1 422 128 BRIDGING THE SCHISM OF SCHIZOPHRENIA THROUGH YOGA-REVIEW OF PUTATIVE MECHANISMS. SCHIZOPHRENIA PATIENTS EXPERIENCE A 'DISCONNECT' AT MULTIPLE LEVELS-NEURONAL NETWORKS, MENTAL PROCESSES, AND INTERPERSONAL RELATIONSHIPS. THE RESULTANT POOR QUALITY-OF-LIFE AND FUNCTIONAL DISABILITY ARE RELATED TO THE PERSISTENT COGNITIVE DEFICITS AND NEGATIVE SYMPTOMS, WHICH ARE RATHER RESISTANT TO CONVENTIONAL ANTIPSYCHOTIC MEDICATIONS. YOGA HAS EMERGED AS AN IMPORTANT THERAPEUTIC INTERVENTION TO IMPROVE QUALITY-OF-LIFE IN SCHIZOPHRENIA. RECENT PRELIMINARY EVIDENCE SUGGESTS THAT EFFECTS OF YOGA ON COGNITIVE AND NEGATIVE SYMPTOMS MAY DRIVE THIS BENEFIT. THIS STUDY ATTEMPTS TO INTEGRATE EVIDENCE FROM NEUROSCIENCE-BASED RESEARCH, WHICH FOCUSES ON THE NEUROPLASTICITY-HARNESSING EFFECTS OF YOGA TO BRIDGE THE SCHIZOPHRENIA CONNECTOPATHY. IN AN OVERARCHING MODEL TO STUDY PUTATIVE NEUROBIOLOGICAL MECHANISMS THAT DRIVE THERAPEUTIC EFFECTS OF YOGA, IT IS PROPOSED THAT (A) VARIOUS STYLES OF MEDITATION MAY HELP IN STRENGTHENING THE LATERAL AND MEDIAL PREFRONTAL BRAIN NETWORKS, THUS IMPROVING NEUROCOGNITION AND MENTALIZING ABILITIES, AND (B) LEARNING AND PERFORMING CO-ORDINATED PHYSICAL POSTURES WITH A TEACHER FACILITATES IMITATION AND THE PROCESS OF BEING IMITATED, WHICH CAN IMPROVE SOCIAL COGNITION AND EMPATHY THROUGH REINFORCEMENT OF THE PREMOTOR AND PARIETAL MIRROR NEURON SYSTEM. OXYTOCIN MAY PLAY A ROLE IN MEDIATING THESE PROCESSES, LEADING TO BETTER SOCIAL CONNECTEDNESS AND SOCIAL OUTCOMES. CLINICAL AND HEURISTIC IMPLICATIONS OF THIS MODEL ARE FURTHER DISCUSSED. 2016 2 2486 31 YOGA AS AN INTEGRATIVE APPROACH FOR PREVENTION AND TREATMENT OF ORAL CANCER. DESPITE TREMENDOUS ADVANCEMENTS IN MEDICINE, THE NUMBER OF ORAL CANCER CASES CONTINUES TO INCREASE, AND THE NEED FOR INTEGRATING ALTERNATE MEDICINE OR ADOPTING AN INTEGRATIVE APPROACH HAS BECOME A COMPELLING COST-EFFECTIVE REQUIREMENT FOR THE MANAGEMENT AND TREATMENT OF DISEASES. CONVENTIONAL TREATMENT OF ORAL CANCER INVOLVES SURGERY FOLLOWED BY RADIOTHERAPY WITH OR WITHOUT CHEMOTHERAPY WHICH CAUSES SEVERAL COMPLICATIONS INCLUDING POOR QUALITY OF LIFE AND HIGH CHANCES OF RECURRENCE OF CANCER. ORAL CANCER IS OFTEN LINKED WITH OBESITY WHICH IS MAJOR RISK FACTORS IN OTHER CANCERS. APART FROM OBESITY, ORAL CANCER IS THOUGHT TO HAVE AN INVERSE RELATION WITH NEURODEGENERATIVE DISORDERS PRESUMABLY BECAUSE CELL DEATH DECREASES IN THE FORMER CASE AND INCREASES IN THE LATTER. ANCIENT MIND-BODY TECHNIQUES SUCH AS YOGA HAVE NOT BEEN ADEQUATELY TESTED AS A TOOL TO SYNERGIZE THE CELLULAR EQUILIBRIUM PERTAINING TO THE TREATMENT OF ORAL CANCER. NERVE GROWTH FACTOR (NGF), TUMOR NECROSIS FACTOR-ALPHA (TNF-ALPHA), AND INTERLEUKIN-6 (IL-6) ARE AMONG THE EARLY EXPERIMENTAL CELLULAR BIOMARKERS THAT MAY BE USED TO PROBE THE MODULATION OF ORAL CANCER, OBESITY, AND NEURODEGENERATIVE DISORDERS. YOGA HAS BEEN REPORTED TO INFLUENCE THESE MOLECULES IN HEALTHY INDIVIDUALS BUT WHETHER THEIR EXPRESSION CAN BE ALTERED IN PATIENTS OF ORAL CANCER BY YOGA INTERVENTION IS THE SUBJECT OF THIS RESEARCH BEING DISCUSSED IN THIS REVIEW ARTICLE. THEREFORE, THE PRESENT ARTICLE NOT ONLY REVIEWS THE CURRENT STATUS OF RESEARCH STUDIES IN ORAL CANCER, OBESITY, AND NEURODEGENERATIVE DISORDERS BUT ALSO HOW THESE ARE LINKED TO EACH OTHER AND WHY THE INVESTIGATIONS OF THE PUTATIVE NGF PATHWAY, INVOLVING TNF-ALPHA AND IL-6, COULD PROVIDE USEFUL CLUES TO UNDERSTAND THE MOLECULAR EFFECTS BROUGHT ABOUT BY YOGA INTERVENTION IN SUCH PATIENTS. 