Dr. Shamanthakamani Narendran

M.D. (Pead), Ph.D. (Yoga Science)

• Psychiatry is a branch of medicine that concerns with the diagnosis and treatment of mental, emotional and behavioral disorders, like depression, schizophrenia, etc.

• The Greeks recognized the significance of emotion in mental disorders.

• Scientists of the period sought under lying cause of mental and nervous disorders.

• The German psychiatrist was the first to divide psychosis into the two general classifications of manic-depressive psychosis and schizophrenia.

• Today, psychiatry involves psychological or psychological treatment or a combination of the two.

• Physiological treatment generally involves the use of drugs influencing neurotranmitter functions in the brain or electroconvulsive treatment.

• When we speak of the causes of mental disorders, we typically distinguish between two basic approaches: Psychological approach (functioning of the mind – on mental causes of behavior) versus a biological approach (functioning of nervous system – on biological causes of behavior).

• There are 4 ways in which these two approaches are used to explain the development of mental disorders.

CAUSES OF MENTAL DISORDERS

1. A normally functioning mind develops abnormality after experiencing a psychosocial stressor that can be caused by family, occupation, education, etc.

2. An abnormally functioning Nervous system causes abnormal mental events and/or behavior.

3. A biological predisposition causes the development of abnormal mental events and/or behavior in the presence of environmental stressors.

4. A psychological predisposition causes ------- in the presence of environmental stressors.

• There are a host of psychiatric disorders that affect the young, adult and the old.

• The following addresses briefly a summary of common psychiatric problems in the population.

COMMON PSYCHIATRIC DISORDERS

• Apprehension of danger and dread accompanied by restlessness, tension, tachycardia, and dyspnea unattached to a clearly identifiable stimulus.

• In experimental psychology, a drive or motivational state learned from and thereafter associated with previously neutral cues.

• A vague, unpleasant and sometimes debilitating emotion that is experienced in anticipation of some misfortune.

DEFINITION

• It is a feeling of unease.

• Everybody experiences it when faced with stressful situation, like before an exam or an interview.

• It is normal to feel anxious when facing something difficult or dangerous, and mild anxiety can be positive and useful.

– It is considered abnormal when

– It is very prolonged or severe

– It happens in the absence of a stressful event

– It is interfering with everyday activities such as going to work or socializing.

• Abdominal discomfort

• Diarrhea

• Dry mouth

• Rapid heartbeat

• Tightness or pain in chest

• Shortness of breath

• Dizziness

• Frequent urination

• Difficulty swallowing

SYMPTOMSThe physical symptoms of anxiety are caused by the brain sending messages to parts of the body to prepare for the “fight or fight” response.

• Insomnia

• Irritability or anger

• Inability to concentrate

• Fear of madness

• Feeling unreal and not in control of action (depersonalization) bereavement. Sometimes symptoms occur before a forthcoming event such as an important exam. This is called situational anxiety. Symptoms usually settle fairly quickly and no treatment may be needed.

Psychological symptoms can include:

• This is similar to acute stress reaction, but symptoms develop over days or weeks after a stressful situation.

ADJUSTMENT REACTION

• May follow after experiencing or witnessing a traumatic event such as major accident or military combat.

• Anxiety is only one of the symptoms, which may come and go.

• The person may re-live their traumatic experience in dreams or flashbacks.

• It is normal to only applied if symptoms persist.

• It may start years after the triggering event.

POST-TRAUMATIC STRESS DISORDER [PTSD]

• A phobia is a fear that is out of proportion to the real danger posed by the thing or event that triggers it.

• Phobias interfere with a person’s ability to lead a normal life.

• The most common phobias are fear of heights, spiders, mice, blood, injections or enclosed space.

• Social phobia is one of the more common phobias.

• Meeting people causes anxiety and people are worried about what others think of them.

PHOBIAS

• One form of social phobia is severe anxiety about speaking or performing in public.

• It is common to feel nervous in these situations, but people with social phobia find these activities impossible.

• Agoraphobia – fear of various places and situations, such as crowd or public places.

• This consists of recurring obsessions or compulsions.

• Obsessions are recurring thoughts or images that cause feeling of disgust.

• Common obsession includes germs, dirt or violence.

• Compulsions are thoughts or actions that people must do or repeat.

• A compulsion is usually response to ease the anxiety of an obsession.

Eg. Excessive hand washing to deal with an obsession about dirt.

