Schizophrenia


About

Stress and anxiety can detach us from reality; we can lose sense of the world around us, and indeed ourselves. Suffering from schizophrenia can make the world a scary place, so grounding and reassuring routines maintain stability.

Yoga, breathing, and meditation return a scattered mind to the present moment, via the breath. They facilitate the relaxation response, which helps to filter out unnecessary stimulus from the outside world as well as reducing the misinterpretation of internal thoughts - which are key contributing factors in schizophrenia.

Clinical studies suggest that yoga is a positive add-on treatment for schizophrenia because it can reduce both hallucinations/delusions and de-motivation/social withdrawal.

The studies also show that yoga helps to counteract the side effects of antipsychotic medication, including weight gain and the associated anxiety and depressive symptoms.

Intensive periods of meditation have been found to trigger symptoms in some individuals, so care should be taken when using meditation as a treatment. Always seek the guidance of an health professional.


What the clinical studies say

Yoga
  • Can counteract facial emotion recognition deficits
  • Improves physical health and reduces incidence of cardiovascular disease which is an associated risk factor of the disease
  • Improves quality of life
  • Is more effective than regular physical exercise for symptom reduction
  • Reduces stress and anxiety
Meditation
  • Creates connection to others
  • Increases hope and purpose in life
  • Reduces the distress resulting from psychotic episodes and the experience of hospitalisation

The clinical studies

Effectiveness of yoga therapy as a complementary treatment for major psychiatric disorders: a meta-analysis
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objective:

To examine the efficacy of yoga therapy as a complementary treatment for psychiatric disorders such as schizophrenia, depression, anxiety, and posttraumatic stress disorder (PTSD).

Data Sources:

Eligible trials were identified by a literature search of PubMed/MEDLINE, Cochrane Control Trials Register, Google Scholar, and EBSCO on the basis of criteria of acceptable quality and relevance. The search was performed using the following terms: yoga for schizophrenia, yoga for depression, yoga for anxiety, yoga for PTSD, yoga therapy, yoga for psychiatric disorders, complementary treatment, and efficacy of yoga therapy. Trials both unpublished and published with no limitation placed on year of publication were included; however, the oldest article included in the final meta-analysis was published in 2000.

Study Selection:

All available randomized, controlled trials of yoga for the treatment of mental illness were reviewed, and 10 studies were eligible for inclusion. As very few randomized, controlled studies have examined yoga for mental illness, this meta-analysis includes studies with participants who were diagnosed with mental illness, as well as studies with participants who were not diagnosed with mental illness but reported symptoms of mental illness. Trials were excluded due to the following: (1) insufficient information, (2) inadequate statistical analysis, (3) yoga was not the central component of the intervention, (4) subjects were not diagnosed with or did not report experiencing symptoms of one of the psychiatric disorders of interest (ie, schizophrenia, depression, anxiety, and PTSD), (5) study was not reported in English, and (6) study did not include a control group.

Data Extraction:

Data were extracted on participant diagnosis, inclusion criteria, treatment and control groups, duration of intervention, and results (pre-post mean and standard deviations, t values, and f values). Number, age, and sex ratio of participants were also obtained when available.

Data Synthesis:

The combined analysis of all 10 studies provided a pooled effect size of −3.25 (95% CI, −5.36 to −1.14; P = .002), indicating that yoga-based interventions have a statistically significant effect as an adjunct treatment for major psychiatric disorders. Findings in support of alternative and complementary interventions may especially be an aid in the treatment of disorders for which current treatments are found to be inadequate or to carry severe liabilities.

Conclusions:

As current psychopharmacologic interventions for severe mental illness are associated with increased risk of weight gain as well as other metabolic side effects that increase patients’ risk for cardiovascular disease, yoga may be an effective, far less toxic adjunct treatment option for severe mental illness.
Citations

29
Authors

Patricia Cabral, Hilary B. Meyer, Donna Ames
Published

2011
Journal

The Primary Care Companion for CNS Disorders
Volume / Issue

13 : 4
Author's primary institution

Department of Psychology, California State University, Nothridge
Yoga in schizophrenia: a systematic review of randomised controlled trials
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objective:

The objective of this systematic review was to assess the effectiveness of yoga as a complementary treatment on general psychopathology, positive and negative symptoms and health-related quality of life (HRQL) for people with schizophrenia.

Method:

Randomised controlled trials (RCTs) were considered whether they investigated a yoga intervention in patients with schizophrenia. The selection of studies, data extraction and quality assessment were performed independently by two reviewers.

Results:

Only three RCTs met the inclusion criteria. Lower Positive and Negative Syndrome Scale (PANSS) total scores and subscale scores for positive and negative symptoms were obtained after yoga compared with exercise or waiting list control conditions. In the same way, the physical, psychological, social and environmental HRQL as measured with the abbreviated version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) increased more significantly after yoga than after exercise or waiting list control conditions. None of the RCTS encountered adverse events. Dose–response relationships could, however, not be determined.