2018 3 1343 27 HOW YOGA IMPACTS THE SUBSTANCE USE OF PEOPLE LIVING WITH HIV WHO ARE IN REENTRY FROM PRISON OR JAIL: A QUALITATIVE STUDY. OBJECTIVES: NASCENT RESEARCH REFLECTS THE PROMISE OF YOGA AS A COMPLEMENTARY TREATMENT FOR SUBSTANCE USE. WHILE PUTATIVE MECHANISMS BEHIND YOGA'S IMPACT ON SUBSTANCE USE HAVE BEEN PROPOSED, THE RESEARCH IS LIMITED. THIS MANUSCRIPT AIMS TO DETERMINE HOW A HATHA YOGA INTERVENTION IMPACTS THE SUBSTANCE USE OF PEOPLE WHO ARE IN REENTRY FROM PRISON OR JAIL (RETURNING CITIZENS), AND LIVING WITH HIV AND SUBSTANCE USE PROBLEMS. DESIGN: SEMI-STRUCTURED INTERVIEWS WERE CONDUCTED WITH 28 RETURNING CITIZENS WHO PARTICIPATED IN A YOGA INTERVENTION. GUIDED BY A QUALITATIVE DESCRIPTIVE METHODOLOGY, THEMATIC ANALYSIS WAS USED TO IDENTIFY THEMES THAT ANSWERED HOW YOGA IMPACTED PARTICIPANT SUBSTANCE USE. SETTING: A COMMUNITY ORGANIZATION IN PHILADELPHIA, PA, USA THAT CONNECTS PEOPLE TO HEALTH SERVICES, PROVIDES EDUCATION AND SUPPORTIVE SERVICES, AND ADVOCATES FOR PEOPLE WITH CRIMINAL JUSTICE INVOLVEMENT. INTERVENTION: A 90-MINUTE HATHA YOGA CLASS OFFERED ONCE A WEEK FOR 12 WEEKS. RESULTS: FOURTEEN PARTICIPANTS REPORTED THAT YOGA EITHER REDUCED SUBSTANCE USE OR MAINTAINED NON-USE, VIA THE MECHANISMS OF PURPOSEFUL DISTRACTION, STRESS COPING (BY CULTIVATING MINDFULNESS AND REDUCING PHYSICAL DISCOMFORT), SOCIAL SUPPORT AND CONFIDENCE. ELEVEN PARTICIPANTS REPORTED THAT YOGA DID NOT IMPACT THEIR SUBSTANCE USE. THREE PARTICIPANTS DID NOT DISCUSS IT. CONCLUSIONS: BY PROVIDING PURPOSEFUL DISTRACTION, INCREASED STRESS COPING, SOCIAL SUPPORT AND CONFIDENCE; YOGA MAY REDUCE SUBSTANCE USE AND MAINTAIN ENGAGEMENT IN RECOVERY. THESE MECHANISTIC ACTIONS PROVIDE GUIDANCE FOR THEMES TO HIGHLIGHT IN YOGA CLASSES THAT AIM TO IMPACT SUBSTANCE USE AMONG RETURNING CITIZENS LIVING WITH HIV. 2019 4 349 28 ASSESSING THE EFFECTIVENESS OF YOGA AS A COMPLEMENTARY AND ALTERNATIVE TREATMENT FOR POST-TRAUMATIC STRESS DISORDER: A REVIEW AND SYNTHESIS. OBJECTIVES: POSTTRAUMATIC STRESS DISORDER (PTSD) IS A DEBILITATING CONDITION THAT AFFECTS MANY WHO HAVE EXPERIENCED TRAUMA. IN ADDITION TO SKILLS-FOCUSED TREATMENTS, EXPOSURE-BASED TREATMENTS, COGNITIVE THERAPY, COMBINATION TREATMENTS, AND EMDR, A NUMBER OF ALTERNATIVE TREATMENTS FOR PTSD HAVE EMERGED IN RECENT YEARS. THE SEARCH FOR ALTERNATIVE TREATMENTS IS JUSTIFIED BASED ON THE EMPIRICAL OBSERVATION THAT A LARGE PERCENTAGE OF INDIVIDUALS FAIL TO BENEFIT OPTIMALLY FROM EXISTING TREATMENTS (E.G., BETWEEN 30 AND 60). MOREOVER, CURRENT STUDIES OFTEN UTILIZE STRINGENT INCLUSION CRITERIA (E.G., ABSENCE OF COMORBID DISORDERS), RAISING THE LIKELIHOOD THAT RESULTS WILL NOT GENERALIZE TO MANY INDIVIDUALS CURRENTLY EXPERIENCING PTSD. THE PRIMARY OBJECTIVE OF THE CURRENT PAPER WAS TO EXPLORE THE EFFECTS OF ONE TYPE OF ALTERNATIVE TREATMENT: YOGA. DESIGN: A COMPREHENSIVE REVIEW OF THE LITERATURE WAS CONDUCTED TARGETING RESEARCH EXAMINING YOGA POSTURES AND PTSD. SEVEN RANDOMIZED CONTROLLED TRIALS (RCTS) WERE IDENTIFIED AND REVIEWED, AND EFFECT SIZES WERE COMPUTED FOR THE POST-TEST ASSESSMENTS. RESULTS: COHEN'S D FOR EACH STUDY RANGED (IN ABSOLUTE VALUE) FROM A LOW OF -0.06 TO A HIGH OF 1.42 (AVERAGE WEIGHTED D ACROSS STUDIES WAS 0.48; 95% CI: 0.26, 0.69). CONCLUSIONS: PUTATIVE MECHANISMS OF ACTION FOR THE POSSIBLE BENEFICIAL EFFECTS OF YOGA FOR PTSD-RELATED SYMPTOMATOLOGY AND CLINICAL IMPLICATIONS ARE DISCUSSED. 