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... e existing scientific literature includes multiple randomized clinical trials evaluating the effects of aromatherapy on PMS. Some of them identified beneficial effects of aromatherapy on PMS symptoms [14][15][16]. To our knowledge, there is no meta-analysis evaluating the entirety of the clinical literature on the effects of aromatherapy on PMS symptoms. ...
... Six of the studies had parallel design, and the other 2 studies had a crossover design. Studies were conducted in Iran [15,16,22,23], Japan [24,25], India [26], and Turkey [14]. All of the studies were published in the English language. ...
... Study participants were women who had moderate to severe PMS. Four of the studies measured PMS symptoms with PSST questionnaires [15,22,23,26], two used PMOS [24,25], one used ACOG [14], and one used the PMS score [16] questionnaire. One of the studies used aromatherapy with massage while the other seven studies used aromatherapy as the exclusive intervention [16]. ...
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Objectives Premenstrual syndrome (PMS) is a common disturbance among women of childbearing age. Aromatherapy is a commonly used form of complementary and alternative medicine (CAM) to treat PMS. The purpose of this study is to quantify and summarize the effects of aromatherapy on premenstrual syndrome symptoms. Methods. PubMed, Scopus, and Cochrane Library databases were searched through relevant search terms until October 2020. The effect sizes were pooled as weighted mean difference (WMD) and 95% confidence interval (CI) using the random effect model. Egger tests and visual inspection of the funnel plot were performed to identify the existence of publication bias. The I-squared (I2) test was applied to measure heterogeneity. Results. Eight studies (n = 8) were included in this analysis. The quantitative synthesis of evidence found that aromatherapy decreases PMS scores (WMD –13.83; 95% CI (−22.04, −5.63), I2 = 94.5%), total psychological symptoms of PMS (WMD –3.51; 95% CI (−4.84, −2.18), I2 = 82.6%), anxiety of PMS (WMD–1.78; 95% CI (−3.17, −0.38), I2 = 94.2%), depression of PMS (WMD–2.0; 95% CI (−3.65, −0.34), I2 = 93.7%), and fatigue of PMS (WMD – 1.44; 95% CI (−2.44, −0.44), I2 = 89.7%) compared to the control group. Conclusion. Aromatherapy is an effective tool for the relief of PMS symptoms. Additional randomized controlled clinical trials with different durations and essential oils should be conducted to confirm our findings.
... It also decreased the overall symptoms of premenstrual syndrome (PMS) in university students. In addition to its antidepressant effects, positive effects on the mood, blood pressure, pain, inflammation, bloating, and indigestion were observed (Heydari et al., 2018). Neroli oil is a smooth muscle-and endothelium-dependent vasodilator that can relieve cardiovascular symptoms. ...
... Moreover, Neroli showed a robust antioxidant activity (Ammar et al., 2012 (Anwar et al., 2015;Ben Hsouna et al., 2013). It was antifungal against Alternaria alternata, Aspergillus flavus, A. fumigants, A. nidulans, A. niger, Fusarium culmorum, F. graminearum, and F. oxysporum (Ammar et al., 2012;Heydari et al., 2018;Ben Hsouna et al., 2013;Anwar et al., 2015). Neroli oil also showed anti-amoebic activity against Entamoeba histolytica (Karthikeyan and Karthikeyan, 2014). ...
Article
Members of Citrus L. (Rutaceae) are evergreen shrubs or small trees cultivated all over the world. The genus that includes the volatile secondary metabolites from fruit peel, leaf, and flower oils is Citrus. Citrus flowers are famous for their sweet, pleasant, and highly desirable scent. The color and odor of Citrus flowers are major contributors in attracting pollinators and repelling herbivores. In this article, we will compare the properties of several Citrus floral essential oils and take a closer look at the most frequently examined among them, Neroli (Citrus aurantium var. amaraflos.) essential oil
... It also decreased the overall symptoms of premenstrual syndrome (PMS) in university students. It showed positive effects on the mood, blood pressure, pain, inflammation, bloating, and indigestion in addition to its anti-depressant effects [75]. Inhaling neroli odor enhances sexual desire [59]. ...
