Beruflich Dokumente
Kultur Dokumente
UNDER
(SATYAM)
Project Title:
electrophysiological study
Dr.Rashmi Arsappa
Dr.V.Judu Iavarasu
Dr.Pradeep Y
SECTION – A (GENERAL INFORMATION)
1 Project Title Effect of Bhramari Pranayama in patients with auditory hallucination- An
electrophysiological study
2 Sub Area Basic & Applied Research
3 Duration in 36 months
months
4 Total cost 30,32,000/- (Thirty lacs and thirty two thousand only)
5 Project Basic Research
Category Applied Research
6 Principal Designation : Speech therapist
Investigator Department : Speech pathology and Audiology
(P.I) Institute name : National Institute of Mental Health and Neurosciences
(NIMHANS)
Address : OPD Block, Hosur Road
Telephone : 9945033757; 080-26995568; E-mail: raravindk@gmail.com
Date of birth: 24.08.1980; Sex: Male
7 Name: Dr. B.K.Yamini
Designation: Associate Professor
Department: Speech pathology and Audiology
1 Institute name NIMHANS
Address: Hosur Road, Bangalore, Pin: 560 029
Telephone: 9980229280; E-mail:yamhari@yahoo.com
Date of birth: 15.05.1968 Sex: Female
Name: Dr.Rashmi Arsappa
Designation: Asisstant .Professor
Department: Psychiatry
2 Institute name: NIMHANS
Address: Hosur Road, Bangalore, Pin: 560 029
Co-PIs Telephone: 9916386006 ; E-mail: rashmia07@gmail.com
Date of birth: 08.07.1979 Sex: Female
Name: Dr.V.Judu Iavarasu
Designation: Assistant Professor
Department: Division of Yoga and Physical Sciences
Institute: Swami Vivekananda Yoga AnusandhanaSamsthana
3 name (S-VYASA)
Address: 19, EknathBhavan, Gavipuram Circle, K.G. Nagar,
Bangalore. Pin: 560 019
Telephone: 9035730812; E-mail:judu@svyasa.edu.in
Date of birth: 03.10.1983 Sex: Male
4 Name: Dr.Pradeep Y
Designation: Speech therapist
Department: Speech pathology and Audiology
Institute name: NIMHANS
Address: Hosur Road, Bangalore, Pin: 560 029
Telephone: 9886143995 E-mail:pradaud@gmail.com
Date of birth 19.12.1983 Sex: Male
1. Project Title :Effect of Bhramari Pranayama in patients with auditory hallucination- An
electrophysiological study
The current research study proposes to investigate the effect of Bhramari Pranayama (BhPr) in
measures. The studies have documented an increase in brain activity in theta range following
Br.P. At the same time, studies have documented theta wave dysfunctions in subjects with
measure is primarily composed of theta oscillations and is arobust biomarker in the disease
(Bohlken et al., 2017). Thus MMN is a strong tool to study AVH. Auditory N100 (N1); yet
another auditory physiological measure reflect the arrival of auditory stimuli to the temporal
lobe and represent the basic auditory processing at the sensory level. Studies have reported N1
thereby producing a resonant sound, similar to that heard during the hovering of a bumblebee.
The advantage of BhPr is that it involves a bottom-up mechanism and has an exclusive focus
to ‘auditory perception’, which is the primary problem in AVH. Studies have shown that BhPr
betters auditory sensation (Prasad et al., 2007), improves response inhibition (Rajesh et al.,
2014), improves mental health scores (Srivastava et al., 2017) and enhances
cognitive/executive faculties all of which, have an overall positive impact on health (Rajesh et
al., 2014). Interestingly Bh.Pris also found to cause synchronous brain activity (Vialatte et al.,
2009).
Thus, the current research proposes to study the possible effect of BhPr training on auditory
3. Key words: Auditory verbal hallucination, Bhramari pranayama, Mismatch negativity, N100.
4. Introduction:
condition, in which, the person perceivesspeech in the absence of any real stimuli. These
patients are found to have dysfunctional theta activity, poor fronto-temporal connectivity,
cognitive dysfunction and failure to recognise internal events. The basis and the
extensively used in studying this patient group. These measures are; P50 reflecting early
filtering mechanism, N100 (N1) reflecting the early processing at the temporal lobe and
an overt production of ‘humming’ sound like that of a bumble bee. Bhramari Pranayama is
patients with AVH. Further, the effect of Bhramari Pranayama on these patients can be
MMN. Medical intervention is the basic treatment modality in this patient group.
