FILE META ANALYSIS YOGA schizophrenia.pptx

metanalysis data

1. YOGA THERAPY SIGNIFICANTLY IMPROVES PANSS TOTAL SCORES IN SCHIZOPHRENIA A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS I KOMANG ANA MAHARDIKA ICOSPI 8-8-2024

2. INHALE… EXHALE…

3. INTRODUCTION Schizophrenia is a chronic and severe mental disorder 20 million people worldwide (1% of the global population) distortions in thinking, perception, emotions, language, sense of self, and behavior despite pharmacological treatment, 30% of patients experience significant symptoms and functional impairments Need further exploration of complementary and alternative therapies to enhance treatment outcomes

4. Yoga as an adjunctive treatment for Schizophrenia: further stabilizing symptoms and improving overall functioning improved emotional regulation, reduced anxiety, and enhanced social functioning, making it a valuable component of comprehensive schizophrenia management yoga may influence schizophrenia by modulating brain structure and function yoga can lead to increased gray matter volume in brain regions associated with emotional regulation and cognitive function, such as the hippocampus and prefrontal cortex involving meditation and breath control, can enhance neuroplasticity and improve connectivity between different brain regions increase levels of gamma-aminobutyric acid (GABA)

5. Objective systematically evaluate the effect of yoga interventions on PANSS total scores in schizophrenia patients

6. METHODS Search Strategy PRISMA guideline Searched on PubMed, Google Scholar, and Web of Science databases ("schizophrenia," "yoga," "exercise," "physical activity," "randomized controlled trial," and "PANSS.“) Time Frame 2009 - now Eligibility Criteria : PICOS criteria: Participants (P): Adults diagnosed with schizophrenia. Intervention (I): Yoga as an adjunctive treatment. Comparison (C): Control group receiving standard care or no additional intervention. Outcomes (O): Primary outcome was the change in Positive and Negative Syndrome Scale (PANSS) total scores. Study Design (S): Randomized controlled trials (RCTs).

7. METHODS Data Extraction Data extraction was performed independently by two reviewers using a pre-defined data extraction form. Extracted data included: Study characteristics: author(s), publication year, country Participant characteristics: sample size, mean age, gender distribution, duration of illness Intervention details: type, frequency, duration of yoga sessions Control group details: type of control, standard care procedures Outcome measures: PANSS total scores at baseline and follow-up, mean differences in PANSS total scores between groups, and 95% confidence intervals (CI).

8. METHODS Quality Assessment Low risk of bias: Adequate procedures and detailed reporting indicating minimal risk of bias. Unclear risk of bias: Insufficient information provided to make a clear judgment. High risk of bias: Inadequate procedures or reporting indicating a significant risk of bias. Statistical Analysis Heterogeneity  I² statistic, with I² values around 25%, 50%, and 75% representing low, moderate, and high heterogeneity. The overall effect size was determined using the Z statistic. Statistical significance was set at p < 0.05. All analyses were conducted using RevMan software (version 5.4)

9. RESULTS 143 record identified through database searching PubMed, Google Scholar, and Web of Science 72 records after duplicates removed 21 records assessed for eligibility through title and abstract 7 studies included 6 studies included In quantitative synthesis 1 full text excluded, insufficient data 14 full text excluded due to eligible criteria 51 records excluded Fig 1. PRISMA Diagram

10. Study Total Samples Intervention Groups Follow up Outcome measure Results Quality Assesment Yoga Treatment (YT) Control (Co) Ikai , 2014 50 patients weekly 1-hour session of Hatha yoga therapy Waitlist group 8 weeks Resilience Scale (RS), PANSS, BDNF, SAA PANSS Total YT > Co PANSS (+) YT>Co PANSS (-) YT=Co RS YT>Co insignificant BDNF NA SAA NA Low Risk of Bias Manjunath, 2013 88 patients yoga daily over 2 weeks (min 10 sessions) physical exercise group 6 weeks CGIS, PANSS, HDRS PANSS Total YT > Co PANSS (+) YT>Co insignificant PANSS (-) YT>Co insignificant CGI illness YT>Co HDRS YT>Co Low Risk of Bias Table 1. Descriptive of Included Study

11. Study Total Samples Intervention Groups Follow up Outcome measure Results Quality Assesment Yoga Treatment (YT) Control (Co) Patel, 2017 100 patients Yoga exercise 1 hours/session Exercise 6 weeks PANSS, HDRS, CGIS PANSS Total YT>Co PANSS Positive YT>Co PANSS Negative YT>Co CGI YT>Co Some Unclear Explanation Reddy, 2013 65 SCHZ patients Suryanamaskaras and Pranayama for 30’/day Pharmacotherapy only 4 weeks PANSS Total, Positive & Negative PANSS Total YT>Co PANSS Positive YT>Co PANSS Negatie YT>Co Low risk of bias Table 1. Descriptive of Included Study

12. Study Total Samples Intervention Groups Follow up Outcome measure Results Quality Assesment Yoga Treatment (YT) Control (Co) Varambally , 2012 120 patients Yogasana , postures and breathing patterns, 45’/session 25 sessions/month Exercise and Waitlist (TAU) 16 weeks PANSS, SOFS PANSS Total YT>Co PANSS (+) YT>Co PANSS (-) YT>Co SOFS (social occupational functioning scale) YT>Co Low Risk of Bias Visceglia , 2011 18 stable patients Yoga postures, breathing exercises, and relaxation Waitlist group 8 weeks PANSS WHOQOL-BREF PANSS Total YT > Co PANSS (+) YT>Co PANSS (-) YT>Co WHOQOL: Perceived quality of life in physical YT>Co Psychologic Domains YT>Co Unclear data risk of bias Table 1. Descriptive of Included Study

13. Table 2. Forest Plot for Main Outcome

14. Table 3. Forest Plot for Subgroup Analysis (PANSS Positive)

15. Table 4. Forest Plot for Subgroup Analysis (PANSS Negative)

16. Effects of yoga on schizophrenia symptoms using the Positive and Negative Syndrome Scale (PANSS). A meta-analysis by Vancampfort et al. (2012) reported a standardized mean difference (SMD) of -0.64 (95% CI -0.88 to -0.40) for PANSS total scores, indicating a moderate to large effect size in favor of yoga interventions compared to control conditions. Yoga has been shown to improve physical, mental, and emotional well-being through a combination of physical postures, breathing exercises, and meditation practices (Cramer et al., 2013). The significant effects observed in studies by Reddy (2013) and Visceglia (2011) demonstrate the efficacy of yoga interventions in reducing symptom severity. The high mean difference reported in Visceglia (2011) may reflect the intensive nature of the yoga intervention used in this study, highlighting the importance of intervention intensity and duration in achieving therapeutic benefits. DISCUSSION

17. The moderate heterogeneity (I² = 62%) observed in this meta-analysis suggests that there is some variability in the effect sizes across the included studies. This heterogeneity could be attributed to differences in study designs, intervention protocols, participant characteristics, and outcome measures. For instance, variations in the type and frequency of yoga practices, as well as the duration of the interventions, may contribute to differences in treatment efficacy. DISCUSSION

18. LIMITATION Variation in sample sizes, intervention protocols, and control conditions Incomplete data on participant characteristics, intervention details, or outcome measures The moderate heterogeneity observed suggests that other unmeasured factors may influence the treatment effects DISCUSSION

19. Strong evidence for the efficacy of yoga interventions in reducing psychiatric symptoms as measured by PANSS scores (Total, Positive and Negative) CONCLUSION

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