteration of questionnaires comprised of four open-ended questions concerning the experts’ understanding of the term yoga and opinions on its’ use in therapy generally and more specifically in the treatment of AN. Using content analysis, statements were derived from this data and included as Likert-based items in two subsequent rounds where panellists rated their level of agreement on each item. Seventeen out of 18 respondents completed all three iterations.
Results
Consensus (level of agreement defined at ≥ 85%) was achieved for 36.47% of the items included in the second and third rounds. The panel reached consensus on items defining yoga and pertaining to its’ general benefits. The panel agreed that yoga is a adjunct therapy for various problems, consensus was not achieved on the specific use of yoga as an adjunct therapy in the treatment of comorbid anxiety, depression or trauma in patients with AN. Although the expert panel acknowledged a number of benefits for use of yoga in AN, they strongly endorsed that future research should evaluate the potential risks of using yoga as an embodied practice.
Conclusions
It is possible that yoga could be considered for inclusion in future guidelines if supported by empirical research. We conclude that there seems to be enough consensus that such further scientific investigation is warranted.
Plain English summary
This study aimed to explore expert opinion on the use of yoga as an adjunctive therapy in the management of anxiety, depression and over-exercise in individuals with Anorexia Nervosa (AN). Clinicians considered experts in the treatment of AN recruited internationally to form the panel ( n = 18). Experts were asked about their understanding of the term yoga and their opinions on its’ use in therapy. The panel reached consensus on items defining yoga and pertaining to its’ general benefits. Although the panel agreed that yoga is a nice additional therapy for various problems, consensus was not achieved on the use of yoga as an additional therapy in the treatment of specific problems like anxiety, depression or trauma in people with AN. The expert panel acknowledged a number of benefits for use of yoga in AN. However the panel strongly considered that future research should evaluate the potential risks of using yoga as an embodied practice. The areas of collective agreement gained in the study can serve as preliminary guidelines for the use of yoga in AN whilst guiding future research directions.
... Preliminary observations suggest that yoga improves psychological, physical, and cognitive function warranting further investigation. 26,27 Although early results are promising, their reliability and generalizability are limited by the paucity of studies and methodological constraints, including small sample sizes, variations in clinical measurements, blinding methods, and patient selection. 20,28 Moreover, there are considerable differences in the forms of yoga employed, with many yoga publications not including the key components of yoga in the intervention. ...
Objective
Patients with depression frequently experience persistent residual symptoms even with optimal interventions. These patients often use complementary treatments, including yoga, as a preferred alternative or adjunctive treatment. There is evidence for the benefit of yoga for depression, but this has not been rigorously evaluated, particularly in bipolar depression. We aimed to determine the feasibility and benefit of manualized breathing-focused yoga in comparison to psychoeducation as augmentation to pharmacotherapy for improving residual symptoms of depression in unipolar and bipolar patients.
Methods
Using a randomized single-blind crossover design, 72 outpatients with unipolar or bipolar depression were augmented with the two 8-week interventions at separate times, as add-ons to current first-line antidepressants and mood stabilizers. The primary outcome measure was the Montgomery-Åsberg Depression Rating Scale (MADRS). Due to the high dropout of participants after crossover at Week 8, analysis focused on between-group comparisons of yoga and psychoeducation during the initial 8 weeks of the study.
Results
There was a significant decline in depressive symptoms, as measured by the MADRS, following 8 weeks of yoga. However, there was no significant difference in MADRS ratings between intervention groups. Similar improvements in self-rated depressive symptoms and well-being were also observed across time.
Conclusions
Both yoga and psychoeducation may improve residual symptoms of unipolar and bipolar depression as add-on to medications. In-class group sessions and long study durations may reduce feasibility for this population. Larger trials with parallel group design and shorter duration may be more feasible.
... Other populations seem to experience benefits that are similar to exercise alone, such as patients with bipolar disorder or lower back pain (Sherman et al., 2010;Cramer et al., 2013;Uebelacker et al., 2014). Buffart et al. (2012) found that cancer patients reported a decrease in stress and anxiety post yoga treatments and only a moderate change in fatigue, quality of life, and social and emotional functioning. ...
World-wide, billions of dollars are spent each year on body-centered interventions to alleviate both physical and psychological pathologies. Given the high demand and increasing popularity of body-centered interventions, there is need for a systematic organization of empirical evidence associated with body-centered therapies. This article reviews the psychological effects of body-centered interventions on emotional well-being, including both self and other-administered (receptive) therapies. Theory behind body-centered interventions rely upon the bidirectional communication pathway between the brain and body. We investigated the bidirectional communication pathway between the brain and body by evaluating evidence across multiple body-centered therapies. The research reviewed includes studies that investigate effects of massage therapy, reflexology, acupuncture, functional relaxation, emotional freedom technique, Rolfing, yoga, tai-chi, and dance/movement therapy on psychological conditions across the lifespan. Results demonstrated that overall, massage therapy, tai-chi, dance/movement therapy, functional relaxation, reflexology, acupuncture and emotional freedom technique seem to alleviate stress, depression, anxiety, bipolar disorder and facilitate pain reduction. Of these, the most robust evidence available was for massage therapy, indicating it is an effective intervention for numerous age groups and populations. Rolfing and reflexology had the least amount of support, with few studies available that had small sample sizes. Although these conclusions are limited by scarcity of high-quality empirical data and contradictory findings, available evidence indicates that body-centered interventions can be effective in reducing psychopathology and supports the proposed mechanism of the bidirectional pathway between the brain and body: the body holds the potential to influence the mind. Integrating body-centered therapies in both clinical settings and as self-care could lead to better outcomes. Lastly, we propose the first taxonomy of body-centered interventions and empirical evidence of their effectiveness for clinicians and researchers.
... [21][22][23] Preliminary data found that 90% of individuals with bipolar disorder who practiced yoga reported that they believed that yoga improves their symptoms of depression and mania. 24 A recent pilot trial of adjunctive yoga for bipolar depression yielded some initial support for the reduction of depressive symptoms as well as secondary prevention of manic symptoms. 25 Altogether, these data suggest that yoga may be a feasible, acceptable, and effective intervention for mood disorders. ...
Background:
Despite ongoing advances in the treatment of mood disorders, a substantial proportion of people diagnosed with major depression or bipolar disorder remain symptomatic over time. Yoga, which has been shown to reduce stress and depressive symptoms, as well as to improve overall quality of life, shows promise as an adjunctive treatment. However, dissemination of yoga for clinical populations remains challenging. The purpose of this pilot study was to test the feasibility and acceptability of an online yoga intervention for individuals with mood disorders.
Methods:
In total, 56 adults who reported being diagnosed with a mood disorder (bipolar disorder, major depressive disorder, cyclothymia, or schizoaffective disorder) were recruited from MoodNetwork, an online community of individuals with mood disorders. A feedback survey and a measure of positive and negative affect were administered before and after a 30-minute online Hatha yoga class.
Results:
In total, 44 individuals (78.6%) completed all components of the yoga class. The mean score on a 10-point Likert scale rating how much participants liked the online yoga class was 7.24 (SD=2.40). Most participants (67.9%) reported that they would be "somewhat likely" or "very likely" to participate in an online yoga program again. There was a statistically significant decrease in negative affect after completing the class (t=-6.05; P<0.001), but positive affect did not change (P>0.10).
Discussion:
These preliminary data support the utility of online yoga tailored specifically for people with mood disorders as a possible adjunctive intervention that warrants further investigation.
... Yoga has also been occasionally associated with serious adverse events, and patients with psychiatric disorders might be particularly prone to symptom aggravation due to yoga practice (Cramer et al., 2013a). About five percent of yoga practitioners diagnosed with bipolar disorder have e.g. reported yoga-associated aggravations of their depressive symptoms (Uebelacker et al., 2014). This should be closely monitored in future RCTs. ...