Conclusion:

Although the number of RCTs included in this review was limited, results indicated that yoga therapy can be an useful add-on treatment to reduce general psychopathology and positive and negative symptoms. In the same way, HRQL improved in those antipsychotic-stabilised patients with schizophrenia following yoga.
Citations

4
Authors

D. Vancampfort, K. Vansteelandt, T Scheewe, M. Probst, J. Knapen, A. De Herdt, M. De Herdt
Published

2012
Journal

Acta Psychiatrica Scandinavia
Volume / Issue

126 : 1
Author's primary institution

University Psychiatric Centre Katholieke Universiteit Leuven, Campus Kortenberg, Kortenberg, Belgium
Yoga for schizophrenia: a systematic review and meta-analysis
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Background

The aim of this review was to systematically review and meta-analyze the effects of yoga on symptoms of schizophrenia, quality of life, function, and hospitalization in patients with schizophrenia.

Methods

MEDLINE/Pubmed, Scopus, the Cochrane Library, PsycInfo, and IndMED were screened through August 2012. Randomized controlled trials (RCTs) comparing yoga to usual care or non-pharmacological interventions were analyzed when they assessed symptoms or quality of life in patients with schizophrenia. Cognitive function, social function, hospitalization, and safety were defined as secondary outcomes. Risk of bias was assessed using the risk of bias tool recommended by the Cochrane Back Review Group. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.

Results

Five RCTs with a total of 337 patients were included; 2 RCTs had low risk of bias. Two RCTs compared yoga to usual care; 1 RCT compared yoga to exercise; and 2 3-arm RCTs compared yoga to usual care and exercise. No evidence was found for short-term effects of yoga compared to usual care on positive symptoms (SMD =-0.58; 95% CI -1.52 to 0.37; P=0.23), or negative symptoms (SMD=-0.59; 95% CI -1.87 to 0.69; P=0.36). Moderate evidence was found for short-term effects on quality of life compared to usual care (SMD=2.28; 95% CI 0.42 to 4.14; P=0.02). These effects were only present in studies with high risk of bias. No evidence was found for short-term effects on social function (SMD=1.20; 95% CI -0.78 to 3.18; P=0.23). Comparing yoga to exercise, no evidence was found for short-term effects on positive symptoms (SMD=-0.35; 95% CI -0.75 to 0.05; P=0.09), negative symptoms (SMD=-0.28; 95% CI -1.42 to 0.86; P=0.63), quality of life (SMD=0.17; 95% CI -0.27 to 0.61; P=0.45), or social function (SMD=0.20; 95% CI -0.27 to 0.67; P=0.41). Only 1 RCT reported adverse events.

Conclusions

This systematic review found only moderate evidence for short-term effects of yoga on quality of life. As these effects were not clearly distinguishable from bias and safety of the intervention was unclear, no recommendation can be made regarding yoga as a routine intervention for schizophrenia patients.
Citations

26
Authors

Holger Cramer, Romy Lauche, Petra Klose, Jost Langhorst, Gustav Dobos
Published

2013
Journal

BMC Psychiatry
Volume / Issue

13 : 32
Author's primary institution

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, Essen 45276, Germany
Yoga therapy as an add-on treatment in the management of patients with schizophrenia – a randomized controlled trial
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objective:

Treatment of schizophrenia has remained unsatisfactory despite the availability of antipsychotics. This study examined the efficacy of yoga therapy (YT) as an add-on treatment to the ongoing antipsychotic treatment.

Method:

Sixty-one moderately ill schizophrenia patients were randomly assigned to YT (n = 31) and physical exercise therapy (PT; n = 30) for 4 months. They were assessed at baseline and 4 months after the start of intervention, by a rater who was blind to their group status.

Results:

Forty-one subjects (YT = 21; PT = 20) were available at the end of 4 months for assessment. Subjects in the YT group had significantly less psychopathology than those in the PT group at the end of 4 months. They also had significantly greater social and occupational functioning and quality of life.

Conclusion:

Both non-pharmacological interventions contribute to reduction in symptoms, with YT having better efficacy.
Citations

169
Authors

G. Duraiswamy, J. Thirthalli, H. R. Nagendra, B. N. Gangadhar
Published

2007
Journal

Acta Psychiatrica Scandinavia
Volume / Issue

116 : 3
Author's primary institution

Department of Psychiatry, National Institute of Mental Health and NeuroSciences, Bangalore 560029, India
Loving-kindness meditation to enhance recovery from negative symptoms of schizophrenia
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

In this article, we describe the clinical applicability of loving-kindness meditation (LKM) to individuals suffering from schizophrenia-spectrum disorders with persistent negative symptoms. LKM may have potential for reducing negative symptoms such as anhedonia, avolition, and asociality while enhancing factors consistent with psychological recovery such as hope and purpose in life.

