Anxiolytic Research Articles

Commercial Incense: Compound Analysis and Its Molecular Docking Studies as Anxiolytic Agents

In the context of Indonesian culture, incense has been traditionally utilized in various rituals. Incense possesses a calming impact and has the potential to reduce anxiety. This physiological response stems from the interplay of chemical components within incense and receptors associated with relaxation, specifically GABAA. This research aims to explore the interaction between substances found in commercially incenses with the GABAA receptors. The compounds of incense were identified through Gas Chromatography-Mass Spectrometry (GCMS) analysis. And there were 54 compounds identified from the 5 incense samples. Next, the ligands employed for docking studies were compounds predicted to traverse the blood-brain barrier (BBB). There were 31 compounds potential of crossing the blood-brain barrier (BBB). Docking results indicated that the majority of tested compounds exhibited notably lower S-scores during receptor interaction, suggesting their potential as anxiety-relieving agents. Furthermore, molecular docking outcomes highlighted that 9-Octadecenoic acid (Z)-, 2-hydroxy-1-(hydroxymethyl)ethyl ester showed the lowest S-score (-6.573). These findings imply that odorant and other volatile organic compounds (VOCs) present in incenses possess the ability to function as anxiety-reducing (anxiolytic) agents, potentially assisting in anxiety treatment.

(108) ENHANCING PELVIC EXAM COMFORT AND DIAGNOSTIC ACCURACY: REVIEWING THE UTILITY OF NITROUS OXIDE FOR HYPERTONIC PELVIC FLOOR ASSESSMENT

Abstract Introduction Nitrous oxide is an anesthetic, anxiolytic, and analgesic commonly used for general and dental anesthesia, sedation, and severe pain. Studies show that nitrous oxide is also used in several in-office gynecological and urological procedures as a sedative and anxiolytic agent with a safer drug profile than other anesthetic agents. It is also being trialed as a treatment for mood disorders. Nitrous oxide does not render individuals unconscious, making it a more favorable option for stressful and painful medical procedures than general anesthesia because it allows the patient to feel more in control of their body and aware of the proceedings. Objective To analyze the use of in-office nitrous oxide during medical procedures and evaluate its effectiveness in reducing pain and anxiety levels to predict the utility of it during pelvic exams in patients with vestibulodynia. Methods A literature review was performed through the PubMed database between 2007-2022. The authors independently and thoroughly screened abstracts and full-text articles and assessed the relevant medical literature that acknowledged the use of nitrous oxide in in-office medical procedures. Key terms used to refine the search include [“nitrous oxide in medical procedures”], [“nitrous oxide in gynecology”], [“nitrous oxide in urology”]. Results One study explored the use of nitrous oxide during childbirth in women diagnosed with PTSD, and the results were significant for nitrous oxide reducing PTSD symptom severity. Multiple studies suggest the use of nitrous oxide during dental procedures reduces patient anxiety; one specifically measured sixty anxious patients pre- and post-endodontic procedures and noted a significant reduction in anxiety during the procedure with the use of nitrous oxide. Various studies of gynecological and urological procedures report the successful use of nitrous oxide in reducing peri-procedural pain compared to other analgesic alternatives. A common example is its use during intrauterine device insertion, which is correlated with higher patient satisfaction as it decreases pain. Additionally, a study among patients undergoing extracorporeal shockwave lithotripsy found no significant difference between the use of meperidine, an opioid, and nitrous oxide in post-procedural Visual Analog Scale pain scores with no adverse events reported in the nitrous oxide group. Another study revealed that using local anesthesia in transrectal prostate biopsies resulted in some patients experiencing notable anxiety and pain. At the same time, no such relationship was observed among patients who received nitrous oxide before this procedure. Conclusions Vestibulodynia is a subset of genitopelvic pain isolated to the vulvar vestibule. Vestibulodynia has three proposed etiologies: tissue neural proliferation, musculoskeletal, and hormonally mediated. Discriminating these three etiologies can be difficult, especially when a proper pelvic exam cannot be achieved due to patients’ discomfort. The three etiologies are biologically intertwined, often resulting in vestibulodynia patients experiencing pelvic floor hypertonicity without regard to specific etiology. A painful pelvic exam is stressful and often an anxiety-producing experience for patients with pelvic hypertonicity and vulvodynia. Hence, with the data provided, we suspect that nitrous oxide will be a useful treatment option to mitigate these consequences for the patient, with the added benefit of easing the exam for the provider, leading to a more accurate diagnosis. Disclosure No.

