ROLE OF YOGA IN GERIATRIC PSYCHIATRIC DISORDERS

Yogacharya Dr. ANANDA BALAYOGI BHAVANANI

MBBS, ADY, DPC, DSM, PGDFH, PGDY, FIAY

Programme Co-ordinator ACYTER, JIPMER, PUDUCHERRY-6

A nervous breakdown is actually an opportunity for a spiritual breakthrough if we can realise the positive implications in our moment of despair and dejection Yogamaharishi Dr Swami Gitananda Giri Guru Maharaj

Introduction
Yoga: primarily a Moksha Shastra Restores homeostatic balance Good health is a by-product of Yogic life Preventive, adjunct & restorative capabilities Yogic concept of Positive Health a unique contribution to modern healthcare

Geriatric psychiatry: mental disorders in elderly Chronic and seemingly never ending Requires care, compassion, patience & empathy

Geriatric Psychiatric Disorders

Dementia Depression Delirium Psychosis Anxiety Substance abuse Sleep disorders Cognitive impairment Behavioural disturbances

Lack of suitable physical activity & stimulation are common problems in geriatric psychiatry - Dr Karel Nespor, Czech psychiatrist (1993)

Role of Various Facets of Yoga

Wholistic approach of Yoga Bahiranga practices - physical health Antaranga practices - mental health Becoming one with the breath Shifting from individuality to universality Kriya Yoga of Maharishi Patanjali Simple Yogic techniques for elderly

Becoming One with the Breath

Synchronization of body movement and breath produces psychosomatic harmony Bhastrika strengthens solar plexus improved stamina, endurance and internal cleansing Kapalbhathi, Surya Nadi and Ujjayi - break out of depression through activation Bandha Trayam /Aswini Mudra - revitalize psychoneuro-endocrine axis & induce sense of well being Pranava and Bhramari Pranayama create inner harmony / mental calmness- inherent regenerative processes are brought into play.

Shifting from Individuality to Universality

Yoga emphasizes the Universal, wider perspective The ego only runs into the blank wall of depression and despair, overwhelmed by its own superficiality. Yoga helps us to shift from I-centric to WE-centric approach The striving spirit which looks within at the universal aspect of its own nature and sees the oneness of the whole of creation will find an endless fountain of inspiration and joy.

Wholistic Approach of Yoga

Everything is important Use of early morning sunlight Use of water for internal & external cleansing Careful attention to aspects of diet & hydration Need for balance between exertion &relaxation Yogic counseling - a working philosophy in both the face of triumph & defeat. Increased self-awareness sensitizes us to our own bio-rhythms (physical, mental and emotional cycles).

Kriya Yoga of Maharishi Patanjali

Tapa as disciplined facing of challenges Swadhyaya as introspectional self-analysis Ishwara Pranidhana as doing ones best and leaving the rest Adoption of a healthy Yogic lifestyle with cultivation of Karma, Bhakti and Raja Yoga principles in daily life helps create a sense of inner happiness. Reduces friction that tends to build up in families during the senior years.

Simple Yogic Techniques For The Elderly

Gentle stretching and strengthening practices Breath-body coordination to restore psycho-somatic harmony Gentle Hatha Yoga Kriya-s helps facilitate psychosomatic balance: Chatus Pada, Ardha Kati Chakra, Pawan Mukta, Chri, Sethu and Vyagraha Pranayama Potential activation of Thymus through- Vakra & Bharadwaja / Paryanka Asana with Hastha Mudras Brahma Mudra when done with the breath sequences and appropriate nada

 Partner Work: Betterment of physical, emotional & mental health. Helping push a bit more in forward bending, Supporting the partner in back bending, Helping improve range of joint movement and Giving isometric resistance to movement thus improving strength of the musculature.
Pranayama: important link between body, emotions and mind: Vibhaga, Pranava, Nadi Shuddhi, Bhramari & Chandra Nadi Pranayama

 Dharana and Dhyana: Brumadhya Drishti Trataka and Prana Kriya to activate Ajna Chakra Mandala & Chakra Dharana / Dhyana on Anahatha to activate Thymus and on Ajna to normalize neuroendocrine axis. Om Japa and Ajapa Japa mental calm Yoga relaxation: Shavasana with Savitri Pranayama, Spanda - Nishpanda Kriya, Kaya Kriya, Tala Kriya and Yoga Nidra The relaxed state is the state in which healing, regeneration and recuperation can occur. This state of relaxation is vital to maximize our inherent healing potential - restore normalcy at the physical, emotional and mental levels.