Background:
The purpose of this review was to investigate the efficacy and safety of yoga interventions in treating patients with major depressive disorder.
Methods:
MEDLINE, Scopus, and the Cochrane Library were screened through December 2016. Randomized controlled trials (RCTs) comparing yoga to inactive or active comparators in patients with major depressive disorder were eligible. Primary outcomes included remission rates and severity of depression. Anxiety and adverse events were secondary outcomes. Risk of bias was assessed using the Cochrane tool.
Results:
Seven RCTs with 240 participants were included. Risk of bias was unclear for most RCTs. Compared to aerobic exercise, no short- or medium-term group differences in depression severity was found. Higher short-term depression severity was found for yoga compared to electro-convulsive therapy; remission rates did not differ between groups. No short-term group differences occurred when yoga was compared to antidepressant medication. Conflicting evidence was found when yoga was compared to attention-control interventions, or when yoga as an add-on to antidepressant medication was compared to medication alone. Only two RCTs assessed adverse events and reported that no treatment-related adverse events were reported.
Limitations:
Few RCTs with low sample size.
Conclusions:
This review found some evidence for positive effects beyond placebo and comparable effects compared to evidence-based interventions. However, methodological problems and the unclear risk-benefit ratio preclude definitive recommendations for or against yoga as an adjunct treatment for major depressive disorder. Larger and adequately powered RCTs using non-inferiority designs are needed.
... Omega-3 fatty acid supplements (1-2 g/day) may be a reasonable adjunctive treatment for patients with bipolar depression. Exercise has also been shown to improve mood and energy [103]. ...
Opinion Statement
Due to the early age of onset, bipolar disorder is most commonly studied in younger adults, among whom the prevalence is 3.9% in adults aged 18–30 years. Unfortunately, relatively less attention has been paid to the unique needs of older adults with bipolar disorder (OABD), despite clinical complexities that include medical comorbidity, polypharmacy, cognitive decline, and phase of life losses of occupation and social identity. Furthermore, impaired cognitive performance in some older adults may limit the ability to stabilize mood episodes and interfere with the individual’s engagement in multi-modal treatment. Many OABD may also struggle with impairments in their independent activities of daily living (IADLs) which can lead to greater psychiatric, medical, psychological, financial, or social sequelae of mood episodes. Further complicating this picture is the fact that most OABD are treated by general psychiatrists or family practitioners due to a worldwide shortage of geriatric psychiatrists. This will become increasingly common as the mean life expectancy continues to increase. It is therefore incumbent on all general practitioners to understand the phases of bipolar disorder and the associated treatment options throughout the lifespan. Treatment of manic or depressive episodes focuses on symptomatic remission primarily through pharmacotherapy and neurotherapeutics. Management of the maintenance phase focuses on optimizing pharmacotherapy while reducing subclinical symptoms, treating comorbid illness, preventing relapse, and restoring psychosocial functioning and intacts identity through multimodal approaches including psychopharmacology, psychotherapy, diet, and lifestyle modifications. Comprehensive care for OABD is best achieved through close collaboration with the affected individual, the family physician, pharmacist, family members, and social supports.
... Development of the yoga manual for bipolar depression drew heavily upon an existing manual of yoga for unipolar depression developed by Uebelacker et al., 2016b, and evaluated with positive symptom reduction outcomes in a recent randomized controlled trial. Manual development was also informed by an earlier qualitative study of the risks and benefits of yoga reported by selfidentified yoga practitioners with BD (Uebelacker, Weinstock, & Kraines, 2014). The program was designed specifically for people who were new to yoga and who may not be physically fit. ...
Although yoga has been recommended as a mood management strategy for bipolar disorder (BD), there are no published studies on yoga for the treatment of BD symptoms. The aim of this pilot study was to develop an adjunctive hatha yoga intervention for bipolar depression, and to evaluate its preliminary feasibility, acceptability, and safety in a 10-week randomized controlled trial. Eighteen adults with bipolar I/II depression were recruited and randomized to yoga (n = 10) or self-directed bibliotherapy (n = 8), both delivered as adjuncts to community pharmacotherapy for BD. Yoga participants were invited to attend at least one of two weekly yoga classes for 10 weeks, following a structured yoga manual. Statistical analyses focused on change in depression severity, assessed post-treatment by a blind rater. Participants also completed assessments of mania symptoms, quality of life (QoL), and treatment satisfaction. Although between-groups analysis yielded no significant difference in depression outcomes by condition, within-group analyses of those assigned to yoga revealed medium effects for improvements in depression symptoms (Cohen's d = 0.66) and QoL (Cohen's d = 0.69). Manic symptom severity remained low throughout the yoga program, in contrast to slight increases in the control arm (F(1,13) = 7.25, p 0.021). Participants attended an average of only 4.80 (SD = 5.12) yoga classes, yet overall satisfaction with yoga was rated as fairly high and 6 of 10 participants reported practicing yoga at home. We conclude that yoga for bipolar depression merits future research, with a focus on alternative avenues of delivery (e.g., internet) that may not require weekly class attendance.
... However, cases of such serious injuries due to yoga-related falls are rare: in a nation-wide survey among Japanese yoga teachers, only 9 cases of moderate or severe yoga-related falls were reported; some of them however requiring discontinued class participation, medical examination or even emergency transport [14]. About 25% of all long-term practitioners have ever been injured during their yoga practice [14,27,28]; but the risk of yoga-associated injuries has been estimated as only 1.45 per 1000 h of yoga practice [29]; and falls are only a minor cause for yogarelated injury [14,27]. Overall, the risk of yoga-related injuries does not exceed the risk related to other forms of moderate intensity exercise such as stretching or walking [25]. ...
Introduction:
Falls are the leading cause of injuries in women across all ages. While yoga has been shown to increase balance, it has also been associated with injuries due to falls during practice. This study aimed to analyse whether regular yoga or meditation practice is associated with the frequency of falls and fall-related injuries in upper middle-aged Australian women.
Methods:
Women aged 59-64 years from the Australian Longitudinal Study on Women's Health (ALSWH) were queried regarding falls and falls-related injuries; and whether they regularly practiced yoga or meditation. Associations of falls and falls-related injuries with yoga or meditation practice were analysed using chi-squared tests and multiple logistic regression modelling.
Results:
Of 10,011 women, 4413 (44.1%) had slipped, tripped or stumbled, 2770 (27.7%) had fallen to the ground, 1398 (14.0%) had been injured as a result of falling, and 901 (9.0%) women had sought medical attention for a fall-related injury within the previous 12 months. Yoga or meditation was practiced regularly by 746 (7.5%) women. No associations of falls, fall-related injuries and treatment due to falls-related injury with yoga or meditation practice were found.
Discussion:
No association between yoga or meditation practice and falls or fall-related injuries have been found. Further studies are warranted for conclusive judgement of benefits and safety of yoga and meditation in relation to balance, falls and fall-related injuries.
... A study examining adjunctive treatments for bipolar patients saw a high rate of self-reported cognitive benefits as a result of yoga practice. Many subjects with bipolar depression reported that ongoing yoga practice assisted with their focus and sense of acceptance [36]. Also related to cognitive benefits, another study showed that 6 weeks of hatha yoga improved working memory and attention-switching ability in healthy older adults [11]. ...