Isolation, characterization and therapeutic potential of a novel furanoid diterpene lactone from Hedychium spicatum rhizomes: Insights into antioxidant, anxiolytic, and circadian rhythm modulating properties

BackgroundHedychium spicatum rhizomes is widely used in ayurvedic medicine and traditional medicine systems around the Himalayas. PurposeStandardization of Hedychium spicatum rhizome SCFE extract by Identification, Isolation, characterization, and screening of pharmacological activity of phytoconstituents. Study designSupercritical fluid extraction, column chromatography, spectroscopic analysis, in-silico, and in-vivo study of compound 1 (3-((E) -2-((1S,8aR)-3,5,5,8a-tetramethyl-4-oxo-1,4,4a,5,6,7,8,8a-octahydro-naphthalen-1-yl) vinyl) furan-2(5H)-one). MethodsA supercritical fluid extract was prepared and further purified to obtain a novel Furanoid diterpene lactone compound 1 (3-((E) -2-((1S,8aR)-3,5,5,8a-tetramethyl-4-oxo-1,4,4a,5,6,7,8,8a-octahydro-naphthalen-1-yl) vinyl) furan-2(5H)-one). It was characterised using IR, LC-ESI/MS, 1H, 13C NMR, 2D NMR-COSY, NOESY, HMBC, and HSQC and thin-layer chromatography. Compound was tested for anxiolytic activity using various animal behavioural model included elevated maze plus test, light and dark box test, social interaction, actophotometer test, rotarod test. ResultsThe compound gives a false Dragendorff's test in favour of the presence of lactone. HPLC profiling was done using DAD using 30 % v/v of o-phosphoric acid (0.1 % v/v) in water and 70 % v/v of acetonitrile (ACN) in the mobile phase. Compound 1 having significant anxiolytic effect tested in animal behavioural model ****p < 0.0001 diazepam as standard. ConclusionFree radical scavenging activity suggested that compound 1 has good potential as an antioxidant, having IC50 values of 75.62 µg and 96.556 µg using DPPH and ABTS inhibition assays. ADMET prediction suggested that compound 1 follows Lipinski's rules of five, absorbed through the intestine, and penetrates the blood-brain barrier and CNS. In-silico studies, suggested that compound 1 has an affinity to bind with GABA, melatonin 1, and glutamate receptor 5 and In-vivo study suggest compound 1 will be a good candidate as anxiolytic agent. It can be used as a promising natural remedy for oxidative stress, mental health issues, and sleep-related disorders, warranting further exploration and clinical investigation.

Unraveling the multi-faceted role of Rosmarinus officinalis L. (rosemary) and diosmetin in managing gut motility

Ethnopharmacological relevanceRosmarinus officinalis L. (Rosemary) is a popular herb with reported effectiveness against diarrhea, anxiety and constipation, albeit with limited pharmacological evidence. Aim of the studyThe current study was aimed at evaluating the therapeutic potential, possible pharmacological mechanisms of action and active constituents of hydro-ethanolic extract of rosemary (Rs.Cr), as potential anti-diarrheal, laxative and anxiolytic agent. MethodRs.Cr was analyzed through reverse-phase high pressure liquid chromatography (RP-HPLC). Laxative, antidiarrheal, and anxiolytic activities were assessed using in vivo models. Spasmogenic and spasmolytic mechanisms were studied on isolated guinea pig ileum and rabbit jejunum tissues, respectively. Possible role of diosmetin, one of the active constituents of Rs.Cr was also evaluated. ResultsRP-HPLC analysis revealed presence of diosmetin, rutin and apigenin in Rs.Cr. Laxative effect was seen at low doses, which was partially reversed in atropinized mice. The spasmogenic mechanism was mediated by cholinergic and histaminergic receptors stimulation. At higher doses, antidiarrheal activity was evident, with reduction in gastrointestinal motility and secretions using charcoal meal and enteropooling assays, respectively. Rs.Cr also showed dose-dependent anxiolytic effect. The antispasmodic mechanisms were mediated by anti-muscarinic and K+ channel opening-like effect (predominant KATP-dependent). Diosmetin exhibited antidiarrheal and antispasmodic activities, but spasmogenic effect was not seen. ConclusionRosemary leaves have dual antidiarrheal and laxative effects, and as well as anxiolytic activity. In addition, the possible modulation of muscarinic and histaminergic receptors, and KATP channels show it as potential herb to be explored for irritable bowel syndrome. Diosmetin is possibly one of its constituents that contributes to its antidiarrheal activity.