... Interestingly, the C. aurantium flower extract showed anti-amnesic and repairing effects on memory, learning impairments, and behavioral disorders induced by scopolamine, and has the potential to treat Alzheimer's disease [72]. Neroli EO inhibits the growth of several bacteria including Bacillus subtilis, B. cereus, Staphylococcus aureus, S. epidermis, Enterococcus faecalis, Micrococcus luteus, Listeria monocytogenes, Salmonella enteritidis, Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumonia [53,79], as well as several fungi including Aspergillus niger, A. flavus, A. nidulans, A. fumigatus, Fusarium graminearum, F. oxysporum, F. culmorum, and Alternaria alternata [20,53,75,79]. ...
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Citrus fruits have been a commercially important crop for thousands of years. In addition, Citrus essential oils are valuable in the perfume, food, and beverage industries, and have also enjoyed use as aromatherapy and medicinal agents. This review summarizes the important biological activities and safety considerations of the essential oils of sweet orange (Citrus sinensis), bitter orange (Citrus aurantium), neroli (Citrus aurantium), orange petitgrain (Citrus aurantium), mandarin (Citrus reticulata), lemon (Citrus limon), lime (Citrus aurantifolia), grapefruit (Citrus × paradisi), bergamot (Citrus bergamia), Yuzu (Citrus junos), and kumquat (Citrus japonica).
... The findings of a review of clinical trials conducted by Manucci et al. showed that the oral administration or inhalation of C. aurantium could have beneficial effects on anxiety reduction (20). The main component of C. aurantium essential oil is limonene, with anti-anxiety and sedative effects, affecting the activity of the central nervous system (21). ...
... However, the results of a study performed by Franco et al. showed that a placebo reduced patients' anxiety, the reason for which could be related to paying too much attention to patients (25). In the present study, no aromatherapy side effects were observed in the patients, which was similar to the results of other studies (4,21). ...
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Background: The control or reduction of anxiety before surgery is one of the most important components of preoperative care. The question is whether anxiety differs in male and female candidates for surgery. Objectives: The current study aimed to evaluate the effect of aromatherapy with Citrus aurantium on anxiety in men and women candidates for surgery. Methods: This single-blind randomized clinical trial was performed on 60 patients and controlled by placebo. The patients were divided into 30 subjects in the control group and 30 subjects in the aromatherapy group (inhaling C. aurantium essential oil). The patients completed the Spielberger state-trait anxiety inventory before and after the intervention. After collecting information, the questionnaire information was analyzed using SPSS software (version 16). Results: After aromatherapy, 20% of men had mild state and trait anxiety. Moreover, 80% of men had relatively mild state and trait anxiety. In the group of women, 20% of the cases had mild state and trait anxiety. Furthermore, 73.3% of women had relatively mild state and trait anxiety. Additionally, 6.7% of women had relatively severe anxiety. Anxiety reduced after the intervention among men and women (P < 0.001). In addition, the severity of anxiety among women in the control group increased after placebo intervention (P < 0.05). Moreover, the effect of C. aurantium aroma was further observed in women than men; however, there was no statistically significant difference (P > 0.05). Conclusions: The results of this study indicated that inhaling the C. aurantium aroma reduces anxiety in patients. Aromatherapy also has the potential to be replaced by chemical drugs due to fewer side effects and risks, and cost-effectiveness.
... Bitter orange (C. aurantium) and damask rose blossom (Rosa damascena mill L.; R. damascena) aromas, together, were found to improve the symptoms of premenstrual syndrome [184,185]. Neroli, lavender, and bitter orange EOs reduce anxiety and blood pressure in postmenopausal women [186,187] ...
