Efficacy of ketamine, propofol, and dexmedetomidine for anesthesia in electroconvulsive therapy in treatment-resistant major depressive disorder patients: a double-blind randomized clinical trial.

Electroconvulsive therapy (ECT) is one of the therapeutic opportunities for patients with psychological disorders when they may decline to take medication. We sought to systematically compare the anesthetic efficacy of ketamine, propofol, and dexmedetomidine for electroconvulsive therapy in treatment-resistant major depressive disorder patients. This double-blind trial enrolled treatment-resistant major depressive disorder patients (n = 85) who had been hospitalized for ECT in the Amir Kabir Hospital's psychiatric ward (Arak, Iran). The ketamine, propofol, and dexmedetomidine groups received a dose of 0.2 µg/kg ketamine, 1.5 mg/kg propofol, and 0.8 mg/kg dexmedetomidine, respectively. In all intervention groups, 10 mL of interventional drugs was injected intravenously for 10 minutes, and in the placebo group, 10 mL of normal saline was given over the same period. The dexmedetomidine group's blood pressure was revealed comparatively lower at all times. Dexmedetomidine-treated patients showed their marked satisfaction, while those treated with propofol had shorter recovery time, shorter seizure duration, and shorter time to achieve an Aldrete score of 9-10 and increased relaxation, and next dexmedetomidine produced deeper relaxation. Propofol could shorten recovery time and seizure duration, and enhance relaxation, while dexmedetomidine was associated with higher patient satisfaction. Considering that any anesthetic which does not shorten seizure duration may serve efficiently for ECT and that ketamine-treated patients had more prolonged seizure duration, the preferred drug can hence be considered from various angles, thereby offering anesthetic agents with highly favorable efficacy in treatment-resistant major depressive disorder patients needing ECT. The drug choice thus depends on physical conditions, underlying diseases, and psychiatrist consultation.

Berberine: Is it a Promising Agent for Mental Disorders Treatment?

Effective and better-tolerated agents for the treatment of most of psychiatric disorders are one of the main challenges. Recently, anti-inflammatory, antioxidants and neuroprotective agents as adjuvant therapy have been shown to be able to play a role against the degenerative mechanisms commonly related to psychiatric conditions. Berberine, a biologically active alkaloid derived from various plants, represents many pharmacological impacts, such as antimicrobial, antidiabetic, anticancer, antioxidant and anti-inflammatory activities. This compound also protects neurons and improves the survival, growth and action of nerve cells due to its high potential for crossing the blood-brain barrier. Ample evidence reported that berberine had been associated with CNS-related disorders, including Alzheimer's, cerebral ischemia, mental depression, schizophrenia and anxiety. Thus, in this review, we aimed to indicate the effectiveness of berberine on mental disorders.

Comparing the efficacy of aripiprazole as an add-on to valproate with other second-generation antipsychotics in acute mania symptoms in manic patients in Iran.

BACKGROUND: Given the great importance of treating patients with bipolar disorder, the aim of this study was to compare the efficacy of aripiprazole with other second-generation antipsychotics in relieving acute symptoms of mania. MATERIALS AND METHODS: In this study, 50 patients with bipolar I disorder, manic episode, were divided into two groups receiving aripiprazole (n = 25) and other second-generation antipsychotics (risperidone, olanzapine, and quetiapine) (n = 25) for 6 weeks. The disease severity was evaluated and compared according to YMRS and CGI criteria. RESULTS: The mean severity of mania according to YMRS and CGI, at week 0 in comparison with weeks 2, 4 and 6 in both groups was significantly different (p < 0.0001) and the treatment with Aripiprazole at week 2 (p < 0.0001) and 4 (p = 0.0002) was significantly better than the other second-generation antipsychotics. The two groups also showed an overall improvement in CGI-based results at weeks 4 and 6 (p = 0.002). In addition, the efficacy index for aripiprazole at weeks 4 (p = 0.011) and 6 (p < 0.0001) as well as disease improvement in the second (p < 0.0001) and fourth (p = 0.026) weeks after treatment were better than the other second-generation antipsychotics. CONCLUSIONS: Aripiprazole and other second-generation antipsychotics, 2 weeks after initiation of treatment, significantly reduced mania severity in patients with bipolar disorder, however, aripiprazole seems to be more efficient and faster for controlling mania in patients with bipolar disorder.KEY POINTSAripiprazole and other second-generation antipsychotics, 2 weeks after initiation of treatment, significantly reduced mania severity in patients with bipolar disorder.Comparison between the two drugs, aripiprazole showed a more beneficial role in the second and fourth weeks than second-generation antipsychotics.Due to the fact that the possible mechanisms involved in the role of aripiprazole have not been considered compared to other antipsychotics in patients with bipolar disorder, there is a need for more extensive studies in this field.