Previous research has shown the vast mental and physical health benefits associated with yoga. Yoga practice can be divided into subcategories that include posture-holding exercise (asana), breathing (pranayama, Kriya), and meditation (Sahaj) practice. Studies measuring mental health outcomes have shown decreases in anxiety, and increases in cognitive performance after yoga interventions. Similar studies have also shown cognitive advantages amongst yoga practitioners versus non-practitioners. The mental health and cognitive benefits of yoga are evident, but the physiological and structural changes in the brain that lead to this remain a topic that lacks consensus. Therefore, the purpose of this study was to examine and review existing literature on the effects of yoga on brain waves and structural changes and activation. After a narrowed search through a set of specific inclusion and exclusion criteria, 15 articles were used in this review. It was concluded that breathing, meditation, and posture-based yoga increased overall brain wave activity. Increases in graygray matter along with increases in amygdala and frontal cortex activation were evident after a yoga intervention. Yoga practice may be an effective adjunctive treatment for a clinical and healthy aging population. Further research can examine the effects of specific branches of yoga on a designated clinical population.
Copyright © 2015 Elsevier Ltd. All rights reserved.
This study analyzes how the beta index, which is closely related to alertness, caution, concentration, anxiety, and tension in brain activity, varies before and after practicing yoga. Electroencephalogram (EEG) and subjective evaluations were conducted on healthy female yoga trainers with over three years of experience; participants wore yoga clothes with differing characteristics in a hot environment. Repeated ANOVA measurements were conducted on the data by deriving the difference between the corresponding sample t-test pre- and post-yoga. After yoga, concentration increased, while alertness, anxiety, and excitement decreased depending on the yoga clothes. The clothing combination that offered higher pressure and greater absorption, and enhanced concentration while lowering excitation and anxiety increased beta waves the most. The design characteristics of yoga clothes influence beta power for concentration and arousal after yoga practice. Through EEG measurements, it was possible to explore the mental states resulting from wearing clothes suitable for yoga.
Many individual studies and meta-analyses have shown that psychotherapeutic interventions for people with bipolar disorders can positively influence the course of the disease. This article gives an overview of the development of psychotherapy for people with bipolar disorders. According to the current guidelines the evidence-based procedures with their mechanisms of action are presented and new developments in psychotherapy research in this field are outlined. © 2018 Springer Medizin Verlag GmbH, ein Teil von Springer Nature
There is a growing interest in complementary and alternative medicine (CAM) in psychiatric disorders, including bipolar disorder. Individuals may continue to experience symptoms and impairment from their illness despite appropriate pharmacologic treatment. Moreover, psychotropic medications can be especially problematic for many older adults with regard to adverse effects, tolerability, and drug interactions. Complementary and alternative therapies may fill the gaps where traditional treatment modalities fall short. Treatment goals may range from alleviating residual symptoms to improving quality of life and general well-being. There is a dearth of research on CAM in older age bipolar disorder but there is growing research in adult psychiatric populations more generally. CAM studies often have methodological limitations, and so findings should be interpreted with caution. This chapter aims to give a general overview of CAM therapies to consider as adjuncts to standard treatment, including several nutraceutical supplements and meditation. CAM offers the opportunity to take a truly integrative approach to psychiatric care. Psychiatrists have the ability not only to treat troubling symptoms, but also to improve patients’ quality of life. Incorporating dietary supplements when indicated, promoting exercise and nutrient rich diets, and teaching mindfulness and acceptance can be key ingredients in achieving wellness for bipolar patients.
Modern medicine increasingly looks to traditional systems of medicine to combat the chronic disease crisis caused by non-communicable diseases. Yoga and Ayurveda present two ways to eliminate pathology and restore health. In ancient India, health was promoted by the most powerful means available. Traditional Indian systems of medicine like Ayurveda and yoga often restore health when all else has failed. They are increasingly accepted as possible routes to regaining health, even in the face of otherwise incurable chronic diseases. Their seeds in the UpaniÈads are the paðcavÀyus (five subtle energies), prÀõas (vital breaths), controlling the physiology. Acting on 'subtle levels' that control gross physical levels gives yoga and Ayurveda their power to cure chronic diseases and restore health. As integratively practiced today, yoga–medicine combine traditional wisdom with modern medicine. Mentally, yoga aims to balance the mind ('balance of mind' is called yoga) by balancing the three guõas. Physiologically, it acts on the paðcakoÈas (five sheaths) surrounding the abstract level of spirit or Self, so preventing interference with processes maintaining balance and health. Its lifestyle strategies prevent imbalances from arising, thus promoting health. Ayurveda similarly aims to restore balance to regulatory systems in the physiology, describing them in terms of three doÈas and their 15 sub-doÈas. Both yoga and Ayurveda are similarly structured and complement each other. Adopting their lifestyle recommendations offers effective means to avoid disease and maintain health.
Meditation is a popular method of relaxation and dealing with everyday stress. Meditative techniques have been used in the management of a number of psychiatric and physical illnesses. The risk of serious mental illness being precipitated by meditation is less well recognized however. This paper reports a case in which two separate manic episodes arose after meditation using techniques from two different traditions (yoga and zen). Other cases of psychotic illness precipitated by meditation and mystical speculation reported in the literature are discussed.
Yoga is gaining acceptance as an ancillary medical treatment, but there have been few studies evaluating its therapeutic benefits in neurological and major psychiatric conditions. The authors reviewed the literature in English on the efficacy of yoga for these disorders. Only randomized, controlled trials were included, with the exception of the only study of yoga for bipolar disorder, which was observational. Trials were excluded if yoga was not the central component of the intervention. Of seven randomized, controlled trials of yoga in patients with neurological disorders, six found significant, positive effects. Of 13 randomized, controlled trials of yoga in patients with psychiatric disorders, 10 found significant, positive effects. These results, although encouraging, indicate that additional randomized, controlled studies are needed to critically define the benefits of yoga for both neurological and psychiatric disorders.
There has been substantial interest in mindfulness as an approach to reduce cognitive vulnerability to stress and emotional distress in recent years. However, thus far mindfulness has not been defined operationally. This paper describes the results of recent meetings held to establish a consensus on mindfulness and to develop conjointly a testable operational definition. We propose a two-component model of mindfulness and specify each component in terms of specific behaviors, experiential manifestations, and implicated psychological processes. We then address issues regarding temporal stability and situational specificity and speculate on the conceptual and operational distinctiveness of mindfulness. We conclude this paper by discussing implications for instrument development and briefly describing our own approach to measurement.
Although the validity and safety of antipsychotic polypharmacy remains unclear, it is commonplace in the treatment of schizophrenia. This study aimed to investigate the degree that antipsychotic polypharmacy contributed to metabolic syndrome in outpatients with schizophrenia, after adjustment for the effects of lifestyle.
A cross-sectional survey was carried out between April 2007 and October 2007 at Yamanashi Prefectural KITA hospital in Japan. 334 patients consented to this cross-sectional study. We measured the components consisting metabolic syndrome, and interviewed the participants about their lifestyle. We classified metabolic syndrome into four groups according to the severity of metabolic disturbance: the metabolic syndrome; the pre-metabolic syndrome; the visceral fat obesity; and the normal group. We used multinomial logistic regression models to assess the association of metabolic syndrome with antipsychotic polypharmacy, adjusting for lifestyle.
Seventy-four (22.2%) patients were in the metabolic syndrome group, 61 (18.3%) patients were in the pre-metabolic syndrome group, and 41 (12.3%) patients were in visceral fat obesity group. Antipsychotic polypharmacy was present in 167 (50.0%) patients. In multinomial logistic regression analyses, antipsychotic polypharmacy was significantly associated with the pre-metabolic syndrome group (adjusted odds ratio [AOR], 2.348; 95% confidence interval [CI], 1.181-4.668), but not with the metabolic syndrome group (AOR, 1.269; 95%CI, 0.679-2.371).
These results suggest that antipsychotic polypharmacy, compared with monotherapy, may be independently associated with an increased risk of having pre-metabolic syndrome, even after adjusting for patients' lifestyle characteristics. As metabolic syndrome is associated with an increased risk of cardiovascular mortality, further studies are needed to clarify the validity and safety of antipsychotic polypharmacy.