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Chemical compounds from plants have been used as a medicinal source for various diseases. Aromachology is a unique field that studies the olfactory effects after inhaling aromatic compounds. Aromatherapy is a complementary treatment methodology involving the use of essential oils containing phytoncides and other volatile organic compounds for various physical and mental illnesses. Phytoncides possess an inherent medicinal property. Their health benefits range from treating stress, immunosuppression, blood pressure, respiratory diseases, anxiety, and pain to anti-microbial, anti-larvicidal, antiseptic , anti-cancer effects, etc. Recent advancements in aromatherapy include forest bathing or forest therapy. The inhalation of phytoncide-rich forest air has been proven to reduce stress-induced immunosuppression, normalize immune function and neuroendocrine hormone levels, and, thus, restore physiological and psychological health. The intricate mechanisms related to how aroma converts into olfactory signals and how the olfactory signals relieve physical and mental illness still pose enormous questions and are the subject of ongoing research. Aroma-therapy using the aroma of essential oils/phytoncides could be more innovative and attractive to patients. Moreover, with fewer side effects, this field might be recognized as a new field of complementary medicine in alleviating some forms of physical and mental distress. Essential oils are important assets in aromatherapy, cosmetics, and food preservatives. The use of essential oils as an aromatherapeutic agent is widespread. Detailed reports on the effects of EOs in aromatherapy and their pharmacological effects are required to uncover its complete biological mechanism. This review is about the evolution of research related to phytoncides containing EOs in treating various ailments and provides comprehensive details from complementary medicine.
... Citrus aroma was particularly recognized to possess psychological actions such as mood-enhancing. For instance, neroli oil, extracted from bitter orange flower has a well-reported anti-depressant activity and positive effect on the mood, being used in aromatherapy for chronic diseases, such as diabetes, to improve patients physical and mental activities (Heydari et al., 2018). ...
Article
Sweet and bitter oranges are two of the most commercially-important fruit with a total world production of 75.4 Mt, well-recognized for their unique sensory characters in addition to multiple nutritive and therapeutic attributes due to their highly-valued bioactive ingredients. Hence, their differential qualitative/quantitative phytochemical make-ups are presented for better utilization as therapeutic agents. Sweet orange exhibits therapeutic applications as being effective anti-diabetic, anti-obesity, and hypocholesterolemic agents. Whereas, for anti-osteoporotic products and intestinal dysbiosis treatment, bitter orange is more preferred. Moreover, the review recapitulates on different valorization practices of citrus bio-wastes and utilization of their bioactives as therapeutic agents and in functional food industry. Sweet orange waste functions as a fat replacer and preservative to increase food shelf life with better organoleptic attributes than bitter orange. The detailed action mechanism and safety of Citrus bioactives, as well as processing technologies to further improve its effects are posed as future research perspectives.
... It was also shown that aromatherapy with Citrus aurantium flower improved the symptoms of premenstrual tension [31]. ...
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Painful menstruation, premenstrual syndrome and metrorrhagia iuvenilis are one of the most common problems related to the sexual cycle in adolescent girls. Metrorrhagia iuvenilis is acyclic bleeding that occurs in adolescents and lasts from over 10 days even up to 3 months. These bleeds are very abundant and have a tendency to relapse. They cause anemia, and severe cases can be life-threatening. Premenstrual Syndrome (PMS) is a cluster of somatic, emotional and behavioural symptoms occurring in the luteal phase of the menstrual cycle. The aetiology of PMS remains unknown. According to strict diagnostic criteria, an estimated 2.5-5% of girls and women are affected by PMS. However, some researchers maintain that the symptoms of PMS may be prevalent in as many as 40-80% of girls and women. This article it has been discussed premenstrual syndrome and metrorrhagia iuvenilis and aspects related to dietotherapy were included.
... Three English abstracts (full texts were available in Farsi) were explored. 20,21,23,28,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] Two authors assessed the quality of the selected studies according to the Modified Jadad Scale for Randomized Controlled Trials. This assessment tool comprises eight specific items, including a description of randomization, appropriate randomization method, blinding description, appropriate blinding method, description of withdrawals and dropouts, description of inclusion and exclusion criteria, description of adverse effects, assessment method, and the description of statistical analysis. ...