Influence of modafinil on early ejaculation - Results from a double-blind randomized clinical trial.

BACKGROUND: For men, early ejaculation is a serious health concern. Here, we tested the influence of modafinil (Profinil®) on early ejaculation. To this end, we performed a double-blind randomized clinical trial among men with early ejaculation. METHODS: A total of 46 men with early ejaculation (mean age: 37.35 years) and in stable marital relationships with regular weekly penile-vaginal intercourse were randomly assigned either to the modafinil (100 mg) or to the placebo condition. Compounds were taken about 4-6h before intended penile-vaginal intercourse. At baseline and four weeks later at the end of the study, participants completed a series of self-rating questionnaires covering early ejaculation. Female partners also rated their male partners' early ejaculation profile. RESULTS: Dimensions of early ejaculation improved over time, but only so in the modafinil condition, while no improvements were observed in the placebo condition. CONCLUSIONS: Among male adults in stable marital relationships with regular weekly penile-vaginal intercourse modafinil improved dimensions of early ejaculation, always compared to placebo. Given the strong effect of modafinil on cognitive-executive processes, it is conceivable, that modafinil acted both via physiological and cognitive-executive pathways.

Are Essential Trace Elements Effective in Modulation of Mental Disorders? Update and Perspectives.

The emergence of mental disorders is associated with several risk factors including genetic and environmental susceptibility. A group of nutrients serves an especially important role in a number of essential neurodevelopmental processes through brain areas promoting the high degree of brain metabolism during early life, although almost all nutrients are needed. These include macronutrients and micronutrients (e.g., iron, magnesium, zinc, copper, selenium). Numerous nutritional psychiatry trials have been performed to examine the correlation of many individual nutrients with mental health, such as essential trace elements. The increased accumulation or lack of such components will facilitate an alternative metabolic pathway that can lead to many diseases and conditions of neurodevelopment. Mental functions have biochemical bases, so the impairment of such neurochemical mechanisms due to lack of trace elements can have mental effects. In psychological conditions such as depression, anxiety, schizophrenia, and autism, scientific studies demonstrate the putative role of trace element deficiency. Therefore, given the critical roles played by essential trace elements in the neurodevelopment and mental health, the effect of these elements' intake on the modulation of psychological functioning is reviewed.

A Review on Chitosan in Drug Delivery for Treatment of Neurological and Psychiatric Disorders.

Neurological diseases are known as global health problems with a growing number of patients annually. Neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease as well as spinal cord injury, hypoxic ischemia injury, epilepsy, depression and etc., are some examples of neurological diseases. One of the main problems in the treatment of these diseases is the delivery of drugs across the blood-brain barrier (BBB). These days, researchers have tended to find non-invasive and non-toxic strategies for solving this problem. As a non-toxic, safe, and potential agent, chitosan has attracted attention for use in drug delivery systems. Recently, numerous studies have been designed to develop drug delivery systems by using chitosan to treat various neurological diseases. In this paper, the latest developments of chitosan and its derivatives utilization in the drug delivery systems for the treatment of different neurological and psychiatric diseases were reviewed.

Sources of Health Anxiety for Hospital Staff Working during the Covid-19 Pandemic.