Mental health in nursing homes: The role of immigration in the long-term care workforce

One-fourth of nursing home residents are diagnosed with anxiety disorders and approximately half live with depression. Nursing homes have long struggled with staffing shortages, and the lack of care has further heightened the risk of poor mental health. A key solution to both problems could be immigration. Prior studies have documented how immigrant labor could strengthen the long-term care workforce. We add to this picture by exploring the impact of immigrant inflows on the mental health outcomes of nursing home residents. Using a nationally representative dataset and a shift-share instrumental variable approach, we find empirical evidence that immigration reduces diagnoses of depression and anxiety, the use of antidepressant and antianxiety drugs, and self-assessed symptoms of depression. The results are robust to several sensitivity tests. We further find that the effect is more substantial in facilities with lower direct care staff hours per resident and with likely more immigrants without citizenship. Language barriers tend to be a minor issue when providing essential care. The findings suggest that creating a policy framework that directs immigrant labor to the long-term care sector can mutually benefit job-seeking immigrants and nursing home residents.

Assessing the Premedication Properties of Sublingual Melatonin in Young Women Undergoing Cesarean Section With Spinal Anesthesia: A Double-Blind Randomized Study.

Preoperative anxiety can negatively impact patient outcomes by influencing the intraoperative requirements for anesthetics and analgesics, increasing postoperative pain intensity, and augmenting the need for analgesia. Moreover, it may contribute to higher rates of postoperative morbidity and mortality following certain types of surgery. This study investigates the anxiolytic and sedative properties of sublingual melatonin as a premedication agent in young females undergoing cesarean section under spinal anesthesia. A double-blind, randomized, placebo-controlled trial was conducted in Nasiriyah, Iraq. Eighty females were included, 40 in each group, based on specific inclusion and exclusion criteria. Premedication was administered in the morning, 60 minutes before the procedure. In the melatonin group (M), patients received 10 mg of sublingual melatonin, while the placebo group (P) received placebo premedication. Anxiety and sedation levels were evaluated three times: before taking premedication, five minutes before the insertion of the spinal needle, and one hour postoperatively, using the visual analog scale and Richmond Sedation Scale. The results show a highly significant P-value regarding anxiety levels between the M Group and P Group (p-value < 0.001). There was a significant difference in the median sedation scores between the studied groups at pre-spinal insertion and postoperatively (p-value < 0.001). The mean heart rate in the M Group was significantly lower than in the P Group (p-value = 0.0019). Significant differences were noted in systolic and diastolic blood pressures between the two groups, measured five minutes before and after spinal needle insertion (p-value < 0.001). These findings contribute to understanding the impact of sublingual melatonin as an anxiolytic and sedative premedication agent on patients undergoing elective cesarean sections under spinal anesthesia. Further research is warranted to fully elucidate the benefits and implications of melatonin administration in such procedures.

Chlordiazepoxide against signalling, receptor and regulatory proteins of breast cancer: a structure-based in-silico approach.

Among the most prevalent forms of cancer are breast, lung, colon-rectum, and prostate cancers, and breast cancer is a major global health challenge, contributing to 2.26 million cases with approximately 685,000 deaths worldwide in 2020 alone, typically beginning in the milk ducts or lobules that produce and transport milk during lactation and it is becoming challenging to treat as the tissues are developing resistance, which makes urgent calls for new multitargeted drugs. The multitargeted drug design provides a better solution, simultaneously targeting multiple pathways, even when the drug resists one, it remains effective for others. In this study, we included four crucial proteins that perform signalling, receptor, and regulatory action, namely- NUDIX Hydrolases, Dihydrofolate Reductase, HER2/neu Kinase and EGFR and performed multitargeted molecular docking studies against human-approved drugs using HTVS, SP and extra precise algorithms and filtered the poses with MM\GBSA, suggested a benzodiazepine derivative chlordiazepoxide, used as an anxiolytic agent, can be a multitargeted inhibitor with docking and MM\GBSA score ranging from - 4.628 to - 7.877 and - 18.59 to - 135.86 kcal/mol, respectively, and the most interacted residues were 6ARG, 6GLU, 3TRP, and 3VAL. The QikProp-based ADMET and DFT computations showed the suitability and stability of the drug candidate followed by 100 ns MD simulation in water and MMGBSA on trajectories, resulting in stable performance and many intermolecular interactions to make the complexes stable, which favours that chlordiazepoxide can be a multitargeted breast cancer inhibitor. However, experimental validation is needed before its use.

