Effect of cranial electrotherapy stimulation as an add-on therapy on late-life generalized anxiety disorder: An open-label study.

INTRODUCTION: Cranial electrotherapy stimulation (CES) is beneficial in reducing anxiety in psychiatric patients. However, no studies have reported on elderly patients with generalized anxiety disorders (GAD). This study aimed to determine the efficacy and safety of a 6-week CES intervention for late-life GAD. MATERIALS AND METHODS: This single-arm pilot study assessed 6-week CES treatment (Alpha-Stim AID) for late-life GAD and 4-week follow-up post intervention. The Hamilton Rating Scale for Anxiety (HAMA) and Beck Anxiety Inventory (BAI) were used as baseline and outcome measures at weeks 4, 6, and 10, respectively. Treatment response was defined as 50 % or more reduction of the HAMA score and remission was defined as a of score ≤7 on the HAMA. Other measures included depression, sleep quality, and quality of life assessment. RESULTS: We included participants (n = 27) aged 68.0 ± 5.0 years, 81.5 % of whom were female. Fifteen (55.6 %), 18 (66.7 %), and 15 (55.6 %) patients were concurrently treated with antidepressants, BZDs, and antipsychotics, respectively. Intention-to-treat (ITT) analysis revealed a significant decrease in HAMA scores from baseline (20.96 ± 3.30) to week 6 (12.26 ± 7.09) and one-month (12.85 ± 7.08) follow-up at W10 (all p < 0.001). The response and remission rates were 33.3 %, 40.7 %, and 48.1 % and 25.9 %, 29.6 %, and 25.9 % at W4, W6, and W10, respectively. The CES improved depression and sleep conditions as measured by the Beck Depression Inventory-II and Pittsburgh Sleep Quality Index. CONCLUSIONS: CES clinically reduces symptoms of anxiety and depression and may improve sleep quality in late-life GAD. Future randomized controlled study is needed.

Electroconvulsive therapy for obsessive compulsive symptoms in a patient with schizophrenia: a brief report.

Comorbid obsessive-compulsive disorder (OCD) is common among patients with schizophrenia. The role of electroconvulsive therapy (ECT) in the treatment of OCD in schizophrenia is unclear. Herein, we present a 45-year-old man who was diagnosed with schizophrenia along with OCD and received ECT due to relapse of psychosis owing to refractive schizophrenia. Together with psychotic symptoms, obvious symptoms of OCD were observed prior to treatment, including obsessive thoughts, difficulty in starting activities, and repetitive and ritualistic behavior. After 12 sessions of ECT, symptoms of schizophrenia and OCD both improved significantly (Positive and Negative Syndrome Scale [PANSS] score decreased from 95 points to 58 points, and Yale - Brown Obsessive-Compulsive Scale [Y-BOCS] score decreased from 29 points to 11 points). Mild aggravation of OCD symptoms was noted 3 months after ECT treatment (Y-BOCS score increased from 11 points to 17 points) without obvious relapse of psychotic symptoms (PANSS score changed from 58 points to 62 points). In conclusion, ECT could be considered as an alternative therapy for patients with schizophrenia and OCD with limited response to pharmacological treatment.

Elucidating the mechanism of photochemical CO2 reduction to CO using a cyanide-bridged di-manganese complex.

The complex, [{[Mn(bpy)(CO)3]2}(µ-CN)]+ (Mn2CN+), has previously been shown to photochemically reduce CO2 to CO. The detailed mechanism behind its reactivity was not elucidated. Herein, the photoevolution of this reaction is studied in acetonitrile (MeCN) using IR and UV-vis spectroscopy. Samples were excited into the MnI → π* bpy metal-to-ligand charge transfer (MLCT) absorption band triggering CO loss, and rapid MeCN solvent ligation at the open coordination site. It is concluded that this process occurs selectively at the Mn axial ligation site that is trans to the C-end of the bridging cyanide. Upon further photolysis, the metal-metal bonded dimeric species, [(CO)3(bpy)Mn-Mn(bpy)(CO)3] (Mn-Mn) is observed to form under anaerobic conditions. The presence of this dimeric species coincides with the observation of CO production. When oxygen is present, CO2 photoreduction does not occur, which is attributed to the inability of Mn2CN+ to convert to the metal-metal bonded dimer. Photolysis experiments, where the Mn-Mn dimer is formed photochemically under argon first and then exposed to CO2, reveal that it is the radical species, [Mn(bpy)(CO)3˙] (Mn˙), that interacts with the CO2. Since the presence of Mn-Mn and light is required for CO production, [Mn(bpy)(CO)3˙] is proposed to be a photochemical reagent for the transformation of CO2 to CO.

Dose-Dependent Proton Pump Inhibitor Exposure and Risk of Type 2 Diabetes: A Nationwide Nested Case-Control Study.