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Objective The aim of the present systematic review meta-analysis is to assess the effect of olfactory stimulation on reducing dysmenorrhea. Methods Systematic search was conducted in several databases, such as PubMed, Web of Science, Cochrane, and Scopus, to identify relevant research up to October 26, 2019. The identified studies were evaluated based on a modified Jadad scale. The intervention involves aromatherapy alone or in combination with essential oils. There was no restriction for the control group such as a placebo group or other common treatments. The Comprehensive Meta-Analysis Version 2 (Bio stat, Englewood, NJ, USA) was used for meta-analysis. Cochran's Q and I2 tests were utilized. Results The findings of our meta-analysis, which contained 13 trials (15 data), showed that dysmenorrhea decreased significantly in the group receiving aromatherapy with herbal compared with the control group (standardized mean difference [SMD] = -0.795; 95% confidence interval [CI]: -0.922 to- 0.667; 17 trials O < 0.001); heterogeneity; I2 = 19.47%; p = 0.236). In addition, four studies with insufficient data were not included in our meta-analysis. The results of all studies suggested that aromatherapy with herbal medicine group compared with control group is effective. Conclusion Aromatherapy with herbal medicine decreased dysmenorrhea. This treatment was particularly effective when aroma oil was combined with massage or when a mixture of aroma oil was used for the treatment of dysmenorrhea.
... The results showed that aromatherapy with C. aurantium essential oil decreases anxiety in patients with AMI. This finding is consistent with the results obtained by Moslemi et al., and other findings of recent studies indicating that C. aurantium affects the central nervous system activity (Moslemi et al., 2019;Heydari et al., 2018). Sedative and anti-anxiety effects of this plant have been shown in previous studies. ...
... Application of The lavender essential oil was found to positively affect in hemodialysis patients' anxiety level and sleep quality [30], fatigue [7,18], pain following needle insertion into a fistula [31,32], pruritus relief [33] and restless leg syndrome [34]. Similarly, aromatherapy with orange has been positively influenced on invasive pain, procedure adherence, vital signs, and saturation during port catheterization in oncology patients [35], premenstrual syndrome in university students [36], depression in community-dwelling older adults [37], pain and vital signs of patients with fractured limbs [38] and anxiety during labor [39]. Nonetheless, no comparative study has yet evaluated the effects of inhalation aromatherapy and aromatherapy massage with two essences. ...
Article
Objectives Fatigue, regardless of the causes, could leave a negative impact on individual performance. The aim of this study was to compare the effects of inhalation and massage aromatherapy with lavender and sweet orange on fatigue among hemodialysis patients. Methods This study was a randomized controlled trial. The patients (96 patients) were allocated to three groups (control, an inhalation aromatherapy, and an aromatherapy massage group). A demographic questionnaire as well as the rhoten fatigue scale (RFS) was used to collect the data. The data were analyzed by descriptive and analytical statistics using SPSS version 18. Results Before the intervention, there was no significant difference among the groups regarding fatigue level (p=0.54). However, eight and 16 weeks after the study, the levels of fatigue in both experimental groups were significantly lower than the control group (p < 0.05). Conclusions Interventions with essential oils are effective in reducing fatigue in hemodialysis patients, although the effects of aromatherapy massage on fatigue are stronger than the effects of inhalation aromatherapy.
... Additionally, researchers found that the bitter orange essential oils and their major component, limonene, exhibited significant antiulcerogenic and gastro-protective activities that can be considered as a promising pharmaceutical agent for the prevention of gastric ulcer (Moraes et al., 2009). Limonene is traditionally known as a fatigue recovery and a treatment for severe dermatitis (Baik et al., 2008) and depression (Heydari et al., 2018). ...