(273) The Use of In-Office Nitrous Oxide to Aid in Diagnosing Hypertonic Pelvic Floor and Improve Patient Comfort with Pelvic Exams

Abstract Introduction Nitrous oxide is an anesthetic, anxiolytic, and analgesic commonly used for general and dental anesthesia, sedation, and severe pain. Studies show that nitrous oxide is also used in several in-office gynecological and urological procedures as a sedative and anxiolytic agent with a safer drug profile than other anesthetic agents. It is also being trialed as a treatment for mood disorders. Nitrous oxide does not render individuals unconscious, making it a more favorable option for stressful and painful medical procedures than general anesthesia because it allows the patient to feel more in control of their body and aware of the proceedings. Objective To analyze the use of in-office nitrous oxide during medical procedures and evaluate its effectiveness in reducing pain and anxiety levels to predict the utility of it during pelvic exams in patients with vestibulodynia. Methods A literature review was performed through the PubMed database between 2007-2022. The authors independently and thoroughly screened abstracts and full-text articles and assessed the relevant medical literature that acknowledged the use of nitrous oxide in in-office medical procedures. Key terms used to refine the search include [“nitrous oxide in medical procedures”], [“nitrous oxide in gynecology”], [“nitrous oxide in urology”]. Results One study explored the use of nitrous oxide during childbirth in women diagnosed with PTSD, and the results were significant for nitrous oxide reducing PTSD symptom severity. Multiple studies suggest the use of nitrous oxide during dental procedures reduces patient anxiety; one specifically measured sixty anxious patients pre- and post-endodontic procedures and noted a significant reduction in anxiety during the procedure with the use of nitrous oxide. Various studies of gynecological and urological procedures report the successful use of nitrous oxide in reducing peri-procedural pain compared to other analgesic alternatives. A common example is its use during intrauterine device insertion, which is correlated with higher patient satisfaction as it decreases pain. Additionally, a study among patients undergoing extracorporeal shockwave lithotripsy found no significant difference between the use of meperidine, an opioid, and nitrous oxide in post-procedural Visual Analog Scale pain scores with no adverse events reported in the nitrous oxide group. Another study revealed that using local anesthesia in transrectal prostate biopsies resulted in some patients experiencing notable anxiety and pain. At the same time, no such relationship was observed among patients who received nitrous oxide before this procedure. Conclusions Vestibulodynia is a subset of genitopelvic pain isolated to the vulvar vestibule. Vestibulodynia has three proposed etiologies: tissue neural proliferation, musculoskeletal, and hormonally mediated. Discriminating these three etiologies can be difficult, especially when a proper pelvic exam cannot be achieved due to patients’ discomfort. The three etiologies are biologically intertwined, often resulting in vestibulodynia patients experiencing pelvic floor hypertonicity without regard to specific etiology. A painful pelvic exam is stressful and often an anxiety-producing experience for patients with pelvic hypertonicity and vulvodynia. Hence, with the data provided, we suspect that nitrous oxide will be a useful treatment option to mitigate these consequences for the patient, with the added benefit of easing the exam for the provider, leading to a more accurate diagnosis. Disclosure No.

Benzodiazepine derivatives for the treatment of neuropharmacological disorders and pain management: Docking investigations and in-vivo studies

Benzodiazepines are well-known for their medicinal properties. The current study aimed to evaluate and seek new therapeutic possibilities of some of these compounds for addressing anxiety and pain. Four benzodiazepine derivatives were synthesized, characterized, and subjected to computational assessment of the GABAergic response upon interaction with human GABA-A receptors (PDBID: 6×3x) relative to the drug diazepam (DZP) to achieve the objective. Apart from the docking analysis, ADME analysis of the compounds was also performed. Following the in-silico evaluations, two of the synthesized compounds (designated as P3 and P4) were identified for subsequent in-vivo investigations utilizing laboratory rats to explore their anxiolytic potential in comparison to diazepam, and their analgesic efficacy relative to diclofenac sodium. The combination of in-silico and in-vivo assessments uncovered the binding sites of P4 (a fluoro derivative) and its potential as a superior anxiolytic drug compared to P3 (a hydroxy derivative) for analgesic relief. The ADME pharmacokinetic evaluation of the synthesized compounds by Lipinski rule of 5 suggested the oral bioavailability of these drugs. These findings are important as they provide valuable insights into the potential development of new anxiolytic and analgesic agents from the benzodiazepine derivatives that can be easily synthesized and developed into affordable drugs.