Background: To investigate the association between proton pump inhibitor (PPI) exposure and a risk of type 2 diabetes mellitus (T2DM) among patients with upper gastrointestinal disease (UGID). Method: We conducted a case−control study from Taiwan's National Health Insurance Research Database between 1998 and 2013. A total of 20,940 patients with T2DM and 20,940 controls were included. The dose of PPIs was categorized according to the cumulative defined daily dose (cDDD). The risk of T2DM was assessed using conditional logistic regression analysis. Result: Compared with cDDD ≤ 30, higher dosage of PPI exposure was associated with an increased risk of T2DM development: cDDD 31−120 (odds ratio [OR]: 1.20, 95% confidence interval [CI]: 1.13−1.26); cDDD 121−365 (OR: 1.26, 95% CI: 1.19−1.33); and cDDD > 365 (OR: 1.34, 95% CI: 1.23−1.46). Subgroup analysis of individual PPI showed that pantoprazole (OR: 1.14, 95% CI: 1.07−1.21), lansoprazole (OR: 1.08, 95% CI: 1.03−1.12), and omeprazole (OR: 1.11, 95% CI: 1.06−1.16) have a significantly higher risk of T2DM development. Conclusions: A dose-dependent increased risk of T2DM was found among patients with UGID using higher doses of PPIs compared with those with lower doses of these drugs. Further studies are necessary to investigate the underlying pathophysiology of PPIs and T2DM.

Antidepressants and Risk of Type 2 Diabetes Mellitus: A Population-Based Nested Case-Control Study.

PURPOSE/BACKGROUND: The increased risk of type 2 diabetes mellitus (T2DM) among users of antidepressants (ADs) might be mediated by depression. We investigated whether ADs are associated with increased risk of T2DM in patients with depression. Moreover, the relationship between binding affinities of serotonin transporter (SERT) of ADs and the risk of T2DM is examined. METHODS/PROCEDURES: We conducted a retrospective nested case-control study using data from Taiwan's National Health Insurance Research Database between 2000 and 2013. A total of 3038 patients with depression, 1519 cases of T2DM, and 1519 controls matched for age, sex, and index date, were included. Exposure to ADs was categorized by type and SERT. The association between AD exposure and T2DM development was assessed using conditional logistic regression analysis. FINDINGS/RESULTS: No association between T2DM development and selective serotonin reuptake inhibitors (adjusted odds ratio [AOR], 1.01; 95% confidence interval [CI], 0.87-1.19; P = 0.962), serotonin-norepinephrine reuptake inhibitors (AOR, 1.13; 95% CI, 0.94-1.37; P = 1.196), tricyclic antidepressants (AOR, 1.01; 95% CI, 0.85-1.21; P = 0.906), or others (AOR, 0.88; 95% CI, 0.75-1.03; P = 0.104) was found. Alternatively, no association between individual ADs and potency of affinity to SERT and the risk of T2DM was found. IMPLICATIONS/CONCLUSIONS: No association between ADs and increase risk of T2DM was found in patients with depression. However, regular metabolic evaluations are recommended for patients with depression regularly taking ADs.

Reduction-induced CO dissociation by a [Mn(bpy)(CO)4][SbF6] complex and its relevance in electrocatalytic CO2 reduction.

[Mn(bpy)(CO)3Br] is recognized as a benchmark electrocatalyst for CO2 reduction to CO, with the doubly reduced [Mn(bpy)(CO)3]- proposed to be the active species in the catalytic mechanism. The reaction of this intermediate with CO2 and two protons is expected to produce the tetracarbonyl cation, [Mn(bpy)(CO)4]+, thereby closing the catalytic cycle. However, this species has not been experimentally observed. In this study, [Mn(bpy)(CO)4][SbF6] (1) was directly synthesized and found to be an efficient electrocatalyst for the reduction of CO2 to CO in the presence of H2O. Complex 1 was characterized using X-ray crystallography as well as IR and UV-Vis spectroscopy. The redox activity of 1 was determined using cyclic voltammetry and compared with that of benchmark manganese complexes, e.g., [Mn(bpy)(CO)3Br] (2) and [Mn(bpy)(CO)3(MeCN)][PF6] (3). Infrared spectroscopic analyses indicated that CO dissociation occurs after a single-electron reduction of complex 1, producing a [Mn(bpy)(CO)3(MeCN)]+ species. Complex 1 was experimentally verified as both a precatalyst and an on-cycle intermediate in homogeneous Mn-based electrocatalytic CO2 reduction.

A cyanide-bridged di-manganese carbonyl complex that photochemically reduces CO2 to CO.

Manganese(i) tricarbonyl complexes such as [Mn(bpy)(CO)3L] (L = Br, or CN) are known to be electrocatalysts for CO2 reduction to CO. However, due to their rapid photodegradation under UV and visible light, these monomeric manganese complexes have not been considered as photocatalysts for CO2 reduction without the use of a photosensitizer. In this paper, we report a cyanide-bridged di-manganese complex, {[Mn(bpy)(CO)3]2(µ-CN)}ClO4, which is both electrocatalytic and photochemically active for CO2 reduction to CO. Compared to the [Mn(bpy)(CO)3CN] electrocatalyst, our CN-bridged binuclear complex is a more efficient electrocatalyst for CO2 reduction using H2O as a proton source. In addition, we report a photochemical CO2 reduction to CO using the dimanganese complex under 395 nm irradiation.