Psychopathological and neuropsychological outcomes of deep brain stimulation for severe- treatment-resistant obsessive-compulsive disorder: An open-label case series.

OBJECTIVE: Deep brain stimulation (DBS) is considered a promising intervention for treatment-resistant obsessive-compulsive disorder (OCD). The present study describes the outcomes of the first DBS procedures for OCD in Iran. METHODS: Four women patients (age range, 25-35 years) with severe OCD meeting stringent criteria for refractoriness to treatment were selected by Psychosurgery Review Board. DBS electrodes were bilaterally implanted in the internal capsule and nucleus accumbens (NAc). Clinical and neuropsychological assessments were undertaken before and after implantation. The outcomes included Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), neuropsychological assessments including the Wisconsin Card Sorting Test, Wechsler Memory Scale, and adverse events. RESULTS: The baseline mean score of the Y-BOCS and HAM-A was 32 ± 6 and 23 ± 14 respectively and decreased to 26 ± 8 and 17 ± 9 after one-year implantation, showing a 19% improvement. Two patients were responders and showed a notable improvement. One patient's score declined 28%, who was not satisfied with DBS results, and one patient worsened under-stimulation. Improvements in the severity of anxiety and cognitive performance were consistent with OCD improvement, and the successfully treated patients showed improvement in anxiety and cognitive performance. No significant cognitive declines were seen. Two patients' suicidal ideation appeared after DBS as an important adverse event. CONCLUSION: Bilateral DBS of the internal capsule/NAc may be an effective and safe treatment for treatment-refractory OCD. However, there is a need to consider accessibility, high cost, cost-effectiveness, and standardized methodology in future research.

UPLC-PDA-ESI-QTOF-MS/MS and GC-MS analysis of Iranian Dracocephalum moldavica L.

Dracocephalum moldavica L. is a significant component in the Iranian food basket. This study aimed to investigate the bioactive compounds and biological activities of different extracts obtained from D. moldavica aerial parts. From the aerial parts, a crude methanolic (MeOH) extract and its four sub-fractions, that is, petroleum ether (Pet), ethyl acetate (EtOAc), n-butanol (n-BuOH), and aqueous (water) extracts were obtained. The total phenolic and flavonoid contents as well as the antioxidant and cytotoxic activities of the extracts were determined. Moreover, the phytochemical profiles of the essential oil (EO) and of those extracts with the highest antioxidant activity measured by GC/MS and UPLC-PDA-ESI-QTOF-MS/MS. Results showed that the highest concentrations of phenols and flavonoids as well as the most potent antioxidant potential according to the DPPH method were determined in the EtOAc and MeOH extracts with IC50 values of 22.0 and 34.4 µg.ml-1, respectively. Quantitative analysis of these extracts was subsequently performed by UPLC-PDA-ESI-QTOF-MS/MS. Both extracts contained mainly rosmarinic acid, caffeic acid, and 2-hydroxycinnamic acid, which may be responsible for their high antioxidant activity. Moreover, none of the extracts showed cytotoxic effects against MCF7, SW48, and a normal cell line of mouse embryonic fibroblast cells (NIH/3T3) in the tested concentrations (up to 400 µg.ml-1). Additionally, GC-MS analysis showed that oxygenated monoterpenes (55.4%) were the main constituents of the EO of D. moldavica.