The short-term effects of 4 weeks of intensive yoga practice on physiological responses in six healthy adult female volunteers were measured using the maximal exercise treadmill test. Yoga practice involved daily morning and evening sessions of 90 minutes each. Pre- and post-yoga exercise performance was compared. Maximal work output (Wmax) for the group increased by 21%, with a significantly reduced level of oxygen consumption per unit work but without a concomitant significant change in heart rate. After intensive yoga training, at 154 Wmin(-1) (corresponding to Wmax of the pre-yoga maximal exercise test) participants could exercise more comfortably, with a significantly lower heart rate (p < 0.05), reduced minute ventilation (p < 0.05), reduced oxygen consumption per unit work (p < 0.05), and a significantly lower respiratory quotient (p < 0.05). The implications for the effect of intensive yoga on cardiorespiratory efficiency are discussed, with the suggestion that yoga has some transparently different quantifiable physiological effects to other exercises.
Schizophrenia may be associated with hyperthermic syndromes such as febrile catatonia, neuroleptic malignant syndrome, and heatstroke. The authors hypothesized that an exercise-heat tolerance test would disclose abnormal thermoregulation in schizophrenic patients.
Seven male schizophrenic outpatients in remission maintained on depot antipsychotic treatment and eight healthy comparison subjects completed a heat tolerance test that consisted of two 50-minute bouts of walking a motor-driven treadmill at 40xC (relative humidity=40%).
A significantly higher rise in rectal and skin temperatures was observed in the patient group. No differences in heart rate, blood pressure, or perspiration were detected.
Schizophrenic patients maintained on antipsychotic drugs exhibit impaired heat tolerance. Possible explanations are a reduced ability to convey heat from the body's core to the periphery with or without excessive heat production. The hyperthermic response to the heat tolerance test may reflect a dysfunction associated with schizophrenia, a neuroleptic-induced side effect, or both.
To our knowledge, this is the first prospective natural history study of weekly symptomatic status of patients with bipolar I disorder (BP-I) during long-term follow-up.
Analyses are based on ongoing prospective follow-up of 146 patients with Research Diagnostic Criteria BP-I, who entered the National Institute of Mental Health (Bethesda, Md) Collaborative Depression Study from 1978 through 1981. Weekly affective symptom status ratings were analyzed by polarity and severity, ranging from asymptomatic, to subthreshold levels, to full-blown major depression and mania. Percentages of follow-up weeks at each level as well as number of shifts in symptom status and polarity during the entire follow-up period were examined. Finally, 2 new measures of chronicity were evaluated in relation to previously identified predictors of chronicity for BP-I.
Patients with BP-I were symptomatically ill 47.3% of weeks throughout a mean of 12.8 years of follow-up. Depressive symptoms (31.9% of total follow-up weeks) predominated over manic/hypomanic symptoms (8.9% of weeks) or cycling/mixed symptoms (5.9% of weeks). Subsyndromal, minor depressive, and hypomanic symptoms combined were nearly 3 times more frequent than syndromal-level major depressive and manic symptoms (29.9% vs 11.2% of weeks, respectively). Patients with BP-I changed symptom status an average of 6 times per year and polarity more than 3 times per year. Longer intake episodes and those with depression-only or cycling polarity predicted greater chronicity during long-term follow-up, as did comorbid drug-use disorder.
The longitudinal weekly symptomatic course of BP-I is chronic. Overall, the symptomatic structure is primarily depressive rather than manic, and subsyndromal and minor affective symptoms predominate. Symptom severity levels fluctuate, often within the same patient over time. Bipolar I disorder is expressed as a dimensional illness featuring the full range (spectrum) of affective symptom severity and polarity.
This is the first prospective longitudinal study, to our knowledge, of the natural history of the weekly symptomatic status of bipolar II disorder (BP-II).
Weekly affective symptom status ratings for 86 patients with BP-II were based on interviews conducted at 6- or 12-month intervals during a mean of 13.4 years of prospective follow-up. Percentage of weeks at each symptom severity level and the number of shifts in symptom status and polarity were examined. Predictors of chronicity for BP-II were evaluated using new chronicity measures. Chronicity was also analyzed in relation to the percentage of follow-up weeks with different types of somatic treatment.
Patients with BP-II were symptomatic 53.9% of all follow-up weeks: depressive symptoms (50.3% of weeks) dominated the course over hypomanic (1.3% of weeks) and cycling/mixed (2.3% of weeks) symptoms. Subsyndromal, minor depressive, and hypomanic symptoms combined were 3 times more common than major depressive symptoms. Longer intake episodes, a family history of affective disorders, and poor previous social functioning predicted greater chronicity. Prescribed somatic treatment did not correlate significantly with symptom chronicity. Patients with BP-II of brief (2-6 days) vs longer (> or =7 days) hypomanias were not significantly different on any measure.
The longitudinal symptomatic course of BP-II is chronic and is dominated by depressive rather than hypomanic or cycling/mixed symptoms. Symptom severity fluctuates frequently within the same patient over time, involving primarily symptoms of minor and subsyndromal severity. Longitudinally, BP-II is expressed as a dimensional illness involving the full severity range of depressive and hypomanic symptoms. Hypomania of long or short duration in BP-II seems to be part of the same disease process.
This report presents selected estimates of complementary and alternative medicine (CAM) use among U.S. adults, using data from the 2002 National Health Interview Survey (NHIS), conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS).
Data for the U.S. civilian noninstitutionalized population were collected using computer-assisted personal interviews (CAPI). This report is based on 31,044 interviews of adults age 18 years and over. Statistics shown in this report were age adjusted to the year 2000 U.S. standard population.
Sixty-two percent of adults used some form of CAM therapy during the past 12 months when the definition of CAM therapy included prayer specifically for health reasons. When prayer specifically for health reasons was excluded from the definition, 36% of adults used some form of CAM therapy during the past 12 months. The 10 most commonly used CAM therapies during the past 12 months were use of prayer specifically for one's own health (43.0%), prayer by others for one's own health (24.4%), natural products (18.9%), deep breathing exercises (11.6%), participation in prayer group for one's own health (9.6%), meditation (7.6%), chiropractic care (7.5%), yoga (5.1%), massage (5.0%), and diet-based therapies (3.5%). Use of CAM varies by sex, race, geographic region, health insurance status, use of cigarettes or alcohol, and hospitalization. CAM was most often used to treat back pain or back problems, head or chest colds, neck pain or neck problems, joint pain or stiffness, and anxiety or depression. Adults age 18 years or over who used CAM were more likely to do so because they believed that CAM combined with conventional medical treatments would help (54.9%) and/or they thought it would be interesting to try (50.1%). Most adults who have ever used CAM have used it within the past 12 months, although there is variation by CAM therapy.
There is good evidence for cognitive and physiological arousal in chronic insomnia. Accordingly, clinical trial studies of insomnia treatments aimed at reducing arousal, including relaxation and meditation, have reported positive results. Yoga is a multicomponent practice that is also known to be effective in reducing arousal, although it has not been well evaluated as a treatment for insomnia. In this preliminary study, a simple daily yoga treatment was evaluated in a chronic insomnia population consisting of sleep-onset and/or sleep-maintenance insomnia and primary or secondary insomnia. Participants maintained sleep-wake diaries during a pretreatment 2-week baseline and a subsequent 8-week intervention, in which they practiced the treatment on their own following a single in-person training session with subsequent brief in-person and telephone follow-ups. Sleep efficiency (SE), total sleep time (TST), total wake time (TWT), sleep onset latency (SOL), wake time after sleep onset (WASO), number of awakenings, and sleep quality measures were derived from sleep-wake diary entries and were averaged in 2-week intervals. For 20 participants completing the protocol, statistically significant improvements were observed in SE, TST, TWT, SOL, and WASO at end-treatment as compared with pretreatment values.