BACKGROUND: During the COVID-19 pandemic, the likelihood that hospital staff will report symptoms of depression, anxiety, and stress has increased. The aim of this study was to evaluate the relative influences of circumstantial, demographic, and trait-state anxiety variables on health anxiety in this group. METHODS: A total of 168 hospital staff members (mean age: 28.91 years; 56.5% females) participated in the study. They completed a series of questionnaires covering sociodemographic characteristics, health anxiety, state-trait anxiety, and job-related information. Participants also reported whether they had close acquaintances (friends, family members) infected with COVID-19. RESULTS: Higher health anxiety was related to both trait and state anxiety. Working on the frontline, being in contact with close acquaintances infected with COVID-19, and higher state and trait anxiety predicted higher health anxiety. Gender, age, and educational background were not predictors. CONCLUSIONS: In a sample of hospital staff, subjective feelings of anxiety about one own's health were related to personality traits, individual experiences of having close acquaintances infected with COVID-19, and working on the frontline.

Molecular and biological functions of resveratrol in psychiatric disorders: a review of recent evidence.

Mental disorders including depression, anxiety, schizophrenia, autism spectrum disorders, bipolar and etc. have a considerable proportion of global disorder burden. Many nutritional psychiatry investigations have been conducted to evaluate the relationship between several individual nutrients such as herbal compounds with mental health. Resveratrol, a famous polyphenol compound, is known as an antioxidant, anti-inflammatory, anti-apoptotic, and neuroprotective agent regulating the function of brain and improves the behavioral factors associated with learning, anxiety, depression, and memory. In addition, this natural compound can cross the blood-brain barrier representing neurological influences. The pharmacological interest of utilizing resveratrol in mental disorders is due to its anti-inflammatory and antioxidant features. The aim of this paper was to review the studies evaluated the potential effects of resveratrol on mental disorders.

Health Anxiety Predicts Postponing or Cancelling Routine Medical Health Care Appointments among Women in Perinatal Stage during the Covid-19 Lockdown.

To avoid spreading the Corona Virus Disease 2019 (COVID-19), health authorities have forced people to reorganize their working and private lives and to avoid open and public spaces as much as possible. This has also been the case for women both during pregnancy and after delivery. Here, we investigated the associations between subjective beliefs in risk of infections and health anxiety, depression, stress, and other perinatal dimensions. To this end, we assessed 103 women (mean age: 28.57 years) during pregnancy and after delivery. They completed a series of questionnaires covering sociodemographic information, perinatal information, health anxiety, post-partum depression, and stress. Sixty-six participants (64.1%) were in the pre-partum stage, and 37 (35.9%) were post-partum. Health anxiety was unrelated to depression or stress. Knowing and being close to infected people was associated with higher health anxiety. Strict following of the safety recommendations was associated with greater health anxiety, depression, and stress. Postponing or cancelling routine medical check appointments was observed among participants with high health anxiety scores. Higher illness severity, overall health anxiety scores, and lower stress scores predicted those participants who postponed or cancelled their routine medical check appointments. Post-partum stage and a larger number of children were associated with higher stress scores, but not with depression or stress. The results are of practical and clinical importance; it appears that health anxiety, which is to say fear of getting infected with COVID-19 during pregnancy or at the post-partum stage, was associated with postponing or cancelling routine medical check appointments, but not with stress or depression.

Serum oxytocin concentrations in current and recent suicide survivors are lower than in healthy controls.