Article
In this research, hydrodistillation ultrasonic‐assisted green technique was applied to extract the essential oils from bitter orange peel. The effects of independent factors (volume/mass ratio (X1), ultrasonic time (X2) and hydrodistillation extraction time (X3)) on the quantitative, phenolic and antioxidant properties of essential oils were investigated. Linear and quadratic polynomial models with suitable ANOVA results (model p‐values <0.0003, R2 values of 0.84‐0.95, adjusted R2 values of 0.82‐0.90, predicted R2 values of 0.71‐0.75, and lack of fit p‐values >0.5) were used for fitting the responses. Two optimal extraction conditions for bitter orange peel essential oils were determined as follows: optimum responses (OR) with maximum essential oil volume (0.99 ml), maximum TPC (108.33 mg GAE/100 ml) and minimum IC50 (251.56 µl) could be achieved at X1: 6.00 ml/g, X2: 39.10 min and X3: 4.72 h, and optimum phenolic compounds (OP) with maximum TPC of 190.75 mg GAE/100 ml could be obtained at X1: 13.89 ml/gr, X2: 3.75 min and X3: 4.92 h. The most predicted values for optimum conditions were in good agreement with experimental data. The disk diffusion experiments showed high antimicrobial activities of the optimum essential oils against E. coli. The GC‐MS results proved limonene was the main compound in both optimum essential oils. These bitter orange peel essential oils with suitable antioxidant and antimicrobial activities, and healthy compositions, could be considered as dietary and pharmaceutical supplements.
... Application of The lavender essential oil was found to positively affect in HD patients' anxiety level and sleep quality [34], fatigue [18,21], pain following needle insertion into a fistula [35,36], pruritus relief [37], and RLS [38]. Similarly, aromatherapy with orange has been positively influenced on invasive pain, procedure adherence, vital signs, and saturation during port catheterization in oncology patients [39], premenstrual syndrome in university students [40], depression in community-dwelling older adults [41], pain and vital signs of patients with fractured limbs [42], and anxiety during labor [43]. Nonetheless, no comparative study has yet evaluated the effects of foot massage with two essences. ...
Article
Objectives: Hemodialysis (HD) patients suffer more sleep problems (poor sleep quality and restless leg syndrome [RLS]). Complementary therapy, especially massage with aromatherapy oil is one of the non-pharmacological treatment options with less adverse effects than routine methods. The purpose of this study was to determine the effects of foot massage with of lavender and orange essential oil on HD patients' sleep quality and RLS. Methods: This is a double blind randomized controlled trial on 105 HD patients was conducted at a large educational hospital in Iran, Hamadan province between January and September 2017. Patients divided into three groups with random allocation (35 participants per groups in lavender, orange, and control group). Foot massage during HD with lavender and orange essential oil was administered to the patients three times a week for three weeks, and every massage lasted half an hour. The control group received routine care. Before the intervention, the end of the first, second, and third weeks Pittsburgh Sleep Quality Index (PSQI) and RLS questionnaire were completed for all three groups. Data were statistically analyzed with Independent Samples t-test, chi-square test and repeated-measures analysis of variance (ANOVA) by SPSS version 16. Results: The mean score of sleep quality and RLS in the intervention groups were significantly different compare with the control group in all three time of data collecting (p<0 001). Conclusions: Aromatherapy prepared with lavender oil and sweet orange may be recommended to increase sleep quality and RLS level of the HD patients.
... Nowadays, plants that grow in temperate regions are of increasing interest in pharmaceutical research (Chou et al. 2018;Heydari et al. 2018) as well as in the field of cosmetics (Chiocchio et al. 2018;Halla et al. 2018) or agro-food (Calvo-Irabien 2018;Feng et al. 2018). Recent studies have reported on the antioxidant, anti-inflammatory, antibacterial and anti-carcinogenic activities of the essential oils of several spontaneous and cultivated plants, such as Crocus sativus, Nigella sativa, Coriandrum sativum, Ferula assafoetida, Thymus vulgaris, Zataria multiflora, Rosemary, Sage, Oregano and Curcuma herbs (Khazdair et al. 2018;Giacometti et al. 2018;Xiang et al. 2018). ...