Prospective Study of 506 Dogs with Tick Paralysis: Investigating Measures of Severity and Clinical Signs as Predictors of Mortality and Assessing the Benefits of Different Therapeutics.

Survey data from 42 Australian eastern seaboard veterinary practices involving 506 cases are reported with regard to clinical signs, disease severity, mortality, use of pharmaceuticals, and recovery times. New measures of disease severity (visual analogue scales (VAS) and facial expressions) were tested alongside "gold standard" measures (neuromuscular junction (NMJ) scores). Univariable and multivariable logistic regression analyses were conducted to evaluate associations between variables. The VAS scores were progressive, prognostic (especially the respiratory scores) and correlated with the NMJ scores. The presence of inspiratory dyspnoea and crackles on the day of hospitalisation, progressing to expiratory dyspnoea and an expiratory wheeze 24 h later, were highly predictive of mortality. Altered facial features on hospital admission were also highly predictive of mortality. The previously used respiratory score (using various clinical signs) was not predictive of mortality. Older animals had a higher mortality rate, and no gender or breed susceptibility was found. The only pharmaceuticals that were positively associated with mortality were tick antiserum and, in severe cases, antibiotics. The use of many pharmaceutical products (acepromazine, atropine, steroids, antihistamines, antiemetics, diuretics, and S8 anti-anxiety and sedation drugs) had no effect on mortality. More drug classes were used with increasing clinical severity and specific factors (e.g., vomiting/retching, hydration) affected the period of hospitalisation. Geographic variation in respiratory signs and toxicity scores was evident, whereas mortality and disease severity were not different across regions.

Laryngopharyngeal Reflux – Difficulties in treatment during Covid pandemic

Abstract Introduction: Covid-19 as a pandemic has resulted fear of unknown and as a remedy in our population many have turned to home remedies for immune boosting as well as commercially available immune boosters. Most are spices and with overuse tend to cause reflux diseases. Materials and Methods: 52 subjects were chosen and there data was analysed, in 4 zones with sharing geographic borders. Subjects with known gastritis/ gastric surgeries / taking drugs prone to gastritis were excluded from the study. Videolaryngoscopy was done in all subjects during the presentation and in the monthly follow up period. Results: Males were commonly affected. 44% of cases were attributed to overuse of immune boosters. The most common presenting symptoms were foreign body sensation, frequent throat clearing and dysphagia. Only 7 patients had voice change. All patients benefitted with PPI with prokinetics and counselling. 98% of patients needed VLS pictures/ video for counselling. Conclusion: Immune booster intake should be moderated and side effects should be taught to population while taking the same. Anxiety induced LPRD can be treated without anti-anxiety drugs with proper education of the condition to the patient and relaxation techniques.

Investigation of CNS depressant and muscle relaxant effects of the ethnomedicinal plant Macropanax dispermus on Swiss Albino mice and its effect against oxidative stress.

Since plant-based natural drugs are widely accepted in modern times and possess numerous pharmacological effects with an extensive therapeutic range, an ethnomedicinal plant native to Bangladesh was selected to investigate for investigation of its various pharmacological effects. Macropanax dispermus has been traditionally used and has demonstrated numerous pharmacological effects in preclinical investigations. Therefore, this research aimed to assess the central nervous system (CNS) depressant and antioxidant activities of the crude methanol extracts of the stem barks (MDMS), leaves (MDML), and their different fractions. The CNS depressant activity was assessed using the hole cross, rota-rod, and elevated plus maze tests on Swiss Albino mice, while the antioxidant activity was evaluated using the 2,2-diphenyl-1-picrylhydrazyl free radical, hydrogen peroxide (H2O2) nonradical scavenging, and ferric reducing power assays. The conducted assays successfully demonstrated that the chloroform fraction of MDML is a significantly (P < 0.001) effective CNS depressant, muscle relaxant, and anxiolytic agent with excellent antioxidative effects compared to standard and control. The aqueous fraction of MDML also acted as a significantly (P < 0.001) active CNS depressant and muscle relaxant, and it was a highly active ferric-reducing agent. All effects were dose and concentration-dependent. The presence of various phytochemicals might contribute to these activities. However, further research is suggested to isolate their active compounds and evaluate their mechanisms of action.