Yogic breathing is a unique method for balancing the autonomic nervous system and influencing psychologic and stress-related disorders. Part I of this series presented a neurophysiologic theory of the effects of Sudarshan Kriya Yoga (SKY). Part II will review clinical studies, our own clinical observations, and guidelines for the safe and effective use of yoga breath techniques in a wide range of clinical conditions. Although more clinical studies are needed to document the benefits of programs that combine pranayama (yogic breathing) asanas (yoga postures), and meditation, there is sufficient evidence to consider Sudarshan Kriya Yoga to be a beneficial, low-risk, low-cost adjunct to the treatment of stress, anxiety, post-traumatic stress disorder (PTSD), depression, stress-related medical illnesses, substance abuse, and rehabilitation of criminal offenders. SKY has been used as a public health intervention to alleviate PTSD in survivors of mass disasters. Yoga techniques enhance well-being, mood, attention, mental focus, and stress tolerance. Proper training by a skilled teacher and a 30-minute practice every day will maximize the benefits. Health care providers play a crucial role in encouraging patients to maintain their yoga practices.
Mindfulness Based Cognitive Therapy (MBCT) is an 8-week course developed for patients with relapsing depression that integrates mindfulness meditation practices and cognitive theory. Previous studies have demonstrated that non-depressed participants with a history of relapsing depression are protected from relapse by participating in the course. This exploratory study examined the acceptability and effectiveness of MBCT for patients in primary care with active symptoms of depression and anxiety
13 patients with recurrent depression or recurrent depression and anxiety were recruited to take part in the study. Semi-structured qualitative interviews were conducted three months after completing the MBCT programme. A framework approach was used to analyse the data. Beck depression inventories (BDI-II) and Beck anxiety inventories (BAI) provided quantitative data and were administered before and three months after the intervention.
The qualitative data indicated that mindfulness training was both acceptable and beneficial to the majority of patients. For many of the participants, being in a group was an important normalising and validating experience. However most of the group believed the course was too short and thought that some form of follow up was essential. More than half the patients continued to apply mindfulness techniques three months after the course had ended. A minority of patients continued to experience significant levels of psychological distress, particularly anxiety. Statistically significant reductions in mean depression and anxiety scores were observed; the mean pre-course depression score was 35.7 and post-course score was 17.8 (p = 0.001). A similar reduction was noted for anxiety with a mean pre-course anxiety score of 32.0 and mean post course score of 20.5 (p = 0.039). Overall 8/11 (72%) patients showed improvements in BDI and 7/11 (63%) patients showed improvements in BAI. In general the results of the qualitative analysis agreed well with the quantitative changes in depression and anxiety reported.
The results of this exploratory mixed methods study suggest that mindfulness based cognitive therapy may have a role to play in treating active depression and anxiety in primary care.
Die Zeit antagonistischer Wissenschaftskulturen scheint vorüber: Begriffe, Modelle und Objekte wandern zwischen den Geistes-, Sozial- und Technowissenschaften. Dabei entstehen neue und intensive Verflechtungen. So werden ehemals kritische Konzepte des vermeintlich Nicht-Technischen in den Technowissenschaften aufgegriffen, während biokybernetische Denkfiguren auch die Geisteswissenschaften durchziehen. Dieser Band verfolgt solche Übersetzungsversuche und fragt, ob sich eine kreative interdisziplinäre Wissenskultur oder eine restriktive, formale Kultur der ›Interdisziplinierung‹ auf der Grundlage einer neuen Technorationalität herausbildet.
From the world's greatest and best-known teacher of yoga comes this guide to the discipline. Patanjali, an early Indian sage and mystic, was the first to systematize and codify the principle and practice of yoga. Patanjali's collection of 185 aphorisms, "Yoga Sutras", remains the classical work on the subject - this book provides a commentary on Patanjali's work.
Individuals with bipolar disorder (BD) often receive complex polypharmacy regimens as part of treatment, yet few studies have sought to evaluate patient characteristics associated with this high medication burden. This retrospective chart review study examined rates of complex polypharmacy (i.e.,≥4 psychotropic medications), patterns of psychotropic medication use, and their demographic and clinical correlates in a naturalistic sample of adults with bipolar I disorder (BDI; N=230) presenting for psychiatric hospital admission. Using a computer algorithm, a hospital administrator extracted relevant demographic, clinical, and community treatment information for analysis. Patients reported taking an average of 3.31(SD=1.46) psychotropic medications, and 5.94(SD=3.78) total medications at intake. Overall, 82 (36%) met criteria for complex polypharmacy. Those receiving complex polypharmacy were significantly more likely to be female, to be depressed, to have a comorbid anxiety disorder, and to have a history of suicide attempt. Women were significantly more likely than men to be prescribed antidepressants, benzodiazepines, and stimulants, even after controlling for mood episode polarity. Study data highlight the high medication burden experienced by patients with BD, especially those who are acutely symptomatic. Data also highlight the particularly high medication burden experienced by women with BD; a burden not fully accounted for by depression.
Randomized trials of adjunctive psychotherapy for bipolar disorder are reviewed, in tandem with discussion of cost-effectiveness, mediating mechanisms, and moderators of effects.
Systematic searches of the MEDLINE and PSYCHLIT databases yielded 19 randomized controlled trials of individual family and group therapies. Outcome variables included time to recovery, relapse or recurrence, symptom severity, medication adherence, and psychosocial functioning.
Meta-analyses consistently show that disorder-specific psychotherapies [cognitive-behavioral therapy (CBT), interpersonal, family, and group] augment mood stabilizers in reducing rates of relapse (OR = 0.57; 95% CI: 0.39-0.82) over 1-2 years. Specific mediating mechanisms include, but are not limited to, increasing medication adherence, teaching self-monitoring and early intervention with emergent episodes, and enhancing interpersonal functioning and family communication. All therapies have strengths and weaknesses. One group psychoeducation trial, demonstrated effect sizes for recurrence that are at least equivalent to individual therapies, but findings await replication. Family interventions have been successfully administered in both single and multi-family formats, but no studies report the comparative cost-effectiveness of these formats. The best-studied psychotherapy modality, CBT, can have beneficial effects on depression, but findings are inconsistent across studies and vary with sample characteristics and comparison treatments.
Adjunctive psychotherapies can be cost-effective when weighed against observed reductions in recurrence, hospitalization and functional impairments. Future trials need to (i) clarify which populations are most likely to benefit from which strategies; (ii) identify putative mechanisms of action; (iii) systematically evaluate costs, benefits, and generalizability; and (iv) record adverse effects. The application of psychosocial interventions to young-onset populations deserves further study.
Major depressive disorder is frequently associated with the disruption of the natural orderliness of rhythmic physiological processes such as sleep and endocrine function. Several hypotheses have been developed to account for this disturbance in biological rhythms, associated with depressive episodes, which are briefly reviewed. We previously postulated that depression may he the result of loss of “social Zeitgebers” (i.e., persons, social demands, or tasks that set the biological clock). We have been impressed with the need for investigations into how internal as well as external social and environmental factors may disrupt the integrity of biological rhythms. We now present the concept of a “Zeitstorer” (time disturber) which is envisioned as a physical, chemical, or psychosocial event which acts as a source for circadian rhythm disruption. The development of a Zeitstorer concept has led us to a revised hypothesis of rhythm disturbance and affective disorders. It is our expectation that this hypothesis can provide descriptive models for application in the study of human psychopathology, as well as potentially new therapeutic modes of treatment. Depression 1:285–293 (1993). © 1993 Wiley-Liss, Inc.
Self-rated screening studies suggest higher prevalence rates for bipolar disorder than previously thought, but the validity of self-administered diagnostic tools has not been well established in mood-disordered patients with substance misuse.