2017 5 2575 28 YOGA FOR FUNCTIONAL ABILITY, PAIN AND PSYCHOSOCIAL OUTCOMES IN MUSCULOSKELETAL CONDITIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS. OBJECTIVES: MUSCULOSKELETAL CONDITIONS (MSCS) ARE THE LEADING CAUSE OF DISABILITY AND CHRONIC PAIN IN THE DEVELOPED WORLD, IMPACTING BOTH FUNCTIONAL ABILITY AND PSYCHOSOCIAL HEALTH. THE CURRENT REVIEW INVESTIGATES THE EFFECTIVENESS OF YOGA ON PRIMARY OUTCOMES OF FUNCTIONAL ABILITY, PAIN AND PSYCHOSOCIAL OUTCOMES ACROSS A RANGE OF MSCS. METHODS: A COMPREHENSIVE SEARCH OF 20 DATABASES WAS CONDUCTED FOR FULL-TEXT, RANDOMIZED CONTROLLED TRIALS OF YOGA IN CLINICALLY DIAGNOSED MSCS. RESULT: SEVENTEEN STUDIES MET THE INCLUSION CRITERIA, INVOLVING 1,626 PARTICIPANTS WITH LOW BACK PAIN (LBP), OSTEOARTHRITIS (OA), RHEUMATOID ARTHRITIS (RA), KYPHOSIS OR FIBROMYALGIA. STUDIES WERE QUALITY RATED, AND ANALYSED FOR THE EFFECT OF YOGA ON PRIMARY OUTCOMES, IMMEDIATELY POST-INTERVENTION. TWELVE STUDIES WERE RATED AS GOOD QUALITY. YOGA INTERVENTIONS RESULTED IN A CLINICALLY SIGNIFICANT IMPROVEMENT IN FUNCTIONAL OUTCOMES IN MILD-TO-MODERATE LBP AND FIBROMYALGIA, AND SHOWED A TREND TO IMPROVEMENT IN KYPHOSIS. YOGA SIGNIFICANTLY IMPROVED PAIN IN OA, RA AND MILD-TO-SEVERE LBP. PSYCHOSOCIAL OUTCOMES WERE SIGNIFICANTLY IMPROVED IN MILD-TO-MODERATE LBP AND OA. META-ANALYSIS OF GOOD-QUALITY STUDIES SHOWED A MODERATE TREATMENT EFFECT FOR YOGA OF -0.64 (95%CI -0.89 TO -0.39) FOR FUNCTIONAL OUTCOMES AND -0.61 (95%CI -0.97 TO -0.26) FOR PAIN OUTCOMES. CONCLUSIONS: EVIDENCE SUGGESTS THAT YOGA IS AN ACCEPTABLE AND SAFE INTERVENTION, WHICH MAY RESULT IN CLINICALLY RELEVANT IMPROVEMENTS IN PAIN AND FUNCTIONAL OUTCOMES ASSOCIATED WITH A RANGE OF MSCS. FUTURE ANALYSIS OF OUTCOMES WHICH TAKE INTO ACCOUNT THE AMOUNT OF YOGA RECEIVED BY PARTICIPANTS MAY PROVIDE INSIGHT INTO ANY PUTATIVE DURATION OR DOSAGE EFFECTS OF YOGA INTERVENTIONS FOR MSCS. 2013 6 76 31 A HEURISTIC MODEL LINKING YOGA PHILOSOPHY AND SELF-REFLECTION TO EXAMINE UNDERLYING MECHANISMS OF ADD-ON YOGA TREATMENT IN SCHIZOPHRENIA. PRELIMINARY EVIDENCE SUGGESTS EFFICACY OF YOGA AS ADD-ON TREATMENT FOR SCHIZOPHRENIA, BUT THE UNDERLYING MECHANISM BY WHICH YOGA IMPROVES THE SYMPTOMS OF SCHIZOPHRENIA IS NOT COMPLETELY UNDERSTOOD. YOGA IMPROVES SELF-REFLECTION IN HEALTHY INDIVIDUALS, AND SELF-REFLECTION ABNORMALITIES ARE TYPICALLY SEEN IN SCHIZOPHRENIA. HOWEVER, WHETHER YOGA TREATMENT IMPROVES IMPAIRMENTS IN SELF-REFLECTION TYPICALLY SEEN IN PATIENTS WITH SCHIZOPHRENIA IS NOT EXAMINED. THIS PAPER DISCUSSES THE POTENTIAL MECHANISM OF YOGA IN THE TREATMENT OF SCHIZOPHRENIA AND PROPOSES A TESTABLE HYPOTHESIS FOR FURTHER EMPIRICAL STUDIES. IT IS PROPOSED THAT SELF-REFLECTION ABNORMALITIES IN SCHIZOPHRENIA IMPROVE WITH YOGA AND THE NEUROBIOLOGICAL CHANGES ASSOCIATED WITH THIS CAN BE EXAMINED USING EMPIRICAL BEHAVIOURAL MEASURES AND NEUROIMAGING MEASURES SUCH AS MAGNETIC RESONANCE IMAGING. 2016 7 588 34 DETERMINING PSYCHONEUROIMMUNOLOGIC MARKERS OF YOGA AS AN INTERVENTION FOR PERSONS DIAGNOSED WITH PTSD: A SYSTEMATIC REVIEW. THERE IS A GROWING BODY OF RESEARCH ON YOGA AS A THERAPEUTIC INTERVENTION FOR PSYCHOLOGICAL SYMPTOMS OF POST-TRAUMATIC STRESS DISORDER (PTSD) ACCOMPANIED BY SPECULATIONS ON UNDERLYING PHYSIOLOGIC MECHANISMS. THE PURPOSE OF THIS SYSTEMATIC REVIEW IS TO IDENTIFY, QUALITATIVELY EVALUATE, AND SYNTHESIZE STUDIES OF YOGA AS AN INTERVENTION FOR PTSD THAT MEASURED PHYSIOLOGIC OUTCOMES IN ORDER TO GAIN INSIGHTS INTO POTENTIAL MECHANISMS. THE FOCUS IS ON STUDIES EVALUATING YOGA AS A THERAPEUTIC INTERVENTION FOR PTSD RATHER THAN FOR TRAUMA EXPOSURE, PTSD PREVENTION, OR SUBCLINICAL PTSD. MULTIPLE DATABASES WERE SEARCHED FOR PUBLICATIONS FROM THE PAST TWO DECADES USING TERMS DERIVED FROM THE QUESTION, "IN PEOPLE WITH PTSD, WHAT IS THE EFFECT OF YOGA ON OBJECTIVE OUTCOMES?" ELIGIBILITY CRITERIA INCLUDED YOGA-ONLY MODALITIES TESTED AS AN INTERVENTION FOR FORMALLY DIAGNOSED PTSD WITH AT LEAST ONE PHYSIOLOGIC OUTCOME. RESULTS OF THIS REVIEW CONFIRMED THAT, THOUGH MUCH OF THE PUBLISHED LITERATURE PROPOSES PHYSIOLOGICAL MECHANISMS UNDERLYING YOGA'S EFFECTS ON PTSD, VERY FEW STUDIES ( N = 3) HAVE ACTUALLY EVALUATED PHYSIOLOGICAL EVIDENCE. ADDITIONALLY, SEVERAL STUDIES HAD METHODOLOGICAL LIMITATIONS. IN LIGHT