Trace analysis of 47 psychotropic medications in environmental samples by ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS)

Psychotropic medications are one of the most prescribed pharmaceuticals in the world. Given their frequent detection and ecotoxicity to the no-target organism, the emission of these medications into environments has gradually draw attention. The study developed a sensitive and reliable analytic method to simultaneously investigate 47 psychotropic medications in four matrices: wastewater, surface water, activated sludge, and sediment by ultra-performance liquid chromatography-electrospray ionization-tandem mass spectrometry (UPLC-ESI-MS/MS). These 47 target analytes include 24 antidepressants, 17 antianxiety drugs, 5 anticonvulsants, and 1 relevant hormone. Solid phase extraction (SPE) was employed to extract analytes from water-phase samples. Ultrasonic Solvent Extraction method with Enhanced Matrix Removal clean-up (USE-EMR) was utilized to extract target compounds from solid-phase samples, which requires more straightforward and convenient procedures than previous methods. The extraction recoveries of all analytes ranged from 80% to 120% in these four sample matrices. In this study, The limit of quantitation for 47 psychotropic medications were 0.15 ng/L (estazolam) to 2.27 ng/L (lorazepam), 0.08 ng/L (desvenlafaxine) to 2 ng/L (mianserin), 0.22 ng/g (dry weight, dw) (nordiazepam) to 3.65 ng/g (dw) (lorazepam), and 0.07 ng/g (dw) (carbamazepine) to 2.85 ng/g (lorazepam), in wastewater, surface water, sludge, and sediment, respectively. In addition, the developed method was employed to analyse actual samples in two wastewater treatment plants and their receiving rivers. Carbamazepine, escitalopram, clozapine, desvenlafaxine, diazepam, lamotrigine, sertraline, temazepam, and venlafaxine were nearly ubiquitous in all matrices. Moreover, this study indicated that the inadequate removal efficiencies of psychotropic medications in wastewater treatment plants (WWTPs) had resulted in a persistent discharge of these contaminants from human sources into environments.

The Clinical Study of Anti-Anxiety Drugs on Different Types of Vertigo Syndromes

The Clinical Study of Anti-Anxiety Drugs on Different Types of Vertigo Syndromes

A brain-tumor neural circuit controls breast cancer progression in mice.

Tumor burden, considered a common chronic stressor, can cause widespread anxiety. Evidence suggests that cancer-induced anxiety can promote tumor progression, but the underlying neural mechanism remains unclear. Here, we used neuroscience and cancer tools to investigate how the brain contributes to tumor progression via nerve-tumor crosstalk in a mouse model of breast cancer. We show that tumor-bearing mice exhibited significant anxiety-like behaviors and that corticotropin-releasing hormone (CRH) neurons in the central medial amygdala (CeM) were activated. Moreover, we detected newly formed sympathetic nerves in tumors, which established a polysynaptic connection to the brain. Pharmacogenetic or optogenetic inhibition of CeMCRH neurons and the CeMCRH→lateral paragigantocellular nucleus (LPGi) circuit significantly alleviated anxiety-like behaviors and slowed tumor growth. Conversely, artificial activation of CeMCRH neurons and the CeMCRH→LPGi circuit increased anxiety and tumor growth. Importantly, we found alprazolam, an antianxiety drug, to be a promising agent for slowing tumor progression. Furthermore, we show that manipulation of the CeMCRH→LPGi circuit directly regulated the activity of the intratumoral sympathetic nerves and peripheral nerve-derived norepinephrine, which affected tumor progression by modulating antitumor immunity. Together, these findings reveal a brain-tumor neural circuit that contributes to breast cancer progression and provide therapeutic insights for breast cancer.

Does a 30-minute introductory visit to the operating room reduce patients’ anxiety before elective surgery? A prospective controlled observational study