We conducted a cross-sectional assessment of 113 English-speaking, nonintoxicated adults aged 18-69 years who were seeking treatment for mood or anxiety symptoms and substance use symptoms. (Subjects with anxiety complaints at initial presentation were included to possibly increase the pool of subjects with mood symptoms upon formal evaluation.) Subjects were consecutively evaluated from January 2010 through May 2011 at the time of voluntary admission to a private, not-for-profit psychiatric hospital. All subjects completed the Mood Disorder Questionnaire (MDQ), followed by a psychiatrist's review of their responses, using the MDQ as a semistructured interview. MDQ item and total agreements were compared for patient self-report versus clinician interview, alongside analysis of reasons for discordance. DSM-IV-TR criteria were used as the basis for diagnoses of bipolar disorder, other mood disorders, and substance use disorders.
An MDQ positive (+) status was scored more often by subjects through self-report (56%) than by the clinician after review of subjects' MDQ responses (30%) (P < .001). Patients' self-rated MDQ(+) status had high sensitivity (0.77), modest specificity (0.52), low positive predictive value (0.38), and high negative predictive value (0.86) for bipolar I or II diagnoses. MDQ item ratings having the lowest patient-clinician concordance were irritability (κ = 0.12), racing thoughts (κ = 0.15), and distractibility (κ = 0.10), while highest concordance was observed for excessive spending (κ = 0.54), increased goal-directed activity (κ = 0.59), and hypersexuality (κ = 0.77). Patient-clinician MDQ item discordance most often resulted from patients' affirmative mania symptom endorsements during past intoxication states. Logistic regressions indicated that discordant patient-clinician MDQ total scores were significantly associated with the number of lifetime substances of abuse (odds ratio = 1.43; 95% CI, 1.02-1.99) but not with any 1 particular substance.
Past or current substance misuse confounds the reliability of MDQ bipolar self-assessment screening. Clarification of MDQ self-rated responses via interview probing yields a more sensitive and specific indicator of likely bipolar diagnoses.
To determine whether a period of meditation could influence melatonin levels, two groups of meditators were tested in a repeated measures design for changes in plasma melatonin levels at midnight. Experienced meditators practising either TM-Sidhi or another internationally well known form of yoga showed significantly higher plasma melatonin levels in the period immediately following meditation compared with the same period at the same time on a control night. It is concluded that meditation, at least in the two forms studied here, can affect plasma melatonin levels. It remains to be determined whether this is achieved through decreased hepatic metabolism of the hormone or via a direct effect on pineal physiology. Either way, facilitation of higher physiological melatonin levels at appropriate times of day might be one avenue through which the claimed health promoting effects of meditation occur.
Little is known about the therapeutic or iatrogenic effects of exercise in individuals with Bipolar Disorder, despite its potential to benefit physical and mental health. Consequently the aim of the current study was to gather data on experiences of the relationship between exercise and Bipolar Disorder from people with personal experience of the condition. In particular we sought to determine the aspects of this relationship that are pertinent to Bipolar Disorder.
Twenty five individuals with a diagnosis of Bipolar Disorder participated in a semi-structured interview concerning their views on the relationship between exercise and Bipolar Disorder. The data were subjected to qualitative analysis using an Interpretative Phenomenological Analysis approach.
Both a descriptive content analysis and a population-specific thematic analysis were conducted. The latter revealed three themes, all present in the majority of participants, which reflected key aspects of the relationship between Bipolar Disorder and exercise: regulating exercise for mood regulation, exercise as a double-edged sword, and bringing structure to chaos.
Information on past and current treatment regimes was not collected, and additional lifestyle factors, such as diet and alcohol use, were not investigated. Interviews were conducted by telephone.
The data reveal a number of aspects of the relationship between exercise and Bipolar Disorder that require further investigation and that should be taken into account by clinicians or researchers designing exercise-based interventions for individuals with Bipolar Disorder.
Introduction:
Bipolar disorder (BD) is a complex mental illness that results in substantial costs, both at a personal and societal level. Research into BD has been driven by a strongly medical model conception, with a focus upon pathology and dysfunction. Little research to date has focused upon strategies used to maintain or regain wellness in BD. Here, we present results from a qualitative study of self-management strategies used by a Canadian sample of 'high-functioning' individuals with BD. The aims of the present paper are two-fold: (1) To provide a description of the self-management strategies identified as effective by this sample of high functioning individuals and 2) to explore these results from a clinical perspective.
Methods:
High functioning (determined as a score of either 1 or 2 on the objectively-rated Multidimensional Scale of Independent Functioning) individuals with BD type I or II (N = 33) completed quantitative scales to assess depression, mania, psychosocial functioning and quality of life, and underwent either an individual interview or focus group about the self-management strategies they used to maintain or regain wellness.
Results:
The specific self-management strategies that individuals enacted are contained within the following categories: (1) sleep, diet, rest and exercise; (2) ongoing monitoring; (3) reflective and meditative practices; (4) understanding BD and educating others; (5) connecting to others and (6) enacting a plan. These strategies are discussed in the context of current treatment interventions and research findings, offering clinicians a broad range of potential techniques or tools to assist with their efforts to support individuals with BD in maintaining or regaining wellness.
Conclusions:
The strategies adopted by a sample of people coping well with their BD show remarkable overlap with the targets of existing adjunctive psychosocial interventions for BD. The clinician can use this information to motivate clients to engage with such strategies. The present findings also serve to remind the clinician of significant individual differences in the personal meaning and concrete application of superficially similar strategies.
The present open study investigates the feasibility of Mindfulness-based cognitive therapy (MBCT) in groups solely composed of bipolar patients of various subtypes. MBCT has been mostly evaluated with remitted unipolar depressed patients and little is known about this treatment in bipolar disorder.
Bipolar outpatients (type I, II and NOS) were included and evaluated for depressive and hypomanic symptoms, as well as mindfulness skills before and after MBCT. Patients' expectations before the program, perceived benefit after completion and frequency of mindfulness practice were also recorded.
Of 23 included patients, 15 attended at least four MBCT sessions. Most participants reported having durably, moderately to very much benefited from the program, although mindfulness practice decreased over time. Whereas no significant increase of mindfulness skills was detected during the trial, change of mindfulness skills was significantly associated with change of depressive symptoms between pre- and post-MBCT assessments.
MBCT is feasible and well perceived among bipolar patients. Larger and randomized controlled studies are required to further evaluate its efficacy, in particular regarding depressive and (hypo)manic relapse prevention. The mediating role of mindfulness on clinical outcome needs further examination and efforts should be provided to enhance the persistence of meditation practice with time.
Individuals with osteoarthritis can experience difficulty walking and poor strength, possibly leading to falls and fractures. Exercise has been found to increase strength and bone mineral density. The purpose of this study was to determine the effects of 6 months of t'ai chi on knee muscle strength, bone mineral density, and fear of falling in older women with osteoarthritis.
Eighty-two (82) women with osteoarthritis, recruited from outpatient clinics and community health centers, were randomly assigned to either a t'ai chi group and took part in a t'ai chi program, or a control group. Of these, 30 subjects (mean age = 63 years) in the t'ai chi group and 35 (mean age = 61 years) in the control group completed post-test measures at 6 months.
After the 6-month study period, subjects in the t'ai chi program had significantly greater knee extensor endurance (pre- to post-test mean increase = 36.4 W/kg, versus 1.1 W/kg for the controls), and significantly greater bone mineral density in the neck of the proximal femur (mean change = 0.09, versus -0.10 for the controls), Ward's triangle (mean change = 0.04, versus -0.04 for the controls), and trochanter (mean change = 0.07, versus -0.05 for the controls) than the controls. However, knee extensor and flexor strength did not differ significantly between the groups. The fear of falling during daily activities reduced significantly more in the t'ai chi group (mean change = -2.40, versus 0.66 for the controls).
