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Objectives Despite the effectiveness of electroconvulsive therapy (ECT) in a wide range of psychiatric disorders, the role of memory-enhancing agents in post-ECT cognitive disturbances has remained controversial. In this study, we aimed to assess the effect of donepezil on improving the cognitive performance of patients undergoing ECT. Methods In a psychiatry hospital, patients who were admitted for ECT underwent a triple-blind randomized controlled trial. After randomizing the participants into 2 groups, 1 group received ECT with placebo, whereas the other group received ECT plus 5 mg/d donepezil during the ECT period. The patients in both groups were cognitively assessed using the Mini Mental Status Evaluation and Wechsler Memory Scale, 24 hours before ECT and 48 hours after the end of the ECT sessions. Results The results of Mini Mental Status Evaluation scores did not show any significant difference in memory performance between the 2 groups before and after ECT (F = 0.108, P = 0.743). Moreover, the intervention and placebo groups did not have any significant difference in the scores of the 7 subscales of the Wechsler Memory Scale after ECT (P = 0.07). In addition, the patients on donepezil group tolerated the drug well and did not differ significantly compared with the control group in this regard. Conclusions Despite a few evidence confirming the effect of acetylcholinesterase inhibitors in improving cognitive defects related to ECT, this study did not find such an effect in patients under ECT. Further studies are required to reach a clear conclusion.

Background Akathisia is a distressing extrapyramidal complication that follows the use of antipsychotic medications. Early treatment of neuroleptic-associated akathisia (NAA) is of great importance because it may lead to poor therapeutic response and ultimately treatment noncompliance. Considering the lack of adequate response of some patients to conventional treatments and the assumption that serotonin might be involved in the pathophysiology of the disease in addition to dopaminergic mechanisms, we aimed to evaluate the effectiveness of trazodone as an antidepressant agent with strong antagonistic effects on serotonin receptors in the treatment of akathisia. Methods In a double-blind clinical trial, 52 patients receiving antipsychotic medications who were diagnosed to have mild to severe NAA using Barnes Akathisia Rating Scale were treated with trazodone 50 mg daily for 5 days and compared with the placebo control group. Results Patients receiving trazodone did not show a significant difference compared with the control group in terms of the severity of akathisia symptoms until the third day of the study. In contrast, at the end of the fifth day, there was a significant improvement in objective (P = 0.01) and subjective (P = 0.001) symptoms of akathisia and the global clinical assessment of akathisia scale (P = 0.001). Moreover, there was no clear difference between trazodone and placebo group in terms of adverse effects. Conclusions Considering the antagonistic effect of trazodone on postsynaptic 5-hydroxytryptamine2A receptors as a possible mechanism of efficacy of this agent in the treatment of NAA, this study suggests that trazodone might be an effective and relatively safe drug.

Diabetes Mellitus (DM) is the most common metabolic disorder and the most common cause of death in eastern populations, with prevalence estimated to be at the level of epidemic illness. Despite medical attention, psychological factors remain a significant contributor to DM, requiring effective psychological interventions. This study evaluated the effects of Mindfulness-integrated Cognitive Behavior Therapy (MiCBT) on depression, treatment adherence, and control of blood glucose of 25 Iranian patients (11 males and 14 females, mean age = 45.6) with type 2 DM, randomly assigned to either an 8-session MiCBT (n = 12) or treatment-as-usual (TAU) (n = 13). We present a theoretical conceptualization and detailed step-by-step implementation of MiCBT, and an assessment of its effectiveness in this sample. While no between-group differences were found at pre-treatment on any of the measures, the MiCBT group showed a significantly greater reduction in depression and greater treatment adherence than the TAU group at post-treatment. The MiCBT group also showed a significantly greater blood sugar reduction than the TAU group at 6-week follow-up. Within-group analysis found no significant change on any of the measures for TAU, whereas the MiCBT group reported a significant decrease in depression and increase in treatment adherence from pre- to post-treatment and maintained at 6-week follow-up. Blood sugar reduction also only occurred in the MiCBT group from pre- to post-treatment. Replication studies with larger samples are necessary to confirm these findings and validate the transdiagnostic efficacy and transcultural applicability of MiCBT in type 2 DM.