BackgroundPatients scheduled for elective surgery typically suffer from preoperative anxiety related to the unknown environment and unclear expectations. We hypothesized that a virtual or in-person introductory visit to the operating room one day before surgery may decrease the extent of preoperative anxiety by familiarizing patients and their families with the operating room environment. So, this study aimed to evaluate the impact of operating room visits, conducted both in-person and virtual reality, on patients’ preoperative anxiety.MethodsThis prospеctivе controllеd obsеrvational study еxaminеd patiеnts who wеrе candidatеs for gеnеral surgеry in a tеaching hospital in Iran. All patiеnts agеd bеtwееn 18–60 yеars, who wеrе undеrgoing gеnеral surgеry bеtwееn April and Sеptеmbеr 2022 and had prеopеrativе anxiеty basеd on thе Spiеlbеrgеr quеstionnairе, wеrе sеlеctеd. Patients who had emergency surgery or were taking anti-anxiety drugs were excluded from the study. Patiеnts wеrе thеn randomly assignеd to thе in-pеrson visit, virtual rеality visit, and control groups. In thе in-pеrson group, individuals visitеd thе opеrating room for 30 minutеs on thе day bеforе surgеry. In contrast, in thе virtual rеality group, visits wеrе conductеd via a ‘livе’ virtual vidеo tour of thе opеrating room for thе samе duration on thе day bеforе surgеry. The control group received routine care such as prе-surgеry hospitalization and mеdication. All participants completed the Spielberger questionnaire before the intervention (the day before surgery) and again two hours before surgery. Data were analyzed using variance analysis, t-tests, and Chi-square tests in SPSS 22 software.ResultsWе idеntifiеd 105 patiеnts undеrgoing gеnеral surgеry who wеrе dividеd into thrее groups of 35 pеoplе еach. Thе rеsults showеd that, bеforе thе intеrvеntion, thеrе wеrе no statistically significant diffеrеncеs among thе thrее groups in tеrms of dеmographic data and prеopеrativе anxiеty (p > 0.05). Aftеr thе intеrvеntion, thе mеan scorеs of prеopеrativе anxiеty in thе in-pеrson visit, virtual rеality visit, and control groups wеrе 52.82 ± 4.51, 54.48 ± 5.04, and 53.42 ± 4.62, rеspеctivеly, with no significant statistical diffеrеncе (p = 0.33). Furthermore, there was no significant difference in preoperative anxiety scores before and after the intervention in the in-person visit (p = 0.13), virtual reality visit (p = 0.10), and control (p = 0.33) groups.ConclusionA 30-minute visit to familiarize patients with the operating room environment, equipment, and staff, whether conducted in-person or virtually, does not significantly affect patients’ preoperative anxiety or reduce their anxiety levels.

INSOMNIA IN PANIC DISORDER. LITERATURE REWIEW

Sleep disorders and panic disorder (PD) are often comorbid and closely interrelated. Sleep disorders aggravate the severity of panic disorder, and pathological anxiety worsens sleep. In this regard, the treatment of insomnia in patients with PD is aimed at harmonizing the emotional state and correcting sleep and, along with pharmacotherapy, includes a wide range of psychotherapeutic methods. Successful treatment of insomnia increases the effectiveness of PD therapy, reduces the likelihood of relapse and increases the susceptibility of patients to many anti-anxiety drugs.

Risk factors associated with newly diagnosed attention-deficit/hyperactivity disorder in adults: a retrospective case-control study

BackgroundKnowledge of risk factors for attention-deficit/hyperactivity disorder (ADHD) may facilitate early diagnosis; however, studies examining a broad range of potential risk factors for ADHD in adults are limited. This study aimed to identify risk factors associated with newly diagnosed ADHD among adults in the United States (US).MethodsEligible adults from the IQVIA PharMetrics® Plus database (10/01/2015-09/30/2021) were classified into the ADHD cohort if they had ≥ 2 ADHD diagnoses (index date: first ADHD diagnosis) and into the non-ADHD cohort if they had no observed ADHD diagnosis (index date: random date) with a 1:3 case-to-control ratio. Risk factors for newly diagnosed ADHD were assessed during the 12-month baseline period; logistic regression with stepwise variable selection was used to assess statistically significant association. The combined impact of selected risk factors was explored using common patient profiles.ResultsA total of 337,034 patients were included in the ADHD cohort (mean age 35.2 years; 54.5% female) and 1,011,102 in the non-ADHD cohort (mean age 44.0 years; 52.4% female). During the baseline period, the most frequent mental health comorbidities in the ADHD and non-ADHD cohorts were anxiety disorders (34.4% and 11.1%) and depressive disorders (27.9% and 7.8%). Accordingly, a higher proportion of patients in the ADHD cohort received antianxiety agents (20.6% and 8.3%) and antidepressants (40.9% and 15.8%). Key risk factors associated with a significantly increased probability of ADHD included the number of mental health comorbidities (odds ratio [OR] for 1 comorbidity: 1.41; ≥2 comorbidities: 1.45), along with certain mental health comorbidities (e.g., feeding and eating disorders [OR: 1.88], bipolar disorders [OR: 1.50], depressive disorders [OR: 1.37], trauma- and stressor-related disorders [OR: 1.27], anxiety disorders [OR: 1.24]), use of antidepressants (OR: 1.87) and antianxiety agents (OR: 1.40), and having ≥ 1 psychotherapy visit (OR: 1.70), ≥ 1 specialist visit (OR: 1.30), and ≥ 10 outpatient visits (OR: 1.51) (all p < 0.05). The predicted risk of ADHD for patients with treated anxiety and depressive disorders was 81.9%.ConclusionsMental health comorbidities and related treatments are significantly associated with newly diagnosed ADHD in US adults. Screening for patients with risk factors for ADHD may allow early diagnosis and appropriate management.