OF THE LIMITED DATA SUPPORTING YOGA'S BENEFICIAL EFFECTS ON AUTONOMIC NERVOUS SYSTEM DYSREGULATION, WE PRESENT A THEORETICAL MODEL OF THE PSYCHONEUROIMMUNOLOGIC PROCESSES ASSOCIATED WITH PTSD AND THE EFFECTS YOGA MAY HAVE ON THESE PROCESSES TO GUIDE FUTURE RESEARCH. GAPS IN THE LITERATURE REMAIN FOR MECHANISMS RELATED TO ACTIVATION OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS AND INFLAMMATION. ADDITIONAL RIGOROUS MECHANISTIC STUDIES ARE NEEDED TO GUIDE DEVELOPMENT OF EFFECTIVE YOGA INTERVENTIONS FOR PTSD TO AUGMENT EXISTING EVIDENCE-BASED PTSD TREATMENTS. 2018 8 2798 34 YOGA THERAPY FOR SCHIZOPHRENIA. SCHIZOPHRENIA IS ONE OF THE MOST SEVERE MENTAL DISORDERS. DESPITE SIGNIFICANT ADVANCES IN PHARMACOTHERAPY, TREATMENT REMAINS SUB-OPTIMAL, WITH MANY PATIENTS HAVING PERSISTING DEFICITS, ESPECIALLY IN COGNITIVE AND SOCIAL FUNCTIONING. YOGA AS A THERAPY HAS PROVEN TO BE EFFECTIVE AS A SOLE OR ADDITIONAL INTERVENTION IN PSYCHIATRIC DISORDERS SUCH AS DEPRESSION AND ANXIETY. RECENTLY, THERE HAS BEEN SIGNIFICANT INTEREST IN THE APPLICATION OF YOGA THERAPY IN PSYCHOSIS AND SCHIZOPHRENIA. TO REVIEW A) THE EVIDENCE FOR THE USE OF YOGA THERAPY IN PATIENTS WITH SCHIZOPHRENIA B) STUDIES WHICH HAVE BEEN DONE IN THIS AREA, C) THE BARRIERS FOR REACHING YOGA TO PATIENTS, AND D) FUTURE DIRECTIONS, AN ENGLISH LANGUAGE LITERATURE SEARCH OF PUBMED/MEDLINE, GOOGLE SCHOLAR, AND EBSCO AS WELL AS GREY LITERATURE WAS DONE. RESEARCH REPORTS HAVE DEMONSTRATED THE FEASIBILITY AND EFFICACY OF YOGA AS AN ADD-ON THERAPY IN SCHIZOPHRENIA, PARTICULARLY IN IMPROVING NEGATIVE SYMPTOMATOLOGY AND SOCIAL COGNITION. HOWEVER, THE BIOLOGICAL UNDERPINNINGS OF THIS EFFECT REMAIN UNCLEAR, ALTHOUGH THERE ARE SOME INDICATIONS THAT HORMONES LIKE OXYTOCIN MAY CONTRIBUTE TO THE CHANGES IN SOCIAL COGNITION. 2012 9 875 31 EFFECT OF YOGA THERAPY ON PLASMA OXYTOCIN AND FACIAL EMOTION RECOGNITION DEFICITS IN PATIENTS OF SCHIZOPHRENIA. CONTEXT: YOGA THERAPY HAS BEEN DEMONSTRATED TO BE USEFUL IN TREATMENT OF NEGATIVE SYMPTOMS AND IMPROVING THE SOCIO-OCCUPATIONAL FUNCTIONING AND EMOTION RECOGNITION DEFICITS IN ANTIPSYCHOTIC-STABILIZED SCHIZOPHRENIA PATIENTS. OXYTOCIN HAS BEEN RECENTLY IMPLICATED IN SOCIAL COGNITION DEFICITS IN SCHIZOPHRENIA. THE EFFECT OF YOGA THERAPY ON OXYTOCIN LEVELS IN SCHIZOPHRENIA HAS NOT BEEN STUDIED. AIMS: THIS STUDY AIMED TO ASSESS THE EFFECT OF YOGA THERAPY ON SYMPTOMS, SOCIO-OCCUPATIONAL FUNCTIONING, FACIAL EMOTION RECOGNITION DEFICITS AND PLASMA OXYTOCIN LEVELS IN ANTIPSYCHOTIC STABILIZED SCHIZOPHRENIA PATIENTS. SETTINGS AND DESIGN: RANDOMIZED CONTROLLED STUDY ON 43 CONSENTING, MEDICATION STABILIZED PATIENTS WITH SCHIZOPHRENIA IN A TERTIARY PSYCHIATRIC CENTER USING YOGA INTERVENTION AND WAITLISTED GROUPS. MATERIALS AND METHODS: A TOTAL OF 43 SCHIZOPHRENIA PATIENTS WERE RANDOMIZED TO YOGA GROUP (N=15) OR WAITLIST GROUP (N=28). PATIENTS IN THE YOGA GROUP RECEIVED TRAINING IN A SPECIFIC YOGA THERAPY MODULE FOR SCHIZOPHRENIA. PATIENTS IN BOTH GROUPS WERE CONTINUED ON STABLE ANTIPSYCHOTIC MEDICATION. ASSESSMENTS INCLUDED SCALE FOR ASSESSMENT OF POSITIVE SYMPTOMS, SCALE FOR ASSESSMENT OF NEGATIVE SYMPTOMS, SOCIO-OCCUPATIONAL FUNCTIONING SCALE AND TOOL FOR RECOGNITION OF EMOTIONS IN NEUROPSYCHIATRIC DISORDERS (TRENDS) AND PLASMA OXYTOCIN LEVELS; PERFORMED AT BASELINE AND AT THE END OF 1 MONTH. RESULTS: A TOTAL OF 15 PATIENTS IN THE YOGA GROUP AND 12 IN WAITLIST GROUP COMPLETED THE STUDY. THE YOGA THERAPY GROUP SHOWED A SIGNIFICANT IMPROVEMENT IN SOCIO-OCCUPATIONAL FUNCTIONING, PERFORMANCE ON TRENDS (P<0.001) AND PLASMA INCREASE IN OXYTOCIN LEVELS (P=0.01) AS COMPARED WITH THE WAITLIST GROUP. CONCLUSION: THE STUDY SUPPORTED THE ROLE OF ADD-ON YOGA THERAPY IN MANAGEMENT OF SCHIZOPHRENIA AND DEMONSTRATED AN IMPROVEMENT IN ENDOGENOUS PLASMA OXYTOCIN LEVELS IN SCHIZOPHRENIA PATIENTS RECEIVING YOGA THERAPY. 