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This work aims to valorize the solid waste resulting from the extraction of essential oils from three species of Dittrichia plants (viscosa, graveolens and crithmoides). The study includes the characterization of these biomaterials and their use in the elimination of the cadmium ion. For each species, taken in the raw state and then in the exhausted state after hydrodistillation, the studies were conducted on the leaves and flowers on the one hand and on the whole aerial part on the other. The results of the surface characterization (scanning electron microscopy, Fourier transform infrared spectroscopy, point of zero charge and Boehm titration) showed that these residual solids had a low surface area, but revealed the existence of basic and acidic functions ranging from 0.16 to 0.42 meq.g−1 and from 0.65 to 1.90 meq.g−1, respectively. Adsorption experiments showed that solid adsorption capacities ranged from 10.61 to 16.92 mg.g−1 for the raw materials and from 4.72 to 13.16 mg.g−1 for the exhausted materials. Sips three-parameter equation was successfully used to model all adsorption isotherms. The retention of cadmium increased from 4.73 to 16.92 mg.g−1 when varying the acid content from 0.65 to 1.90 meq.g−1. The amount of retained cadmium increased significantly by increasing the pH from 2 to 8 and the temperature from 20 to 60 °C. This work clearly shows the relationship between the surface function content and the retention capacity of cadmium ions by biomaterials.
... The problem of anxiety is faced during the period of abstinence, maintenance, and final abandonment of drugs. A clinical study presented the effectiveness of aromatherapy using CEO for premenstrual syndrome (PMS); it may well be effective as a new therapeutic method for the emotions and symptoms of PMS (Heydari et al., 2018). ...
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Anxiety in the world population has increased significantly; the problem has encouraged studies regarding innovative alternatives for treatment. Research with Citrus aurantium L. essential oil (CEO) has revealed positive results with anxiolytic effects in both animals and humans. However, certain limitations affect its storage and preservation, its efficiency in therapy, and determination of adequate posologies. The potential use of cyclodextrins as drug carriers has been successfully explored. This study aims to assess the anxiolytic potential of a CEO/2-hydroxypropyl-β-cyclodextrin (HP-β-CD) inclusion complex. Preparation of the inclusion complex was performed using the Alpha 1-2 LDplus lyophilizer. To allow formation, and avoid loss of volatiles to the atmosphere, Limonene (LIM), the main compound in CEO, together with HPβ-CD in a molar ratio of (1: 1M) was dispersed in ethanol for 36 hours using a laboratory shaker at room temperature (25°C). Non-clinical murine pharmacological tests were performed for anxiety assessment in experimental and control groups. To assess anxiety and motor impairment, the animals were evaluated using the elevated plus maze, open field, and rota-rod tests. Satisfactory results of the anxiolytic effect of the OEC complexed in HP-β-CD were observed, with the indication of an potentiation of the effect with doses lower than 500 mg/kg and 250 mg/kg complexed, suggesting improvement in the anxiolytic properties of the OEC.
Article
Octenyl succinic anhydride (OSA)-modified starch and maltodextrins (MDs) are important carbohydrate polymers as wall materials. However, few studies have shown whether these two wall materials affect the composition of core materials. In this work, we investigated the effects of OSA-modified starch and MD on the release property of essential oils. Results showed that among the seven characteristic aroma components (CACs) of rose essential oil (REO), the esters released the fastest, followed by the alcohols, while the release of the phenols was the slowest. Environmental factors such as temperature and relative humidities (RHs) had significant influences on the release kinetics of CACs in REO. This work provides new insights into the use of OSA-modified starch and MDs as wall materials for encapsulating complex and bioactive components.
Article
Background: Since the 1990's aromatherapy has been a popular adjunct to nursing and midwifery care in a variety of health care settings. Objective: The scoping review seeks to identify and confirm the benefits of incorporating aromatherapy into holistic nursing and midwifery practice Design: A scoping review using PRISMA-ScR of experimental studies where care is provided to the patient by a registered nurse or midwife. Settings and participants: Any health care setting where nurses or midwives provide care. Review Methods: A multi- engine search using a range of MeSH and non-MeSH terms with the Boolean search [AND]. Inclusion criteria were; publication date from 2005–2021, study involved aromatherapy as an intervention, conducted in a clinical nursing or midwifery environment and the published article is available in full in English. Excluded were; single patient cases, animal studies, in vitro studies, use of essential oils internally or a whole plant extract was used or use was non-nursing/midwifery related. Results: 124 studies met the inclusion criteria (n = 19188), classified into seven themes. Conclusion: The evidence supports the use of aromatherapy within a range of nursing and midwifery practices enhancing a holistic model of care. Impact: This scoping review contributes evidence to support the inclusion of aromatherapy into holistic nursing and midwifery practice.