Bhramari pranayama, which involves overt self-production of humming sound (auditory
modality), may have a therapeutic impact in patients with AVH, as the basic dysfunction
c. Objectives:
(i) To study the effect of Bhramari Pranayama (BhPr) in patients with AVH using
(ii) To study the effect of BhPr in normal controls using electrophysiological test measure
(iii) To compare the effects observed (effect of BhPr) between patients with AVH and the
normal controls.
d. Hypothesis:
a. International status:
(Bohlken et al., 2017). These patients are found to possess basic auditory processing
disorder, brain oscillatory dysfunctions and abnormal corollary discharges, which many a
time found to correlate with the clinical presentation of auditory hallucination. Especially,
task related theta activity is found to be dysfunctional in patients with AVH (Van
schizophrenic patients with auditory hallucinations (n=23) and compared it with the
controls (n=23). They reported significantly lower Theta power at the frontal and the
predictive value of 85% for Schizophrenia onset (Bodatsch et al. 2011). MMN is
can effectively monitor treatment response (Higuchi et al., 2010). It is observed that the
presence of AVH as the main contributor to the observed deficits on MMN (Fisher DJ et
al., 2012). These authors performed a multi-feature MMN (duration, frequency, gap,
intensity and location deviants) in patients with AVH and reported reduced MMN
amplitude. Further, they reported that the gap MMN amplitudes correlated with measures
of hallucinatory state and frequency of AHs, while location MMN was correlated with
perceived location of AHs. Similarly strong co-correlation is also observed for N100
potential. Patients with auditory hallucination exhibit reduced N100 suppression, which is
et al., 2007). Intervention of AVH is basically medical management. Yoga has recently
induce neuronal network plasticity (Xue SW, 2014). Yoga had positive impacts on
reducing stress, anxiety and symptoms as well as enhancing social and occupational
functioning and quality of life (Tsui, CMM, 2012). Bhramari pranayama is found to
b. National status:
Studies have demonstrated that Yoga as an effective add-on therapy in patients with
Schizophrenia (Behere & Gangadhar., 2011; Bangalore, N. G., & Varambally, S., 2012;
Dodell-Feder et al., 2017; Varambally, S., & Gangadhar, B. N., 2012; Mehta et al., 2016).
Yoga Anusandhana Samsthana, (SVYASA) based on Panchakosha model, it was found that
Yoga reduced the negative syndromes and social dysfunction in patients with Schizophrenia
(Bangalore, N. G., & Varambally, S., 2012). Recently a yoga module has been developed
for schizophrenia (Govindaraj et al., 2016). In a review, Mehta & Gangadhar (2016) opined
that meditation involves a series of cognitive practices that may yield many improvements
and benefit in treating schizophrenia. However they opined that it is safe to avoid it in
c. Relevant references:
Bangalore, N. G., & Varambally, S. (2012). Yoga therapy for Schizophrenia. International
Journal of Yoga, 5(2), 85–91.
Behere, R. V., Arasappa, R., Jagannathan, A., Varambally, S., Venkatasubramanian, G.,
Thirthalli, J., Gangadhar, B. N. (2011). Effect of yoga therapy on facial emotion recognition
deficits, symptoms and functioning in patients with schizophrenia. Acta Psychiatrica
Scandinavica, 123(2), 147–153.
Bodatsch, M., Ruhrmann, S., Wagner, M., Mller, R., Schultze-Lutter, F., Frommann, I.,
Brockhaus-Dumke, A. (2011). Prediction of psychosis by mismatch negativity. Biological
Psychiatry, 69(10), 959–966.
Bohlken, M. M., Hugdahl, K., & Sommer, I. E. C. (2017). Auditory verbal hallucinations:
neuroimaging and treatment. Psychological Medicine, 47(2), 199–208.
Dodell-Feder, D., Gates, A., Anthony, D., & Agarkar, S. (2017). Yoga for Schizophrenia: a
Review of Efficacy and Neurobiology. Current Behavioral Neuroscience Reports, 4(3), 209-
220.