OBSESSIVE – COMPULSIVE DISORDER [OCD]

• This is characterized by panic attacks – a sudden attack of severe anxiety that occurs without warning and with no apparent trigger.

• The physical symptoms of anxiety can be very severe.

PANIC DISORDER

• Anxiety can be a long-term disorder in which people feel worried most of the time about things that might go wrong.

GENERALIZED ANXIETY DISORDER [GAD]

• Some people may be able to improve their symptoms by relaxation techniques, exercise or talking to other people in support groups, other technique include meditation, yoga, etc.

TREATING ANXIETY DISORDER

SELF HELP

• A professional relationship and activity in which one person endeavors to help another to understand and to solve his or her adjustment problems; the giving of advice, opinion, and instruction to direct the judgment or conduct of another.

• Treatment of emotional, behavioral, personality, and psychiatric disorders based primarily upon verbal or nonverbal communication and interventions with the patient, in contrast to treatments utilizing chemical and physical measures.

TALKING TREATMENT

COUNSELING

• Any of a variety of techniques in psychotherapy that utilizes guided self-discovery, imaging, self-instruction, symbolic modeling, and related forms of explicitly elicited cognitions as the principal mode of treatment.

• Behavioral therapy aims to change behavior.

• Usually, person gradually exposed to the situation causing anxiety.

• CBT combines these two types of therapies and is proven to be effective for anxiety disorder including phobias and panic disorders.

COGNITIVE BEHAVIOR THERAPY [CBT]

• A short prescription of benzodiazepine may be helpful in relieving short-term stress-related anxieties. They should not be taken for longer periods because of the risk of addiction.

• Buspirone is another medicine that is prescribed in a short-term to relieve anxiety. This has less side effects than benzodiazepines and people do not become dependent on it.

• Antidepressants such as paroxetine may be prescribed for certain anxiety disorders, such as generalized anxiety disorder, social phobia, and OCD, and when anxiety is associated with depression

MEDICATIONS

• Another group of drugs known as beta-blockers relieve many of the physical symptoms of anxiety such as palpitations and tremors and may be helpful for some people.

• They do not affect psychological symptoms, but some people find they can relax more if their physical symptoms are relieved.

• Relaxation training is a feature of some types of psychotherapy.

• Various types of relaxation therapy are available.

• Some people may find yoga, meditation techniques are very helpful.

RELAXATION

YOGA MODULE FORANXIETY

Daily morning Pranayama (1-5) Sithlikarana Vyayama (1-15) Meditation ( 1 or 2) Yogasanas (1-15)

Kriyas – Weekly once Candra Anuloma Viloma Pranayama 4

times a day and 27 rounds each time

• Addiction is a serious illness.

• Health, finances, relationship, careers – all can be ruined.

• The abuse of drugs and alcohol is the leading cause of substance abuse treatment cannot be overstated and fortunately many effective treatments are available.

• The road to recovery begins with recognition.

• People often drink alcohol during social occasions.

• The recklessness often resulting from excessive drinking is a leading cause of serious injuries and accidental deaths.

• Alcohol is the most common cause of preventable birth defects, including fetal alcohol syndrome.

• Alcoholism can have devastating effects on health, like liver damage, greater risk of heart disease, impotence, infertility and premature aging

CONSEQUENCES OF USEALCOHOL

• The most widespread and it is the most widely used illicit drug. It causes:

1. Short-term memory loss.

2. Accelerated heartburn.

3. Increased blood pressure.

4. Difficulty with concentrating and information processing.

5. Lapses in judgment

6. Problems with perception and motor skills.

MARIJUANA

• Cocaine, “crack,” and amphetamines

• Give a temporary illusion of enhanced power and energy.

• As the initial elevation of mood fades a depression emerges. It also can lead to serious medical problems like:

1. Heart attacks.

2. Seizures

3. Strokes

4. Violent, erratic, anxious, or paranoid behavior.

STIMULANTS

• Stimulants used can result in miscarriages, stillbirths, or low-birth weight babies.

• Permanent vegatative, or zombie like, state.

• Psychotic effects, such as paranoid delusions and hallucinations.

• Which can be smoked, eaten, sniffed or injected, produces an intense, but fleeting feeling of pleasure.

• Serious withdrawal symptoms are

– Chills

– Sweating

– Runny nose and eyes

– Abdominal cramps

– Muscle pains

– Insomnia

– Diarrhea

HEROIN

• Heroin use during pregnancy may result in miscarriages, stillbirths, or premature deliveries or babies born physically dependent on the drug.