2013 10 2799 39 YOGA THERAPY FOR SOCIAL COGNITION IN SCHIZOPHRENIA: AN EXPERIMENTAL MEDICINE-BASED RANDOMIZED CONTROLLED TRIAL. NEGATIVE SYMPTOMS AND COGNITIVE DEFICITS ARE DIFFICULT-TO-TREAT SYMPTOMS OF SCHIZOPHRENIA. IN THIS SINGLE BLIND RANDOMIZED CONTROLLED STUDY, WE COMPARED CHANGE IN SOCIAL COGNITIVE PERFORMANCE IN PERSONS WITH SCHIZOPHRENIA (PWS) (AS PER DSM-5), AFTER 6 WEEKS OF YOGA INTERVENTION WITH A WAITLIST CONTROL GROUP. WE ALSO EXAMINED CHANGES IN PUTATIVE MIRROR NEURON SYSTEM (MNS) ACTIVITY MEASURED BY TRANSCRANIAL MAGNETIC STIMULATION (TMS) IN A SUBSET OF SAMPLE (N = 30). 51 PWS STABILIZED ON ANTIPSYCHOTIC MEDICATION FOR AT LEAST 6 WEEKS, WERE ASSIGNED TO ADD-ON YOGA THERAPY (YT) (N = 26) OR WAITLIST (WL) (N = 25). SUBJECTS IN THE YT GROUP RECEIVED ADD-ON YOGA THERAPY (20 SESSIONS IN 6 WEEKS). BOTH THE GROUPS CONTINUED THEIR STANDARD TREATMENT AND WERE ASSESSED AT BASELINE AND AFTER 6 WEEKS FOR SOCIAL COGNITION, CLINICAL SYMPTOMS AND SOCIAL DISABILITY. RM-ANOVA SHOWED SIGNIFICANT INTERACTION BETWEEN TIME AND GROUP FOR SOCIAL COGNITION COMPOSITE SCORE (SCCS) (F = 42.09 [1,44], P < 0.001); NEGATIVE SYMPTOMS (SANS) (F = 74.91 [1,45], P < 0.001); POSITIVE SYMPTOMS (SAPS) (F = 16.05 [1,45], P < 0.001) AND SOCIAL DISABILITY (GSDS) (F = 29.91 [1,46], P < 0.001). MNS ACTIVITY HAD INCREASED AFTER 6 WEEKS IN BOTH GROUPS BUT NOT OF STATISTICAL SIGNIFICANCE. THIS STUDY DEMONSTRATES THAT 6 WEEKS OF ADD-ON YOGA THERAPY COULD IMPROVE SOCIAL COGNITION IN PWS COMPARED TO WAITLIST CONTROL SUBJECTS. HOWEVER, THE CHANGE IN SOCIAL COGNITION WAS NOT ASSOCIATED WITH A CHANGE IN THE PUTATIVE MNS-ACTIVITY. IT NECESSIATATES FURTHER STUDIES TO INVESTIGATE THE MECHANISTIC PROCESSES OF YOGA AND REPLICATE THESE OBSERVATIONS IN A LARGER SAMPLE. 2021 11 1669 34 NEUROPHYSIOLOGICAL AND NEUROCOGNITIVE MECHANISMS UNDERLYING THE EFFECTS OF YOGA-BASED PRACTICES: TOWARDS A COMPREHENSIVE THEORETICAL FRAMEWORK. DURING RECENT DECADES NUMEROUS YOGA-BASED PRACTICES (YBP) HAVE EMERGED IN THE WEST, WITH THEIR AIMS RANGING FROM FITNESS GAINS TO THERAPEUTIC BENEFITS AND SPIRITUAL DEVELOPMENT. YOGA IS ALSO BEGINNING TO SPARK GROWING INTEREST WITHIN THE SCIENTIFIC COMMUNITY, AND YOGA-BASED INTERVENTIONS HAVE BEEN ASSOCIATED WITH MEASUREABLE CHANGES IN PHYSIOLOGICAL PARAMETERS, PERCEIVED EMOTIONAL STATES, AND COGNITIVE FUNCTIONING. YBP TYPICALLY INVOLVE A COMBINATION OF POSTURES OR MOVEMENT SEQUENCES, CONSCIOUS REGULATION OF THE BREATH, AND VARIOUS TECHNIQUES TO IMPROVE ATTENTIONAL FOCUS. HOWEVER, SO FAR LITTLE IF ANY RESEARCH HAS ATTEMPTED TO DECONSTRUCT THE ROLE OF THESE DIFFERENT COMPONENT PARTS IN ORDER TO BETTER UNDERSTAND THEIR RESPECTIVE CONTRIBUTION TO THE EFFECTS OF YBP. A CLEAR OPERATIONAL DEFINITION OF YOGA-BASED THERAPEUTIC INTERVENTIONS FOR SCIENTIFIC PURPOSES, AS WELL AS A COMPREHENSIVE THEORETICAL FRAMEWORK FROM WHICH TESTABLE HYPOTHESES CAN BE FORMULATED, IS THEREFORE NEEDED. HERE WE PROPOSE SUCH A FRAMEWORK, AND OUTLINE THE BOTTOM-UP NEUROPHYSIOLOGICAL AND TOP-DOWN NEUROCOGNITIVE MECHANISMS HYPOTHESIZED TO BE AT PLAY IN YBP. 2015 12 1474 18 INTEGRATED APPROACH TO YOGA THERAPY AND AUTISM SPECTRUM DISORDERS. A SPECIALLY DESIGNED INTEGRATED APPROACH TO YOGA THERAPY MODULE WAS APPLIED TO AUTISM SPECTRUM DISORDERS OVER A PERIOD OF TWO ACADEMIC YEARS. DESPITE LOW NUMBERS (SIX IN EACH ARM), CONSISTENCY AND MAGNITUDE OF EFFECTS MAKE THE FINDINGS SIGNIFICANT. PARENTAL PARTICIPATION, ALLOWING FIRM GUIDANCE TO BE GIVEN TO EACH CHILD, RESULTED IN SIGNIFICANT IMPROVEMENTS IN IMITATION AND OTHER SKILLS, AND IN BEHAVIOR AT HOME AND FAMILY