Erickson, M. A., Ruffle, A., & Gold, J. M. (2016). A Meta-Analysis of Mismatch Negativity
in Schizophrenia: From Clinical Risk to Disease Specificity and Progression. Biological
Psychiatry, 79(12), 980–987.
Fisher, D. J., Labelle, A., & Knott, V. J. (2012). Alterations of mismatch negativity (MMN)
in schizophrenia patients with auditory hallucinations experiencing acute exacerbation of
illness. Schizophrenia Research, 139(1–3), 237–245.
Heinks-Maldonado, T. H., Mathalon, D. H., Houde, J. F., Gray, M., Faustman, W. O., &
Ford, J. M. (2007). Relationship of imprecise corollary discharge in schizophrenia to auditory
hallucinations. Archives of General Psychiatry, 64, 286–296.
Higuchi Y., Sumiyoshi T., Kawasaki Y., Ito T., Seo T., Suzuki M. (2010). Effect of
tandospirone on mismatch negativity and cognitive performance in schizophrenia: a case
report. Journal of Clinical Psychopharmacology, 30(6), 732–734.
Lee, M., Sehatpour, P., Hoptman, M. J., Lakatos, P., Dias, E. C., Kantrowitz, J. T., Javitt, D.
C. (2017). Neural mechanisms of mismatch negativity dysfunction in schizophrenia.
Molecular Psychiatry.
Tsui, C. M. M. (2012). Review of the Effects of Yoga on People with Schizophrenia. Yoga
and Physical Therapy.
Mehta, U. M., Keshavan, M. S., & Gangadhar, B. N. (2016). Bridging the schism of
schizophrenia through yoga—Review of putative mechanisms. International Review of
Psychiatry.
Prasad, R., & Matsuno, F. (2007). Hummgenic changes in large scale temporal correlation of
EEG in BP. In Proceedings of the SICE Annual Conference (pp. 2068–2073).
Rajesh, S., Ilavarasu, J., & Srinivasan, T. (2014). Effect of Bhramari Pranayama on response
inhibition: Evidence from the stop signal task. International Journal of Yoga, 7(2), 138.
Srivastava S., Goyal P., Tiwari S.K., Patel A.K. (2017). Interventional Effect of Bhramari
Pranayama on Mental Health among college Students. The International Journal of Indian
Psychology, 4(2), 29-33.
van Lutterveld, R., Hillebrand, A., Diederen, K. M. J., Daalman, K., Kahn, R. S., Stam, C. J.,
& Sommer, I. E. C. (2012). Oscillatory cortical network involved in auditory verbal
hallucinations in schizophrenia. PloS One, 7(7), e41149.
Varambally, S., Thirthalli, J., Venkatasubramanian, G., Subbakrishna, D., Gangadhar, B.,
Jagannathan, A., Nagendra, H. (2012). Therapeutic efficacy of add-on yogasana intervention
in stabilized outpatient schizophrenia: Randomized controlled comparison with exercise and
waitlist. Indian Journal of Psychiatry, 54(3), 227.
Vialatte, F. B., Bakardjian, H., Prasad, R., & Cichocki, A. (2009). EEG paroxysmal gamma
waves during Bhramari Pranayama: A yoga breathing technique. Consciousness and
Cognition, 18(4), 977–988.
Xue, S. W., Tang, Y. Y., Tang, R., & Posner, M. I. (2014). Short-term meditation induces
changes in brain resting EEG theta networks. Brain and Cognition, 87(1), 1–6.
Zheng, L., Chai, H., Yu, S., Xu, Y., Chen, W., & Wang, W. (2015). EEG theta power and
coherence to octave illusion in first-episode paranoid schizophrenia with auditory
hallucinations. Psychopathology, 48(1), 36–46.
d. Importance of the proposed project in the context of current status:
Intervention of patients with AVH is challenging. Bh.P. is found to have a positive impact
on overall health and has necessary features to contribute in the therapeutic dimension.
However, to our knowledge there is a dearth of scientific studies with reference to Bh.Pr
and AVH both nationally and internationally. Hence, it is justified to explore this arena.
Investigator and the co-investigators together bring about a good clinical and research
experience in the field of auditory processing disorders, Schizophrenia and Yoga. National
along with regular clinical work on Schizophrenia also runs a special clinic towards it.