• Severe damage to the heart, lungs and brain will be caused.

• Hallucinogens are drugs such as LSD (acid) that are taken orally and cause hallucinations (The apparent, often strong subjective perception of an object or event when no such stimulus or situation is present; may be visual, auditory, olfactory, gustatory, or tactile) and feeling of euphoria (A feeling of well-being, commonly exaggerated and not necessarily well founded).

• It causes stressful “flashbacks” re-experiencing the hallucinations despite not taking the drug again.

HALLUCINOGENS

• Group of products consisting of finely powdered or liquid drugs that are carried to the respiratory passages by the use of special devices such as low pressure aerosol containers.

• Inhalants are breathable chemicals like glue, paint, thinner or lighter fluid.

• They produce mind-altering effects when ‘sniffed’ or ‘huffed’.

• High concentrations or inhalant fumes can cause heart failure or suffocation and permanent damage to the nervous system.

INHALANTS

• A drug that quiets nervous excitement; designated according to the organ or system upon which specific action is exerted; e.g., cardiac, cerebral, nervous, respiratory, spinal.

• Sedatives are highly effective medications prescribed by physicians to relieve anxiety and to promote sleep.

• Birth defects who may also be physically dependent on the drugs.

SEDATIVES

• 1-Methyl-2-(3-pyridyl)pyrrolidine; a poisonous volatile alkaloid derived from tobacco (Nicotiana spp.) and responsible for many of the effects of tobacco; it first stimulates (small doses) then depresses (large doses) at autonomic ganglia and myoneural junctions. N. is an important tool in physiologic and pharmacologic investigation, is used as an insecticide and fumigant, and forms salts with most acids.

• Causes, which involves feeling of irritability, frustration, anger, anxiety, insomnia and depression.

NICOTINE

• Medical problems like:

1. Lung cancer

2. Heart attacks

3. Emphysema

4. High blood pressure

5. Ulcers

• The first step on the road to recovery is recognition of the problem, but often this process is complicated by a lack of understanding about substance abuse and addiction or worse, interventions by concerned friends and family.

• Since substance abuse affects many aspects of a person’s life, multiple forms of treatment are often required.

• Formost, a combination of medication and individual or group therapy is most effective.

TREATMENT

• Medications are used to control the drug cravings and relieve the severe symptoms of withdrawal.

• Therapy can help addicted individuals understand their behavior and motivations, develop higher self-esteems, and cope with stress.

• Other treatment methods are used as part of the rehabilitative process which include hospitalizations, therapeutic communities, out patient programs include methadole maintance for heroin addiction.

• Finally, in addition to the treatment, self help groups for substance abusing individuals (alcoholic anonymous, narcotics anonymous) as well as their family members (A1-Anon or Nar-Anon Family Groups) are useful in providing support and reinforcing messages learned in treatment.

• Reduction of the level of functioning.

• A hollow or sunken area.

• Displacement of a part downward or inward.

• A temporary mental state or chronic mental disorder characterized by feelings of sadness, loneliness, despair, low self-esteem, and self-reproach; accompanying signs include psychomotor retardation or less frequently agitation, withdrawal from social contact, and vegetative states such as loss of appetite and insomnia.

DEFINITION

• Depression is a disorder that affects the thoughts, moods, feelings, behavior and physical health.

• People used to think it was “all in your head” and that if really tried, can “pull yourself out of it”

• Doctors now know that depression is not a weakness and cannot treat by its own.

• It is a medical disorder with a biological or chemical basis.

• Sometimes, a stressful life event triggers depression.

• Other times depression seems to occur spontaneously is much more than grieving or a bout of the blues.

• Depression may occur only once in a person’s life.

• Often, however it occurs as repeated episodes over a lifetime, with periods free of depression in between or it may be chronic condition, requiring on going treatment over a lifetime.

• Medications are available that are generally sage and effective, even for the most severe depression.

• With proper treatment, most people with serious depression improve, often within weeks and can return to normal daily activities.

Incidence more in women (twice) Chances of episodes increases with age Risk of serious depression increases in later

years of life Affects children also Loss of energy and interest Feelings of guilt Difficulty in concentration Loss of appetite Thoughts of death or suicide

• The causes of depression are complex, genetic, biological and environmental factors can contribute to its development.

• Some people’s depression can be traced to a single cause while in others, a number of causes are at play.

• For many causes are never known.