RELATIONSHIPS. WE HYPOTHESIZE THAT GUIDED IMITATION OF THERAPIST BODY POSITIONS STIMULATED MIRROR NEURON ACTIVATION, RESULTING IN IMPROVED SENSE OF SELF. 2010 13 644 28 DOES YOGA HAVE A ROLE IN SCHIZOPHRENIA MANAGEMENT? PURPOSE OF REVIEW: TO REVIEW THE EFFICACY OF ADD-ON YOGA THERAPY IN IMPROVING SYMPTOMS OF SCHIZOPHRENIA AND QUALITY OF LIFE AND EXAMINE THE POSSIBLE UNDERLYING BIOLOGICAL MECHANISMS OF YOGA IN SCHIZOPHRENIA. RECENT FINDINGS: QUALITY OF LIFE, COGNITIVE SYMPTOMS, AND NEGATIVE SYMPTOMS HAVE BEEN FOUND TO IMPROVE WITH ADD-ON YOGA THERAPY IN SCHIZOPHRENIA (POOLED MEAN EFFECT SIZE 0.8, 0.6, AND 0.4, RESPECTIVELY). YOGA ALSO SEEMS TO HAVE A SMALL EFFECT ON IMPROVING POSITIVE SYMPTOMS. LESS EXPLORED AREAS INCLUDE ADVERSE EFFECTS OF YOGA ITSELF AS WELL AS ITS EFFECTS ON ANTIPSYCHOTIC-INDUCED COMPLICATIONS. PRELIMINARY FINDINGS SUGGEST THAT THE EFFECTS OF YOGA MAY BE MEDIATED BY NEUROHORMONAL MECHANISMS AND FUNCTIONAL CHANGES IN BRAIN ACTIVITY. ADD-ON YOGA THERAPY IS A POTENTIAL TREATMENT OPTION FOR IMPROVING QUALITY OF LIFE, COGNITIVE SYMPTOMS, AND NEGATIVE SYMPTOMS IN SCHIZOPHRENIA. FUTURE STUDIES SHOULD EXPLORE EFFICACY IN MULTICENTRIC TRIALS AS WELL AS POSSIBLE NEUROBIOLOGICAL CHANGES UNDERLYING THE EFFECTS. 2020 14 1640 37 MOLECULAR SIGNATURE OF THE IMMUNE RESPONSE TO YOGA THERAPY IN STRESS-RELATED CHRONIC DISEASE CONDITIONS: AN INSIGHT. THE WORLD HEALTH ORGANIZATION DEFINES HEALTH AS COMPLETE WELL-BEING IN TERMS OF PHYSICAL, MENTAL AND SOCIAL, AND NOT MERELY THE ABSENCE OF DISEASE. TO ATTAIN THIS, INDIVIDUAL SHOULD ADAPT AND SELF-MANGE THE SOCIAL, PHYSICAL AND EMOTIONAL CHALLENGES OF LIFE. EXPOSURE TO CHRONIC STRESS DUE TO URBANIZATION, WORK STRESS, NUCLEAR FAMILY, POLLUTION, UNHEALTHY FOOD HABITS, LIFESTYLE, ACCIDENTAL DEATH IN THE FAMILY, AND NATURAL CALAMITIES ARE THE TRIGGERING FACTORS, LEADING TO HORMONAL IMBALANCE AND INFLAMMATION IN THE TISSUE. THE RELATIONSHIP BETWEEN STRESS AND ILLNESS IS COMPLEX; ALL CHRONIC ILLNESSES SUCH AS CARDIOVASCULAR DISEASE AND ASTHMA HAVE THEIR ROOT IN CHRONIC STRESS ATTRIBUTED BY INFLAMMATION. IN RECENT TIMES, YOGA THERAPY HAS EMERGED AS AN IMPORTANT COMPLEMENTARY ALTERNATIVE MEDICINE FOR MANY HUMAN DISEASES. YOGA THERAPY HAS A POSITIVE IMPACT ON MIND AND BODY; IT ACTS BY INCORPORATING APPROPRIATE BREATHING TECHNIQUES AND MINDFULNESS TO ATTAIN CONSCIOUS DIRECTION OF OUR AWARENESS OF THE PRESENT MOMENT BY MEDITATION, WHICH HELPS ACHIEVE HARMONY BETWEEN THE BODY AND MIND. STUDIES HAVE ALSO DEMONSTRATED THE IMPORTANT REGULATORY EFFECTS OF YOGA THERAPY ON BRAIN STRUCTURE AND FUNCTIONS. DESPITE THESE ADVANCES, THE CELLULAR AND MOLECULAR MECHANISMS BY WHICH YOGA THERAPY RENDERS ITS BENEFICIAL EFFECTS ARE INADEQUATELY KNOWN. A GROWING BODY OF EVIDENCE SUGGESTS THAT YOGA THERAPY HAS IMMUNOMODULATORY EFFECTS. HOWEVER, THE PRECISE MECHANISTIC BASIS HAS NOT BEEN ADDRESSED EMPIRICALLY. IN THIS REVIEW, WE HAVE ATTEMPTED TO HIGHLIGHT THE EFFECT OF YOGA THERAPY ON IMMUNE SYSTEM FUNCTIONING WITH AN AIM TO IDENTIFY IMPORTANT IMMUNOLOGICAL SIGNATURES THAT INDEX THE EFFECT OF YOGA THERAPY. TOWARD THIS, WE HAVE SUMMARIZED THE AVAILABLE SCIENTIFIC EVIDENCE SHOWING POSITIVE IMPACTS OF YOGA THERAPY. FINALLY, WE HAVE EMPHASIZED THE EFFICACY OF YOGA IN IMPROVING PHYSICAL AND MENTAL WELL-BEING. YOGA HAS BEEN A PART OF INDIAN CULTURE AND TRADITION FOR LONG; NOW, THE TIME HAS COME TO SCIENTIFICALLY VALIDATE THIS AND IMPLEMENT THIS AS AN ALTERNATIVE TREATMENT METHOD FOR STRESS-RELATED CHRONIC DISEASE. 