T'ai chi increased knee extensor muscle endurance and bone mineral density in older women with osteoarthritis, and decreased their fear of falling during daily activities. Further study with long-term follow-up is needed to substantiate the role of t'ai chi exercise in the prevention of fall and its related fracture.
The purpose of this article is to review the evidence for the efficacy of hatha yoga for depression and possible mechanisms by which yoga may have an impact on depression, and to outline directions for future research.
Literature review and synthesis.
A literature search for clinical trials examining yoga for depression uncovered eight trials: 5 including individuals with clinical depression, and 3 for individuals with elevated depression symptoms. Although results from these trials are encouraging, they should be viewed as very preliminary because the trials, as a group, suffered from substantial methodological limitations. We would argue, however, that there are several reasons to consider constructing careful research on yoga for depression. First, current strategies for treating depression are not sufficient for many individuals, and patients have several concerns about existing treatments. Yoga may be an attractive alternative to or a good way to augment current depression treatment strategies. Second, aspects of yoga-including mindfulness promotion and exercise-are thought to be "active ingredients" of other successful treatments for depression. Third, there are plausible biological, psychological, and behavioral mechanisms by which yoga may have an impact on depression. We provide suggestions for the next steps in the study of yoga as a treatment for depression.
The aim of this study was to compare the effect of a short-term intensive residential yoga program with physical exercise (control) on pain and spinal flexibility in subjects with chronic low-back pain (CLBP).
This was a wait-list, randomized controlled study.
The study was conducted at a residential integrative health center in Bangalore, South India.
Eighty (80) subjects (females, n = 37) with CLBP, who consented were randomly assigned to receive yoga or physical exercise if they satisfied the selection criteria. Intervention: The intervention consisted of a 1-week intensive residential yoga program comprised of asanas (physical postures) designed for back pain, pranayamas (breathing practices), meditation, and didactic and interactive sessions on philosophical concepts of yoga. The control group practiced physical exercises under a trained physiatrist and also had didactic and interactive sessions on lifestyle change. Both of the groups were matched for time on intervention and attention.
Pain-related outcomes were assessed by the Oswestry Disability Index (ODI) and by spinal flexibility, which was assessed using goniometer at pre and post intervention. Data were analyzed using repeated measures analysis of variance (RMANOVA).
Data conformed to a Gaussian distribution. There was a significant reduction in ODI scores in the yoga group compared to the control group (p = 0.01; effect size 1.264). Spinal flexibility measures improved significantly in both groups but the yoga group had greater improvement as compared to controls on spinal flexion (p = 0.008; effect size 0.146), spinal extension (p = 0.002; effect size 0.251), right lateral flexion (p = 0.059; effect size 0.006); and left lateral flexion (p = 0.006; effect size 0.171).
Seven (7) days of a residential intensive yoga-based lifestyle program reduced pain-related disability and improved spinal flexibility in patients with CLBP better than a physical exercise regimen.
Adverse effects of meditation were assessed in twenty-seven long term meditators (average 4.27 years) both retrospectively (time one) and prospectively at one month (time two) and six months (time three) following a meditation retreat. At both time one and time three subjects reported significantly more positive effects than negative from meditation. However, of the twenty-seven subjects, seventeen (62.9%) reported at least one adverse effect, and two (7.4%) suffered profound adverse effects. When subjects at time one were divided into three groups based on length of practice (16.7 months; 47.1 months; 105 months) there were no significant differences in adverse effects. How the data should be interpreted, and their implications both for the clinical and psychotherapeutic use of meditation as a relaxation/self-control strategy, and as a technique for facilitating personal and spiritual growth, are discussed. Limitations of the study and suggestions for future research are also offered.
A case in which prescription medications induced heat intolerance which led to heat stroke is presented. A subject who suffered from depression and was treated with fluoxetine HCL (prozac) and lithium carbonate was engaged in mild intermittent work for 4 hours under hot/dry climatic conditions (Ta = 37 degrees C, rh = 15%). The subject lost consciousness, was hyperthermic and suffered from disseminated intravascular coagulation. A year later residual cerebellar symptoms were still evident and severe atrophy of the cerebellar tissue was demonstrated in a CT scan. It is suggested that drug-induced heat intolerance was the predisposing factor that reduced the patient ability to sustain exercise-heat stress, and under the favorable environmental circumstances led to excessive heat accumulation which ultimately caused heat stroke. This is the first description, to our knowledge, of heat intolerance of a patient treated by a combination of fluoxetine and lithium carbonate.
Bipolar spectrum disorders, which include bipolar I, bipolar II, and bipolar disorder not otherwise specified, frequently go unrecognized, undiagnosed, and untreated. This report describes the validation of a new brief self-report screening instrument for bipolar spectrum disorders called the Mood Disorder Questionnaire.
A total of 198 patients attending five outpatient clinics that primarily treat patients with mood disorders completed the Mood Disorder Questionnaire. A research professional, blind to the Mood Disorder Questionnaire results, conducted a telephone research diagnostic interview by means of the bipolar module of the Structured Clinical Interview for DSM-IV.
A Mood Disorder Questionnaire screening score of 7 or more items yielded good sensitivity (0.73) and very good specificity (0.90).
The Mood Disorder Questionnaire is a useful screening instrument for bipolar spectrum disorder in a psychiatric outpatient population.
The vital capacity of the lungs is a critical component of good health. Vital capacity is an important concern for those with asthma, heart conditions, and lung ailments; those who smoke; and those who have no known lung problems.
To determine the effects of yoga postures and breathing exercises on vital capacity.
Using the Spiropet spirometer, researchers measured vital capacity. Vital capacity determinants were taken near the beginning and end of two 17-week semesters. No control group was used.
Midwestern university yoga classes taken for college credit.
A total of 287 college students, 89 men and 198 women.
Subjects were taught yoga poses, breathing techniques, and relaxation in two 50-minute class meetings for 15 weeks.
Vital capacity over time for smokers, asthmatics, and those with no known lung disease.
The study showed a statistically significant (P < .001) improvement in vital capacity across all categories over time.
It is not known whether these findings were the result of yoga poses, breathing techniques, relaxation, or other aspects of exercise in the subjects' life. The subjects' adherence to attending class was 99.96%. The large number of 287 subjects is considered to be a valid number for a study of this type. These findings are consistent with other research studies reporting the positive effect of yoga on the vital capacity of the lungs.
Ten healthy, untrained volunteers (nine females and one male), ranging in age from 18-27 years, were studied to determine the effects of hatha yoga practice on the health-related aspects of physical fitness, including muscular strength and endurance, flexibility, cardiorespiratory fitness, body composition, and pulmonary function. Subjects were required to attend a minimum of two yoga classes per week for a total of 8 weeks. Each yoga session consisted of 10 minutes of pranayamas (breath-control exercises), 15 minutes of dynamic warm-up exercises, 50 minutes of asanas (yoga postures), and 10 minutes of supine relaxation in savasana (corpse pose). The subjects were evaluated before and after the 8-week training program. Isokinetic muscular strength for elbow extension, elbow flexion, and knee extension increased by 31%, 19%, and 28% (p<0.05), respectively, whereas isometric muscular endurance for knee flexion increased 57% (p<0.01). Ankle flexibility, shoulder elevation, trunk extension, and trunk flexion increased by 13% (p<0.01), 155% (p<0.001), 188% (p<0.001), and 14% (p<0.05), respectively. Absolute and relative maximal oxygen uptake increased by 7% and 6%, respectively (p<0.01). These findings indicate that regular hatha yoga practice can elicit improvements in the health-related aspects of physical fitness. (c)2001 CHF, Inc.
During recent years, a lot of research work has been done to show the beneficial effects of yoga training. The present study was undertaken to assess the effects of yogic practice on some pulmonary functions. Sixty healthy young female subjects (age group 17-28 yrs.) were selected. They had to do the yogic practices daily for about one hour. The observations were recorded by MEDSPIROR, in the form of FVC, FEV-1 and PEFR on day-1, after 6 weeks and 12 weeks of their yogic practice. There was significant increase in FVC, FEV-1 and PEFR at the end of 12 weeks.