Case studies will illustrate how to conduct this group treatment with clients with negative symptoms, the potential benefits to the client, and difficulties that may arise. Although LKM requires further empirical support, it promises to be an important intervention since there are few treatments for clients afflicted with negative symptoms
Citations

78
Authors

David P. Johnson, David L. Penn, Barbara L. Fredrickson, Piper S. Meyer, Ann M. King, Mary Brantley
Published

2009
Journal

Journal of Clinical Psychology
Volume / Issue

65 : 5
Author's primary institution

University of North Carolina, Chapel Hill
Precipitation of acute psychotic episodes by intensive meditation in individuals with a history of schizophrenia
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Presents 3 case reports of persons who had psychotic episodes after engaging in intensive meditation. The cases suggest that the combination of intensive meditation, fasting, sleep deprivation, a history of schizophrenia, and the discontinuation of maintenance doses of phenothiazines can be hazardous.
Citations

80
Authors

Roger Walsh, Lorin Roche
Published

1979
Journal

The Amiercan Journal of Psychiaty
Volume / Issue

136 : 8
Author's primary institution

Effect of yoga therapy on facial emotion recognition deficits, symptoms and functioning in patients with schizophrenia
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objective:

Facial emotion recognition deficits have been consistently demonstrated in schizophrenia and can impair socio-occupational functioning in these patients. Treatments to improve these deficits in antipsychotic-stabilized patients have not been well studied. Yoga therapy has been described to improve functioning in various domains in schizophrenia; however, its effect on FERD is not known.

Method:

Antipsychotic-stabilized patients randomized to receive Yoga (n = 27), Exercise (n = 17) or Waitlist group (n = 22) were assessed at baseline, 2nd month, and 4th month of follow-up by raters blind to group status. Assessments included Positive and Negative Syndrome Scale (PANSS), Socio-Occupational Functioning Scale (SOFS), and Tool for Recognition of Emotions in Neuropsychiatric DisorderS.

Results:

There was a significant positive correlation between baseline FERD and socio-occupational functioning (r = 0.3, P = 0.01). Paired samples t test showed significant improvement in positive and negative symptoms, socio-occupational functioning and performance on TRENDS (P < 0.05) in the Yoga group, but not in the other two groups. Maximum improvement occurred at the end of 2 months, and improvement in positive and negative symptoms persisted at the end of 4 months.

Conclusion:

Yoga therapy can be a useful add-on treatment to improve psychopathology, FERD, and socio-occupational functioning in antipsychotic-stabilized patients with schizophrenia.
Citations

48
Authors

R. V. Behere, R. Arasappa, A. Jagannathan, S. Varambally, G. Venkatasubramanian, J. Thirthalli, D. K. Subbakrishna, H. R. Nagendra, B. N. Gangadhar
Published

2011
Journal

Acta Psychiatrica Scandinavia
Volume / Issue

123 : 2
Author's primary institution

Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore
Yoga therapy as an adjunctive treatment for schizophrenia: a randomized, controlled pilot study
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objectives:

There has been limited study of therapeutic yoga as a complementary treatment for schizophrenia. This study investigates the effects of a Yoga Therapy program on symptomatology and quality of life in adults with schizophrenia in a state psychiatric facility.

Methods:

In a randomized, controlled pilot study, 18 clinically stable patients (12 men and 6 women) with schizophrenia (mean age=42±13.5) were randomized to an 8-week Yoga Therapy program (YT) and a Waitlist group (WL). YT intervention included yoga postures, breathing exercises, and relaxation. At baseline and at 8 weeks, symptomatology was measured using the Positive and Negative Syndrome Scale (PANSS). Secondary efficacy outcomes were measured with the World Health Organization Quality of Life BREF questionnaire (WHOQOL-BREF).

Results:

The YT group obtained significant improvements in positive and negative symptoms of schizophrenia symptoms compared to WL, including PANSS scores on positive syndrome (t=-2.64, p=0.02), negative syndrome (t=-3.04, p<0.01), general psychopathology (t=-3.74, p<0.00), activation (t=-2.29, p<0.04), paranoia (t=-2.89, p<0.01), and depression subscales (t=-2.62, p<0.02). PANSS total scores also decreased for the YT group (t=-4.54, p<0.00). YT had improved perceived quality of life in physical (t=2.38, p<0.04) and psychologic domains (t=2.88, p<0.01).

Conclusions:

Adults with schizophrenia being treated in a state psychiatric facility who participated in an 8-week therapeutic yoga program showed significant improvements in psychopathology and quality of life compared with controls. The findings of this study need to be confirmed in larger, more sufficiently powered studies with active control groups.
Citations

37
Authors

Elizabeth Visceglia, Stephen Lewis
Published

2011
Journal

The Journal of Alternative and Complementary Medicine
Volume / Issue

17 : 7
Author's primary institution


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