Further, a special Yoga program is being conducted for these patients in the Yoga Centre
NIMHANS and S-VYASA, a premium Institute on Yoga. The labs are equipped with
6. Work plan:
a. Methodology:
ii. Subjects:
In the proposed study, patients with AVH (N=33) would constitute the patient group
and an age and gender matched normal controls (N=33) would constitute the control
group. The sample size was calculated based on the effect size reported in the previous
literature (Kim et al., 2017). As we anticipate that after Bhramari Pranayama the MMN
peak amplitude will increase (like that of healthy participants), we have chosen the
reported Fz electrode MMN peak amplitude for sample size calculation. The effect size
(Cohen’s d) calculated was 0.76. We fixed alpha at 0.05, power 0.80, and two tailed
condition, and derived the required sample size of 28 per group. We propose to take a
both the groups would be recruited after they satisfy the inclusion and the exclusion
criteria (given below). Both the groups would undergo base-line auditory measures and
Inclusion criteria:
Both males and females between the age range of 18 to 50 years (including the
mentioned age).
audiometry
Suitable for yoga practice either in-patient or out-patient [applicable only for the
patient group]
Subjects with severe physical ailments like recent and decompensated myocardial
infarction, fracture, uncontrolled seizure disorders, as well as, those with intellectual
disability.
for the scale taps general symptom indices of frequency, duration, severity
Andreasen and was first published in 1984. SAPS is split into 4 domains
thought disorder and within each domain separate symptoms are rated
for MMN and for N100 it would be a constant stimuli presentation. Both tests
humming, thereby producing a resonant sound, similar to that heard during the
order to enhance the internalization effect. Training and a practice session would
be given before the pre-test session, after which the electrophysiological test would
be carried out. Subjects would be instructed to perform the BhPr practice as per
their ability. Further, measures would be taken to have the subject’s hand
supported to avoid pain and discomfort while adopting Shanmukhi mudra during
v. Steps to be followed: Patients with AVH after satisfying the inclusion and the
exclusion criteria, which also would include consent to participate in the study
would be done as the first step. Following which, the subjects would be asked to
perform BhPr for 10 minutes (pre-test session). Prior to this, pre-test session
training and a practice session would precede it. Baseline electrophysiological test,
BhPr practice and the post- BhPr electrophysiological test would be done on the
same day at the same sitting. However, enough inter session rest periods would be
provided to the subjects and also between the 10 minutes pre test session, to make
Electrophysiological evaluation
N100 & MMN
(Baseline- Pre Bhramari Pranayama)
Training session
Pre-test session
(10 minutes)
Electrophysiological evaluation
N100 & MMN
(Post Bhramari Pranayama)
tests
The activities would be carried out in a phased manner within stipulated time (see figure
given below). A regular report on the status of the research work would be
communicated.
Data collection
Pilot study
Test stanardisation
Recruitment of SRF
0 6
0.2 12
0.4 18
0.6 24
0.8 30
1 361.2
Months
d. Suggested plan of action for utilization of research outcome expected from the
project:
The research outcome can be further expanded to study the effect on exclusive patient
subgroups with different degree of dysfunctions. Further research can focus on studying
the impact of BhPr using default mode network analysis, connectivity analysis, PET study
AVH. Further, the information will also be disseminated through conference presentations
8. List of facilities being extended by parent institution(s) for the project implementation.
a.Infrastructural Facilities:
Sr. No Infra Yes/No/Not required
Full or sharing basis
1 Workshop Facility Yes
2 Water & Electricity Yes
3 Laboratory Space/ Furniture Yes
4 Power Generator Yes
5 AC Room or AC Yes
6 Telecommunication including e- Yes
mail & fax
7 Transportation Yes
8 Administrative/ Secretarial support Yes
9 Information facilities like Internet/ Yes
Library
10 Computational facilities Yes
11 Animal/ Glass House Not required
12 Any other special facility being NIMHANS runs special clinics for multiple
provided Psychiatric conditions. It has an integrated
Yoga centre working on many clinical
populations.
b. Equipment available with the Institute/ Group/ Department/ Other Institutes for
the project
Equipment available Generic Name of Model, Make & Remarks including
with Equipment year of purchase accessories available
and current usage of
equipment
PI & his group 64 channel EEG/ERP NeurOne, Finland, Equipment is currently
system 2012 been used for research
PI's Department purpose and accessories
required are available
Other Inst In the - -
region
FINAL (Approved by Secretary DST)
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