Bipolar (manic-depressive) disorder is a common and severe illness. It is also potentially fatal as a result of accidents and increased mortality associated with comorbid substance use and medical illnesses, but its highest lethality results from suicide. Suicide rates, averaging 0.4% per year in men and women diagnosed with bipolar disorder, are >20-fold higher than in the general population. Suicidal acts often occur early in the illness course and in association with severe depressive and dysphoric-agitated mixed phases of illness, especially following repeated, severe depressions.
Systematic consideration of risk and protective factors enhances assessment of potentially suicidal patients. Short-term interventions employed empirically to manage acute suicidality include close clinical supervision, rapid hospitalisation and use of electroconvulsive treatment. Several plausible therapeutic interventions have limited evidence of long-term effectiveness against mortality risks associated with any psychiatric disorder, including antidepressant, antimanic, antipsychotic and electroconvulsive, as well as psychosocial, treatments. However, in bipolar disorder and other major affective disorders, lithium maintenance treatment is a notable exception, with strong and consistent evidence that it reduces suicidal risk.
The growing range of drugs being introduced to treat acute and long-term phases of bipolar disorder, including antiepileptic drugs, atypical antipsychotics and relatively safe, modern antidepressants, require research assessment for their ability to limit premature mortality from suicide and other causes. For now, however, more can be done to improve treatment in major affective illnesses by application of current knowledge in a systematic fashion, with close and sustained clinical follow-up of patients at risk, hopefully with a resulting reduction of mortality rates.
Yoga has become increasingly popular in Western cultures as a means of exercise and fitness training; however, it is still depicted as trendy as evidenced by an April 2001 Time magazine cover story on "The Power of Yoga." There is a need to have yoga better recognized by the health care community as a complement to conventional medical care. Over the last 10 years, a growing number of research studies have shown that the practice of Hatha Yoga can improve strength and flexibility, and may help control such physiological variables as blood pressure, respiration and heart rate, and metabolic rate to improve overall exercise capacity. This review presents a summary of medically substantiated information about the health benefits of yoga for healthy people and for people compromised by musculoskeletal and cardiopulmonary disease.
The development of treatment guidelines emerged as an important element so as to standardize treatment and to provide clinicians with algorithms, which would be able to carry research findings to the everyday clinical practice.
The MEDLINE was searched with the combination of each one of the key words 'mania', 'manic', 'bipolar', 'manic-depression', 'manic-depressive' with 'treatment guidelines'.
The search was updated until March 1st, 2004 and returned 224 articles. Twenty-seven papers concerning the publication of treatment algorithms were traced.
Despite supposedly being evidence-based, guidelines for the treatment of bipolar disorder vary significantly across committees or working groups. Overall, however, at the first stage of the mania/hypomania algorithm, monotherapy with lithium, divalproex sodium or olanzapine is generally recommended. At latter stages combination therapy is strongly recommended. It is clearly stated that in bipolar depression antidepressants should be used only in combination with antimanic agents in order to avoid switching of phases. During the maintenance phase all patients should receive antimanic agents, while some may need the addition of antidepressants. The most recent guidelines emphasize the use of atypical antipsychotics for mania and lamotrigine for depression. The main problem with guidelines is that they are rapidly outdated and that the evidence base relies mainly on registration monotherapy trials that hardly reflect treatment in routine clinical conditions.
Treatment guidelines may be useful to avoid non-evidence-based treatment decisions, but they are quickly out-of-date and may not fully apply to the clinical setting. The more recent guidelines point the value of atypical antipsychotics, lithium, and valproate in the treatment of mania; the role of lithium, lamotrigine, and olanzapine as options for maintenance therapy; and the scarcity of options for the treatment of bipolar depression. Psychoeducation is also supported by most guidelines as an adjunctive treatment.
Bipolar disorders remain much too often unrecognized and subsequently inappropriately treated. This paper presents the translation into French and validation of the MDQ, a screening instrument for bipolar spectrum disorders, in an adult psychiatric sample. Modifications of its criteria for a positive screening as well as its test-retest reliability are also addressed.
A sample of 96 patients, attending outpatient treatment programs and suffering from mood disorders, completed the MDQ before being interviewed according to the mood module of the structured clinical interview for DSM-IV (SCID). They completed the MDQ a second time 1 month later, in order to examine its stability over time.
According to the SCID interview, 54 patients were suffering from bipolar disorder and 42 from unipolar disorder. Among the bipolar sample, the MDQ identified 74.1% of them, with higher sensitivity in bipolar I (90.3%) than bipolar II (52.4%) and 90.5% specificity. Lowering the level of impairment required for positive screening led to improved sensitivity for bipolar II patients (76.2%). The French MDQ demonstrated adequate internal consistency (Cronbach alpha=0.89). Its test-retest reliability proved to be satisfactory, with a kappa coefficient of 0.79. Similar stability over a 1-month interval was obtained for bipolar type I and type II (kappa=0.75 and 0.77, respectively).
Similarly to the American version, the French MDQ has lower sensitivity for bipolar II disorders.
The performance of the French MDQ is comparable to the one reported in the original American study conducted with a similar patient population. In a psychiatric outpatient sample, the French MDQ proves to be a feasible and reliable screening instrument.
Although bipolar affective disorder is defined by the history of manic or hypomanic episodes, depression is arguably a more important facet of the illness. Depressive episodes, on average, are more numerous and last longer than manic or hypomanic episodes, and most suicides occur during these periods. Misdiagnosis of major depressive disorder delays initiation of appropriate therapy, further worsening prognosis. Distinguishing features of bipolar depression include earlier age of onset, a family history of bipolar disorder, presence of psychotic or reverse neurovegetative features, and antidepressant-induced switching. Bipolar I depressions should initially be treated with a mood stabilizer (carbamazapine, divalproex, lamotrigine, lithium, or an atypical antipsychotic); antidepressant monotherapy is contraindicated. More severe or "breakthrough" episodes often require a concomitant antidepressant, such as bupropion or a selective serotonin reuptake inhibitor (SSRI). The first treatment specifically approved for bipolar depression is a combination of the SSRI fluoxetine and the atypical antipsychotic olanzapine. For refractory depressive episodes, venlafaxine, the monoamine oxidase inhibitor tranylcypromine, and ECT are most widely recommended. The optimal duration of maintenance antidepressant therapy has not been established empirically and, until better evidence-based guidelines are established, should be determined on a case-by-case basis.
A growing number of patients with mood disorders are using complementary and alternative medicine (CAM) interventions. In this paper, we review the published scientific evidence on the benefits and risks of CAM for the treatment of patients with bipolar disorder. Since very few studies of CAM have involved patients with bipolar disorder, most available evidence is derived from trials conducted in patients with major depressive disorder. The use of omega-3 fatty acids has been studied in two controlled studies in bipolar disorder while St. John's wort (Hypericum perforatum), S-adenosyl-l-methionine (SAMe), and acupuncture have been studied in a series of randomized controlled trials in patients with major depression. Overall, the best evidence supports the use of St. John's wort for the treatment of mild to moderate depression. SAMe may also be effective for depression. However, both of these products have the potential to induce mania; the extent of this risk needs to be quantified. St. John's wort can also interact with a variety of medications. Evidence regarding the benefits of omega-3 fatty acids or acupuncture is inconsistent. Data regarding other CAM interventions (e.g., aromatherapy massage, massage therapy, yoga) are almost entirely lacking. In conclusion, better studies are needed before CAM interventions can be recommended to patients with bipolar disorder. In the meantime, patients need to be informed about the possible risks associated with the use of these interventions.
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