CAUSES OF DEPRESSION

• These chemicals are called neurotransmitters.

• The abnormalities are thought to be biological, that are not caused by anything (he/she) did.

• While we still don’t know exactly how levels of these neurotransmitters affect more, we do know that the levels can be affected by a number of factors like heredity, personality, situations, medical conditions, medications, substance abuse, diet, etc.

Currently, it appears that depression occurs as a result of abnormalities in the level of certain chemicals in the brain.

• Certain people are more likely to develop clinical depression. The following are risk factors for depression in adults:

1. Female sex

2. Advanced age

3. Lower socioeconomic status

4. Recent stressful life experience

5. Chronic medical condition.

6. Underlying emotional or personality disorder

7. Substance abuse

8. Family history of depression, especially in a close relative

9. Lack of social support

• Many of these risk factors also apply to children. Other risk factors for depression including the following:

1. Co-occurring illness

2. Medication effects

3. Not taking medications for medical conditions

4. Living alone, social isolation

5. Being recently widowed.

SIGNS AND SYMPTOMS

EMOTIONAL PHYSICAL

• Sadness• Anxiety• Guilt• Anger• Mood swings• Lack of emotion• Responsiveness• Helplessness• Hopelessness

• Chronic fatigue, lack of energy

• Sleeping too much or too little• Overeating or loss of appetite• Constipation• Weight loss or gain• Irregular menstrual cycle• Loss of sexual desire and

unexplained aches and pains.

SIGNS AND SYMPTOMS

BEHAVIORAL THOUGHTS/PERCEPTIONS

• Crying spells• Withdrawal from

others• Worrying• Neglect of

responsibilities• Loss of interest

in personal appearance

• Loss of motivation

• Frequent self criticism• Self blame• Pessimism• Impaired memory and

concentration and confusion• Tendency to believe other see

in a negative light• Thoughts of death and

suicide.

• The goals of treatment are to improve quality of life, increase functioning and reduce the risk of death through suicide.

• Antidepressant medications and/or psychotherapy can be very effective.

• Antidepressant medications - Counteracting depression or an agent used in treating depression

• Electroconvulsive therapy (ECT) - a form of treatment of mental disorders in which convulsions are produced by the passage of an electric current through the brain.

TREATMENT

• Psychotherapy - Treatment of emotional, behavioral, personality, and psychiatric disorders based primarily upon verbal or nonverbal communication and interventions with the patient, in contrast to treatments utilizing chemical and physical measures.

• Support groups - should be lead by an experienced and competent therapist.

• Selective serotonin reuptake inhibitors (SSRIs)

• Other newer antidepressants

• Tricyclic antidepressants

• Monoamine oxidase inhibitors (MAOIs)

SOME COMMON ANTIDEPRESSANTS

YOGA MODULE FORDEPRESSION

Daily morning Sithlikarana Vyayama (1-15) Yogasanas (1-15) Pranayama (1-5) Meditation ( 1 & 2 alternate)

Kriyas – Twice a week once Surya Anuloma Viloma Pranayama 4

times a day and 27 rounds each time

• Schizophrenia is a chronic and often debilitating mental illness.

• The condition can cause to withdraw from the people and activities in the world around and to retreat into a world of delusions or separate reality.

• It is a form of psychosis, which is an impairment of thinking in which the interpretation of reality is abnormal.

• Psychosis is a symptom of disordered brain function.

INTRODUCTION

• The illness affects approximately 1 percent of the population worldwide.

• In men, schizophrenia typically emerges in the teens or 20s. In women, the onset of schizophrenia typically is in the 20s or early 30s.

• There's often no cure for schizophrenia, but by working closely with a psychiatrist and other mental health professionals, schizophrenia can be managed successfully — especially with an early diagnosis.

• Fortunately, newer medications continue to make this poorly understood disorder more manageable.

• Delusions — personal beliefs not based in reality, such as paranoia that are being persecuted or conspired against

• Bizarre delusions — for example, a belief in Martians controlling the thoughts

• Hallucinations — sensing things that don't exist, such as imaginary voices

• Incoherence

• Lack of emotions or inappropriate display of emotions

SIGNS AND SYMPTOMS

• A persistent feeling of being watched

• Trouble functioning at work or in social situations

• Social isolation

• Difficulty with personal hygiene

• Clumsy, uncoordinated movements

• Generally, schizophrenia causes a slowly progressive deterioration in the ability to function in various roles, especially in job and personal life.