2020 15 1918 28 ROLE OF YOGA AND MEDITATION AS COMPLIMENTARY THERAPEUTIC REGIME FOR STRESS-RELATED NEUROPSYCHIATRIC DISORDERS: UTILIZATION OF BRAIN WAVES ACTIVITY AS NOVEL TOOL. DURING RECENT DECADES, STRESS-RELATED NEUROPSYCHIATRIC DISORDERS SUCH AS ANXIETY, DEPRESSION, CHRONIC TENSION HEADACHE, AND MIGRAINE HAVE ESTABLISHED THEIR STRONGHOLD IN THE LIVES OF A VAST NUMBER OF PEOPLE WORLDWIDE. IN ORDER TO ADDRESS THIS GLOBAL PHENOMENON, INTENSIVE STUDIES HAVE BEEN CARRIED OUT LEADING TO THE ADVANCEMENT OF DRUGS LIKE ANTI-DEPRESSANTS, ANXIOLYTICS, AND ANALGESICS WHICH ALTHOUGH HELP IN COMBATING THE SYMPTOMS OF SUCH DISORDERS BUT ALSO CREATE LONG-TERM SIDE EFFECTS. THUS, AS AN ALTERNATIVE TO SUCH CLINICAL PRACTICES, VARIOUS COMPLEMENTARY THERAPIES SUCH AS YOGA AND MEDITATION HAVE BEEN PROVED TO BE EFFECTIVE IN ALLEVIATING THE CAUSES AND SYMPTOMS OF DIFFERENT NEUROPSYCHIATRIC DISORDERS. THE ROLE OF ALTERED BRAIN WAVES IN THIS CONTEXT HAS BEEN RECOGNIZED AND NEEDS TO BE PURSUED AT THE HIGHEST LEVEL. THUS, THE CURRENT STUDY PROVIDES A REVIEW FOCUSED ON DESCRIBING THE EFFECTS OF YOGA AND MEDITATION ON ANXIETY AND DEPRESSION AS WELL AS EXPLORING BRAIN WAVES AS A TOOL FOR ASSESSING THE POTENTIAL OF THESE COMPLEMENTARY THERAPIES FOR SUCH DISORDERS. 2020 16 1089 28 EFFECTS OF YOGA ON THE AUTONOMIC NERVOUS SYSTEM, GAMMA-AMINOBUTYRIC-ACID, AND ALLOSTASIS IN EPILEPSY, DEPRESSION, AND POST-TRAUMATIC STRESS DISORDER. A THEORY IS PROPOSED TO EXPLAIN THE BENEFITS OF YOGA PRACTICES IN DIVERSE, FREQUENTLY COMORBID MEDICAL CONDITIONS BASED ON THE CONCEPT THAT YOGA PRACTICES REDUCE ALLOSTATIC LOAD IN STRESS RESPONSE SYSTEMS SUCH THAT OPTIMAL HOMEOSTASIS IS RESTORED. IT IS HYPOTHESIZED THAT STRESS INDUCES (1) IMBALANCE OF THE AUTONOMIC NERVOUS SYSTEM (ANS) WITH DECREASED PARASYMPATHETIC NERVOUS SYSTEM (PNS) AND INCREASED SYMPATHETIC NERVOUS SYSTEM (SNS) ACTIVITY, (2) UNDERACTIVITY OF THE GAMMA AMINO-BUTYRIC ACID (GABA) SYSTEM, THE PRIMARY INHIBITORY NEUROTRANSMITTER SYSTEM, AND (3) INCREASED ALLOSTATIC LOAD. IT IS FURTHER HYPOTHESIZED THAT YOGA-BASED PRACTICES (4) CORRECT UNDERACTIVITY OF THE PNS AND GABA SYSTEMS IN PART THROUGH STIMULATION OF THE VAGUS NERVES, THE MAIN PERIPHERAL PATHWAY OF THE PNS, AND (5) REDUCE ALLOSTATIC LOAD. DEPRESSION, EPILEPSY, POST TRAUMATIC STRESS DISORDER (PTSD), AND CHRONIC PAIN EXEMPLIFY MEDICAL CONDITIONS THAT ARE EXACERBATED BY STRESS, HAVE LOW HEART RATE VARIABILITY (HRV) AND LOW GABAERGIC ACTIVITY, RESPOND TO PHARMACOLOGIC AGENTS THAT INCREASE ACTIVITY OF THE GABA SYSTEM, AND SHOW SYMPTOM IMPROVEMENT IN RESPONSE TO YOGA-BASED INTERVENTIONS. THE OBSERVATION THAT TREATMENT RESISTANT CASES OF EPILEPSY AND DEPRESSION RESPOND TO VAGAL NERVE STIMULATION CORROBORATES THE NEED TO CORRECT PNS UNDERACTIVITY AS PART OF A SUCCESSFUL TREATMENT PLAN IN SOME CASES. ACCORDING TO THE PROPOSED THEORY, THE DECREASED PNS AND GABAERGIC ACTIVITY THAT UNDERLIES STRESS-RELATED DISORDERS CAN BE CORRECTED BY YOGA PRACTICES RESULTING IN AMELIORATION OF DISEASE SYMPTOMS. THIS HAS FAR-REACHING IMPLICATIONS FOR THE INTEGRATION OF YOGA-BASED PRACTICES IN THE TREATMENT OF A BROAD ARRAY OF DISORDERS EXACERBATED BY STRESS. 2012 17 2776 36 YOGA SCHOOL OF THOUGHT AND PSYCHIATRY: THERAPEUTIC POTENTIAL. YOGA IS A TRADITIONAL LIFE-STYLE PRACTICE USED FOR SPIRITUAL REASONS. HOWEVER, THE PHYSICAL COMPONENTS LIKE THE ASANAS AND PRANAYAAMAS HAVE DEMONSTRATED PHYSIOLOGICAL AND THERAPEUTIC EFFECTS. THERE IS EVIDENCE FOR YOGA AS BEING A POTENT ANTIDEPRESSANT THAT MATCHES WITH DRUGS. IN DEPRESSIVE DISORDER, YOGA 'CORRECTS' AN UNDERLYING COGNITIVE PHYSIOLOGY. IN SCHIZOPHRENIA PATIENTS, YOGA HAS BENEFITS AS AN ADD-ON INTERVENTION IN PHARMACOLOGICALLY STABILIZED SUBJECTS. THE EFFECTS ARE PARTICULARLY NOTABLE ON NEGATIVE SYMPTOMS. YOGA ALSO HELPS TO CORRECT SOCIAL COGNITION. YOGA CAN BE INTRODUCED EARLY IN THE TREATMENT OF PSYCHOSIS WITH SOME BENEFITS. ELEVATION OF OXYTOCIN MAY BE A MECHANISM OF YOGA EFFECTS IN SCHIZOPHRENIA. CERTAIN COMPONENTS OF YOGA HAVE DEMONSTRATED NEUROBIOLOGICAL EFFECTS SIMILAR TO THOSE OF VAGAL STIMULATION, INDICATING THIS (INDIRECT OR AUTOGENOUS VAGAL STIMULATION) AS A POSSIBLE MECHANISM OF ITS ACTION. IT IS TIME, PSYCHIATRISTS EXPLOITED THE BENEFITS IF YOGA FOR A COMPREHENSIVE CARE IN THEIR PATIENTS. 