BACKGROUND: Suicide and suicide attempts are dramatic events both for the individuals concerned and for their social circles. From a psychopathological perspective, suicidal behavior could be understood as a severe breakdown in relations with their social worlds. Oxytocin is a neuropeptide highly involved in the perception of facets of social relationship such as their quality feelings of belongingness, and mutual trust. Given this, we expected that serum oxytocin concentrations would be lower in current and recent suicide survivors than in healthy controls. METHODS: A total of 48 participants (mean age: 27 years; 62.5% females) took part in the study. Of these, 16 (62.5% females) survived a suicide attempt 12-24 h ago; 16 (62.5% females) had made a suicide attempt about 12 weeks ago, and 16 (62.5% females) were healthy age- and gender-matched controls. Blood samples were taken in the morning to assess serum oxytocin concentrations. Participants also completed questionnaires covering sociodemographic information and a scale assessing suicidal ideation. RESULTS: Compared to healthy controls, suicide survivors had significantly lower serum oxytocin concentrations, but these levels did not differ between current and recent suicide survivors. Compared to healthy controls and recent suicide attempters, current suicide attempters recorded significantly higher scores on the Beck scale for suicidal ideation. Across the sample as a whole, higher scores for suicidal ideation were associated with lower serum oxytocin concentrations. Serum oxytocin concentrations and scores on the Beck scale for suicidal ideation did not differ between females and males. CONCLUSIONS: Given that oxytocin is a neurobiological correlate of subjectively perceived quality of social interaction and social relationships, the results support the notion that suicide attempts are closely linked to suicide survivors' perceptions of the quality of their social lives. Speculatively, and based on the serum oxytocin concentrations, it also appears that 12 weeks after a suicide attempt, the survivor's perceived quality of social life has not significantly improved.

Repetitive Transcranial Magnetic Stimulation Improved Symptoms of Obsessive-Compulsive Disorders but Not Executive Functions: Results from a Randomized Clinical Trial with Crossover Design and Sham Condition.

OBJECTIVE: Whereas there is growing evidence that repetitive transcranial magnetic stimulation (rTMS) favorably impacts on symptoms of obsessive-compulsive disorders (OCD), less is known regarding the influence of rTMS on cognitive performance of patients with OCD. Here, we tested the hypothesis that rTMS has a positive impact both on symptom severity and executive functions in such patients. METHODS: We assessed 10 patients diagnosed with OCD (mean age: 33.5 years) and treated with a standard medication; they were randomly assigned either to a treatment-first or to a sham-first condition. Symptom severity (experts' ratings) and executive functions (Wisconsin Card Sorting Test) were assessed by independent raters unaware of the patients' group assignments at baseline, after 2 and 4 weeks. After 2 weeks, treatment switched to sham condition, and sham condition switched to treatment condition. RESULTS: Under treatment but not under sham conditions, symptom severity decreased. Performance on the executive function test increased continuously with every new assessment and was unrelated to rTMS treatment. CONCLUSION: Whereas the present study confirmed previous research suggesting that rTMS improved symptoms of OCD, rTMS did not improve executive functions to a greater degree than sham treatment. More research is needed to investigate the effect of rTMS on executive functions in patients with OCD.

Repetitive Transcranial Magnetic Stimulation (rTMS) improves symptoms and reduces clinical illness in patients suffering from OCD--Results from a single-blind, randomized clinical trial with sham cross-over condition.

OBJECTIVES: Both psychotherapeutic and psychopharmacological methods are used in the treatment of patients suffering from obsessive-compulsive disorders (OCD), and both with encouraging but also mixed results. Here, we tested the hypothesis that repetitive Transcranial Magnetic Stimulation (rTMS) improves symptoms and reduces illness severity in patients suffering from treatment-resistant OCD. METHODS: A total of 21 patients (57% females; mean age: M = 35.8 years) suffering from treatment-resistant OCD were randomly assigned either to an rTMS-first-sham-second, or a sham-first-rTMS-second condition. Treatment sessions lasted for 4 weeks with five sessions per week, each of about 50 min duration. Symptoms were assessed via both self- and expert-ratings. RESULTS: Both self- and expert-reported symptom severity reduced in the rTMS condition as compared to the sham condition. Full- and partial responses were observed in the rTMS-condition, but not in the sham-condition. CONCLUSIONS: The pattern of results from this single-blind, sham- and cross-over design suggests that rTMS is a successful intervention for patients suffering from treatment-resistant OCD.