• The signs and symptoms of schizophrenia vary greatly.

• A person may behave differently at different times.

• He or she may become extremely agitated and distressed, or fall into a trance-like, immobile, unresponsive (catatonic) state, or even behave normally much of the time.

• Signs and symptoms that occur continuously and progressively may indicate schizophrenia.

• In general, schizophrenia has symptoms that fall into three categories:

– Negative

– Positive and

– Cognitive

• Negative signs and symptoms may appear early in the disease, and a person may not think he or she needs treatment.

• They are referred to as negative because they indicate a loss of behavior or of a personality trait.

• Negative signs generally accompany a slow deterioration of function, leading to becoming less sociable. Such signs may include (1) Dulled emotions (lack of expression); (2) Inappropriate emotions (laughing while expressing terrifying images); (3) A change in speech (speaking in a dull monotone)

Negative signs and symptoms

• Positive signs include hallucinations and delusions.

• They are called positive because they indicate a trait or behavior that's been added to the personality.

• Hallucinations:

• Delusions:

Positive signs and symptoms

• These signs and symptoms tend to be more subtle than positive and negative ones.

• Cognitive signs and symptoms may include:

– Problems making sense of incoming information

– Difficulty paying attention

– Memory problems

Cognitive signs and symptoms

Schizophrenia may exist alone or in combination with other psychiatric or medical conditions. Misconceptions about schizophrenia and its relation to other mental illnesses abound. The following truths will help clarify what it is and is not:

• Schizophrenia isn't the same as a split or multiple personality. Multiple personality disorder is a separate, rare condition.

• Although some people with schizophrenia develop violent tendencies, most don't. Many withdraw into themselves rather than interact with others.

Misconceptions about schizophrenia

• Not everyone who acts paranoid or distrustful has schizophrenia. Some people have a paranoid personality disorder, a tendency to be suspicious or distrustful of others, without the other features of schizophrenia.

• Not everyone who hears voices is schizophrenic. Some people with depression may hear voices. Hearing voices may also occur as a result of a serious medical illness or from the effects of medication.

• While not necessarily a sign of schizophrenia, drug abuse is more common in people with schizophrenia.

• Nicotine is a commonly abused drug by people with schizophrenia; it's estimated that 75 percent to 90 percent of people with schizophrenia smoke compared with about one-quarter of the general population.

• Some drugs, such as amphetamines, cocaine and marijuana, can make schizophrenia symptoms worse. Others, such as nicotine, can interfere with schizophrenia medications.

Substance abuse and schizophrenia

• Researchers haven't identified the cause or causes of schizophrenia, although they believe genetic factors play a role.

• About 1 percent of the general population develops schizophrenia compared with 10 percent of those with a close family relative who has the disease.

• Chemical or subtle structural abnormalities in the brain may contribute to causing this illness.

CAUSES

• Before making a diagnosis of schizophrenia, doctor likely will rule out other possible causes of the signs that may suggest schizophrenia.

• It's possible that other mental or physical illnesses may cause signs similar to schizophrenia.

• Doctor wants to discuss the family and medical history and do a physical examination.

SCREENING AND DIAGNOSIS

• Doctor may ask for blood or urine samples to see if medications, substance abuse or another physical illness may be a factor in signs.

• Among the other mental illnesses that may at least partly resemble schizophrenia are depression, bipolar disorder, other psychoses, and abuse of alcohol and other drugs.

• It's also possible that physical illnesses such as certain infections, cancers, nervous system disorders, thyroid disorders and immune system disorders may produce some psychotic signs.

• Psychosis is also a possible side effect of some medications.

• If no other underlying cause is found, doctors diagnose schizophrenia based on the signs and symptoms.

• Antipsychotic medications, also known as neuroleptics, are the cornerstone of treatment. Until the 1990s, antipsychotics generally were much more effective in controlling positive symptoms than negative symptoms.

• A new generation of antipsychotics provides more effective management of both positive and negative symptoms.

• These antipsychotics include clozapine, risperidone, olanzapine, etc.

TREATMENT

• According to the American Diabetes Association, certain antipsychotic drugs may increase the risk of diabetes, obesity and high blood pressure.

• For this reason, people who take Clozaril, Risperdal, Zyprexa, Seroquel, Geodon or Abilify should be screened and carefully monitored by their doctors.

• Smokers may need higher doses of antipsychotic medication because nicotine interferes with these medications.

• Newer antipsychotic medications have fewer side effects.