Evaluation of the α&lt;sub&gt;2&lt;/sub&gt;-adrenergic Agonist Mafedine Effects on White Outbred Mouse Behaviour Following Acute Administration

Introduction. α2-adrenergic agonists are not only used as antihypertensive and sedative agents, but are also of interest as potential medications for the treatment of neurological disorders. Previous research has shown a compound from this class, 6-oxo-1-phenyl-2-(phenylamino)-1,6-dihydropyrimidine-4-ol (mafedine), to exert strong neuroprotection under experimental conditions. Despite its long record of development, the effects of mafedine on animal behavioural characteristics remain unknown.Aim. This work was aimed at evaluating the effects of mafedine sodium at three doses (1, 10, or 50 mg/kg) on white outbred mouse behavior in three tests: Open Field, Elevated Plus Maze, and Light/Dark Box.Materials and methods. Experiments were carried out on 60 white outbred male mice weighing 20–22 g, randomized into 4 groups (n = 15): 1) control (0,9 % saline); 2) mafedine (1 mg/kg); 3) mafedine (10 mg/kg); 4) mafedine (50 mg/kg). All agents were administered via single intraperitoneal injections 20 min before testing. Animal behavior was assessed using the Open Field, Elevated Plus Maze, and Light/Dark Box tests following conventional protocols with group reassignment between tests and an inter-test time interval of at least 2 days. Statistical analysis was carried out using the Prism 8.0.2 software package.Results and discussion. At 1 or 10 mg/kg, mafedine did not affect animal behaviour in either of the tests. At 50 mg/kg, it produced an anxiolytic effect, as indicated by the decrease in the anxiety index values for the Elevated Plus Maze test as well as the increase in peeking out frequency in the Light/Dark Box test, compared to respective control values.Сonclusion. Mafedine sodium salt at doses between 1 and 50 mg/kg was shown to produce no adverse effect on mouse behaviour, indicating a good safety profile of the compound. The discovered anxiolytic effect of mafedine at the highest dose validates its further research not only as a neuroprotector, but also as an anti-anxiety agent.

Aromatherapy Effectivity in Controlling Anxiety, Respiration Rate, Pulse Rate, and Pain in Bronchoscopy

ackground: Bronchoscopy is a relatively safe diagnostic and therapeutic procedure, but it is often reported as an uncomfortable experience and causes acute procedural anxiety that affects the procedure and the patient and operator's comfort. Anti-anxiety drugs have the risk of causing mild to severe side effects. Therefore, we need premedication with potent anxiolytics with minimal side effects, such as the use of aromatherapy. This study aims to analyze the effectiveness of aromatherapy as an additional premedication to reduce anxiety, respiratory rate, pulse rate, and pain in patients undergoing bronchoscopy. Method: A clinical study with experimental quasi pre-post test control group design using consecutive sampling was performed in pulmonary patients undergoing bronchoscopy in dr. Moewardi Hospital from February to March 2020. The study subjects were randomized into three groups: lavender aromatherapy, orange aromatherapy, and control. Hospital anxiety and depression scale (HADS) score, respiratory rate, pulse, and visual analogue scale (VAS) pain score were measured before and after bronchoscopy. Results: A total of 45 subjects of lung patients undergoing bronchoscopy participated in this study. Post hoc test differences in the HADS anxiety score of lavender and orange groups showed a significant decrease (P=0.011); (P=0.083), respectively. The decrease in the control group was not significant (P=0.622). There was a significant decrease in the respiratory rate of lavender (P≤0.0001), and orange groups (P=0.001), while the control group did not decrease (P=0.515). There was a significant decrease in pulse rate in the lavender (P=0.004) and orange (P=0.011) groups. The decrease in the control group was not significant (P=0.900). There was a significant decrease in VAS pain scores in the lavender and orange groups with each (P&lt;0.001), whereas, in the control group, there was an increase in VAS pain scores. Conclusion: Aromatherapy effectively controls anxiety, respiration rate, pulse, and pain in bronchoscopy patients.