2013 18 2668 25 YOGA IN MAJOR DEPRESSIVE DISORDER: MOLECULAR MECHANISMS AND CLINICAL UTILITY. MAJOR DEPRESSIVE DISORDER (MDD) IS A MIND-BODY DISORDER. CELLULAR AGING HAS BEEN IMPLICATED IN THE PATHOGENESIS OF MDD WITH THE ALTERED MIND-BODY COMMUNICATION MARKERS LIKE STRESS RESPONSE, IMMUNE RESPONSE, NUTRITION SENSING, AND A RANGE OF OTHER REGULATORY FEEDBACK SYSTEMS. IN THIS AGE OF SUPER SPECIALIZATIONS, ONE SPECIFIC TARGET AND INTERVENTIONS (PREFERABLY A DRUG) ON IT ARE BEING RIGOROUSLY SOUGHT BY THE HEALTH CARE COMMUNITY AND INDUSTRY, BUT HAVE FAILED IN IT IN THE LAST FIFTY YEARS IN SPITE OF ADVANCES IN TECHNOLOGY. SINCE, DEPRESSION IS A COMPLEX DISORDER ASSOCIATED WITH INCREASED INCIDENCE OF OTHER COMPLEX DISORDERS, IT MUST BE TREATED BY AN INTEGRATED HOLISTIC APPROACH THAT CAN ADDRESS THE COMPLEXITY OF MDD. INTERVENTIONS TARGETING ACCELERATED BIOLOGICAL AGING TO INCREASE CELLULAR HEALTH IN WHOLE BODY HAVE POTENTIAL TO MANAGE COMPLEX CONDITIONS LIKE MDD AND ITS OVERLAPPING SYMPTOMS AND COMORBIDITIES. YOGA HAS THE POTENTIAL TO BE THE NEXUS BETWEEN, CLINICAL MANAGEMENT OF MDD AND OTHER LIFESTYLE DISEASES. 2021 19 1515 24 IS YOGA A SUITABLE TREATMENT FOR RHEUMATOID ARTHRITIS: CURRENT OPINION. WE REVIEWED PUBLISHED LITERATURE REGARDING THE USE OF YOGA FOR MANAGING RHEUMATOID ARTHRITIS TO DETERMINE WHETHER ADEQUATE EVIDENCE EXISTS TO SUGGEST ITS USEFULNESS AS A THERAPY. A SEARCH FOR PREVIOUS STUDIES INVOLVING YOGA AND RHEUMATOID ARTHRITIS IN PUBMED YIELDED EIGHT REPORTS. THESE STUDIES REPORTED THE BENEFITS OF YOGA IN THE PHYSICAL AND MENTAL HEALTH OF PATIENTS WITH RHEUMATOID ARTHRITIS (RA), SUGGESTING THAT YOGA IS A USEFUL ADD-ON THERAPY FOR RA PATIENTS. HOWEVER, ALL STUDIES SHOWED LIMITATIONS WITH RESPECT TO SAMPLE SIZE, STUDY DESIGN, DESCRIPTION AND DURATION OF YOGA INTERVENTION, AND ASSESSMENT TOOLS AND STATISTICAL METHODS USED. ADDITIONALLY, THE STUDIES DID NOT ATTEMPT TO UNDERSTAND THE MECHANISMS UNDERLYING OBSERVED BENEFITS. HENCE, EVIDENCE SUGGESTS A DEFINITE ROLE OF YOGA IN RA IMPROVEMENT, REDUCING PAIN, IMPROVING FUNCTION, AND CREATING A POSITIVE MENTAL STATE. HOWEVER, DETAILED ANALYSIS AND ADDITIONAL STUDIES ARE NECESSARY TO VERIFY THESE OBSERVATIONS. 2012 20 2466 20 YOGA AS A THERAPEUTIC INTERVENTION: A BIBLIOMETRIC ANALYSIS OF PUBLISHED RESEARCH STUDIES. ALTHOUGH YOGA IS HISTORICALLY A SPIRITUAL DISCIPLINE, IT HAS ALSO BEEN USED CLINICALLY AS A THERAPEUTIC INTERVENTION. A BIBLIOMETRIC ANALYSIS ON THE BIOMEDICAL JOURNAL LITERATURE INVOLVING RESEARCH ON THE CLINICAL APPLICATION OF YOGA HAS REVEALED AN INCREASE IN PUBLICATION FREQUENCY OVER THE PAST 3 DECADES WITH A SUBSTANTIAL AND GROWING USE OF RANDOMIZED CONTROLLED TRIALS. TYPES OF MEDICAL CONDITIONS HAVE INCLUDED PSYCHOPATHOLOGICAL (E.G. DEPRESSION, ANXIETY), CARDIOVASCULAR (E.G. HYPERTENSION, HEART DISEASE), RESPIRATORY (E.G. ASTHMA), DIABETES AND A VARIETY OF OTHERS. A MAJORITY OF THIS RESEARCH HAS BEEN CONDUCTED BY INDIAN INVESTIGATORS AND PUBLISHED IN INDIAN JOURNALS, PARTICULARLY YOGA SPECIALTY JOURNALS, ALTHOUGH RECENT TRENDS INDICATE INCREASING CONTRIBUTIONS FROM INVESTIGATORS IN THE U.S. AND ENGLAND. YOGA THERAPY IS A RELATIVELY NOVEL AND EMERGING CLINICAL DISCIPLINE WITHIN THE BROAD CATEGORY OF MIND-BODY MEDICINE, WHOSE GROWTH IS CONSISTENT WITH THE BURGEONING POPULARITY OF YOGA IN THE WEST AND THE INCREASING WORLDWIDE USE OF ALTERNATIVE MEDICINE. 2004