• For example, for most people there's a lower incidence of tardive dyskinesia (TD) with the newer drugs than with the older medications.

• TD results in involuntary movements of the mouth, lips, tongue and other parts of the body.

• Other possible side effects of the older medications include interactions with other medications, risk of seizures and reductions of the white blood count.

• The new drugs represent a real advance in the treatment of schizophrenia and have led to greater independence and a higher quality of life for many people with schizophrenia.

• In general, the goal of treatment with antipsychotic medications is to effectively control signs and symptoms at the lowest possible dosage.

• The appropriate medication and dosage vary widely from person to person.

• Even with good treatment, may experience relapses despite ongoing drug treatment, but medications may reduce the frequency of relapses.

• Although the newer-generation medications have fewer side effects and better adherence rates, nonadherence with medication schedules remains a difficult problem.

• Unfortunately, some people with schizophrenia fail to adhere to treatment recommendations and deny that anything is wrong with them.

• The nature of the disorder may prevent them from seeking help or adhering to treatment on their own.

Failing to take medications is a problem

• Although medications are the mainstay of treatment to reduce signs and symptoms, many people with schizophrenia also benefit from nondrug therapies. These may include:

• Individual therapy. Cognitive therapy involves a therapist helping to learn ways of coping with stressful thoughts and situations to reduce the risk of a relapse.

• Learn to change negative patterns of thought and behavior into ways that put in control of the thoughts and feelings.

Nondrug therapies

• Illness may have made it more difficult to do things in the daily life that people without schizophrenia may take for granted.

• A therapist can also help to comply with the schedule of medications.

• Family therapy. Both the patient and family members may benefit from therapy that provides support and education to families.

• Symptoms have a better chance of improving if family members understand illness, can recognize stressful situations that might trigger a relapse and can help to stick to schedule of drug treatment.

• Conversely, may not do as well if family members distance themselves from patient and are less understanding and more critical of illness.

• Rehabilitation. Training in social and vocational skills necessary to live independently is an important part of recovery.

• With the help of a therapist, he/she can learn social skills such as good hygiene, cooking and traveling.

• People with schizophrenia who are in programs to train them in social skills or for jobs — and help them find and keep jobs — seem to experience much greater improvement in symptoms than do those who don't receive vocational training and job placement.

For family members and friends of people with schizophrenia, coping with the illness may involve a significant commitment of time and effort.

COPING SKILLS

Support groups

• Support groups can be a valuable part of a wider network of social support that includes health care professionals, family, friends and a place of religious worship.

• Various support groups bring together people, family and friends who are coping with any of a wide variety of physical or mental health problems.

• Support groups for schizophrenia provide a setting in which people can share their common problems and provide ongoing support to one another.

• Ask doctor about self-help groups that may exist in the community.

• Local health department, public library, telephone book and the Internet also may be good sources to locate a support group in area.

• As a family member or friend of someone with schizophrenia, can make a big difference in the success of treatment.

• Taking antipsychotic medications is a mainstay of treatment of schizophrenia, as are nonmedication approaches such as individual therapy.

• Helping a person with schizophrenia keep to his or her schedule of medications and follow-up treatment will help prevent relapses.

Follow-through

• Be observant about unusual behavior or signs of a relapse that may indicate a need for immediate medical attention.

• Keep in mind that positive support and encouragement may work much better than criticism and pressure.

INTEGRATED YOGA MODULE FOR COMMON PSYCHIATRIC DISORDERSSithilikarana Vyayama (loosening exercises) Jogging Spinal twist and Spinal stretch Knee stretch Forward and Backward bending Alternate toe touching Suryanamaskar Relax by walking Tiger stretch Alternate Bhujangasana and Parvathasana Cycling Pascimottanasana stretch Side leg raising Quick relaxation technique (QRT)

Yogasanas Ardhakati cakrasana Padahastasana Ardha cakrasana Bhujangasana Salabhasana Dhanurasana Sarvangasana Matsyasana Halasana Chakrasana Sasankasana Vakrasana/ Ardha-Matsyendrasana Ustrasana Deep relaxation technique (DRT)

Pranayama Kapalabhati Vibhaga pranayama (Sectional breathing) Surya Anuloma pranayama Nadi suddhi Sitali/ Sitkari/ Sadanta BhramariMeditation (Dhyana Dharana) Nadanusandhana OM meditationKriyas Jala Neti Sutra Neti Vaman Dhouti