Academic journal article Indian Journal of Psychiatry

Therapeutic Efficacy of Add-On Yogasana Intervention in Stabilized Outpatient Schizophrenia: Randomized Controlled Comparison with Exercise and Waitlist

Academic journal article Indian Journal of Psychiatry

Therapeutic Efficacy of Add-On Yogasana Intervention in Stabilized Outpatient Schizophrenia: Randomized Controlled Comparison with Exercise and Waitlist

Article excerpt

Byline: Shivarama. Varambally, B. Gangadhar, Jagadisha. Thirthalli, Aarti. Jagannathan, Santosh. Kumar, G. Venkatasubramanian, D. Muralidhar, D. Subbakrishna, H. Nagendra

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


Schizophrenia affects persons in the productive age group and the majority of the affected have a chronic course. Consequently, the disorder ranks in the top ten causes of disease-related disability in the age group 15 to 44 years. [sup][1] Despite best antipsychotic medications, residual symptoms particularly in the form of negative and cognitive symptoms, produce significant disability. [sup][2] Treatment strategies, individually or in combination, are hence aimed at containing these symptoms.

Some of these include rehabilitation, behavior modification, and other psychosocial therapies, which produce variable benefits. Cognitive retraining has been shown to have salutary effects on cognition and global functioning in patients with schizophrenia. [sup][3] Yoga has emerged as an attractive add-on intervention. Cognitive benefits have been obtained with addition of Yoga in patients with schizophrenia residing in an institutional setting. [sup][4] Most patients with schizophrenia, however, can remain on outpatient follow up, though they may have residual symptoms. Duraiswamy et al. [sup][5] evaluated a yogasana regimen against comparable duration of non-yoga exercises as an add-on therapy to outpatients with schizophrenia "stabilized" on antipsychotics. Both groups of patients improved with respect to negative symptoms and social functions over four months, more so in the yogasana group. The authors concluded that yogasana and, if not available, exercise should be added to the therapy for patients with schizophrenia. However, it is not known if this benefit observed was due to the time lag alone. Therefore, the present study was designed to control for this nonspecific time-lag effect. Efficacy of add-on yogasana was compared with exercise and a waitlisted group in three groups of outpatients with schizophrenia, with the hypothesis that Yoga would be more efficacious than physical exercise, which in turn would be better than waitlist.

Materials and Methods

The study was conducted at the National Institute of Mental Health and Neurosciences, a large psychiatric hospital with both inpatient and outpatient services. …

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