Studies on Yoga and Psychiatry

Yoga may be a useful to reduce stress during inpatient psychiatric treatment (Lavey R et al -2005) Yoga produced improvement in various psychophysiological parameters in geriatric population following 6 months integrated Yoga programme (NK Manjunath 2005-06) He also reported improved semantic, primary and working short term memory as well as episodic memory. Depression scores and self rated quality of sleep showed improvement Interestingly wait list control group showed deterioration in different aspects of functioning.

 Karel Nespor (1993) has suggested that gentle joint exercise and relaxation are well accepted by patients and are found to be beneficial. Yogic relaxation & meditation relieve stress, anxiety and depression. Provides a safer social network Increased self awareness & self control opposes the feeling of helplessness often found in patients of abuse these problems. Reduced use of addictive analgesics - provides a safer, non-pharmacological management of psychosomatic problems such as insomnia, headaches & general bodily pain. Yoga enables those coming out of substance abuse to overcome stress of early abstinence after the withdrawal symptoms.

 Yoga, a promising intervention for depression, cost effective & easy to implement (Shapiro D et al 2007) . Many beneficial emotional, psychological and biological effects, as supported by significant reductions in depression, anger, anxiety, neurotic symptoms and low frequency HRV with improvement in mood. 11 of 17 patients who completed the programme achieved remission levels. Studies by Sharma VK et al (2006) & Krishnamurthy MN and Telles S (2007) have shown efficacy of Yoga in managing depression. Extensive work on Sudarshan Kriya Yoga and depression at NIMHANS. SKY recommended as a potential alternative to drugs in melancholia as a first line treatment.

 Sharma VK (2006) demonstrated improvement in executive functions (information manipulation in verbal working memory & improved attention span & visuo-motor speed of depressives. Krishnamurthy MN and Telles S (2007) reported that an integrated approach of Yoga was useful for institutionalized older persons. MOA of Yoga increased GABA levels? -Streeter CC et al (2007) Streeter CC and colleagues (2010) recently also reported greater improvement in mood and anxiety with Yoga as compared to a metabolically matched walking exercise programme. This is 1st time (?) a behavioral intervention (Yoga) has been associated with +ve correlation between acute increases in thalamic GABA levels & improvement in mood & anxiety scales.

Caring For The Caregiver

Dementia caregivers spend much more time on care giving than in other illnesses. Great physical, mental, emotional and economical strain - reduced rest and recreation. Feelings of anger, resentment, guilt, and hopelessness ----- Depression Fountainhead of Yogic philosophy: Karma, Dharma, Shraddha, Veerya & Seva develops inner strength that carries both towards a better state of being. Yoga-meditation programme may be a feasible & effective intervention for family caregivers and may improve affect, coping, physical well-being, and stress management (Waelde LC 2004) .

Practical Issues in Integrating Yoga With Psychiatry

Compliance of the patients Social and family support Attitudes of the treating doctors Tendency of the patients to overexert themselves Lack of competent Yoga therapists and standard Yoga therapy protocols

Conclusion
Yoga as a way of life is a panacea for psychosomatic, stress related physical, emotional and mental disorders With the adoption of Yogic attitudes & lifestyle old age becomes a time of variety, creativity, and fulfillment. The Kriya Yoga of Maharishi Patanjali can help our Silver Citizens develop and maintain a healthy and harmonious state of being during the challenging twilight years of their life. Major challenges of dementia, depression and substance abuse can be countered with the Yogic way of right living and positive support groups

 Many who were in depressed despair before they came to Yoga have now become beacon lights to hundreds of their fellow humans A lighted lamp gives off more light when it shares itself by giving to other lamps thus enlightening the universe. So also, these harmonious human beings are spreading the Joy of Yoga all over the world and in doing so fulfilling their destiny. May we all grow old gracefully through Yoga, the mother of all sciences.