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Sleep disorders are common among the general population and can generate health problems such as insomnia and anxiety. In addition to standard drugs and psychological interventions, there are different complementary plant-based therapies used to treat insomnia and anxiety. This review aimed to find and examine the most recent research on the use of herbal medicines for treating anxiety and insomnia as compiled from clinical trials, as well as to assess the safety and efficacy of these medicines and to elucidate their possible mechanisms of action. The process entailed a search of PubMed, Scopus, and the Cochrane Library databases from 2010 to 2020. The search terms included “sleep disorder”, “insomnia”, “sedative”, “hypnotic”, “anxiety”, “anxiolytic”, and “clinical trial”, combined with the search terms “herbs” and “medicinal plants”, in addition to individual herbal medicines by both their common and scientific names. This updated review, which focuses mainly on clinical trials, includes research on 23 medicinal plants and their combinations. Essential oils and their associations have also been reviewed. The efficacy of medicinal plants depends on treatment duration, types of study subjects, administration route, and treatment method. More clinical trials with an adequate, standardized design are necessary, as are more preclinical studies to continue studying the mechanisms of action. As a result of our work, we can conclude that the 3 plants with the most potential are valerian, passionflower, and ashwagandha, with the combination of valerian with hops and passionflower giving the best results in the clinical tests.
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Aromaterapi; tedavi, sağlığı korumak, geliştirmek ve genel iyilik hali için uygulanan kadim bir yöntemdir. Bu derleme çalışması kapsamında, Avrupa Farmakopesi’nde yer alan uçucu yağlara ait geleneksel kullanım, iyi tanımlanmış etki, endikasyon, kontrendikasyon, uygulama yolu, pozoloji; en önemlisi güvenli kullanımı şekillerini içeren yapılmış çeşitli klinik veriler, ayrıca Avrupa İlaç Kurumu (EMA) monograflarından yararlanılmıştır.
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The current study aimed to determine the effects of hypnotism on the severity of gastrointestinal symptoms and quality of life in individuals with irritable bowel syndrome (IBS). This trial study was conducted on 100 people with IBS in Shiraz, Iran. Hypnotism of participants was performed in 1-hour sessions for the intervention group at Weeks 4 and 6. A demographic characteristic questionnaire, Gastrointestinal Symptom Rating Scale, and IBS Quality of Life Index were used for data collection. The severity of gastrointestinal symptoms of participants in the intervention group significantly improved at 6 and 15 weeks after hypnotherapy. These individuals also had a significantly better quality of life after 15 weeks of hypnotherapy. Hypnotherapy may be beneficial in reducing gastrointestinal symptoms and improving quality of life in individuals with IBS. Combining this method with medicinal treatments could be effective for patients and health systems. [Journal of Psychosocial Nursing and Mental Health Services, 60(5), 55-62.].
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Introduction: Premenstrual syndrome (PMS) is a set of physical and psychological symptoms of menstruation in women which is one of the most common disorders of reproductive age. Several early articles have been published on the effect of aromatherapy on the symptoms of premenstrual syndrome. However, a comprehensive study was not found that shows the results of these studies uniformly and clearly, so this study was performed with aim to determine the effect of aromatherapy on the symptoms of premenstrual syndrome using systematic review. Methods: To achieve the studies related to the research objective, databases of SID, Magiran, Pubmed, Google scholar, Scopus and Science direct were searched without time limit until 2021 using the keywords of premenstrual syndrome, aromatherapy in both Persian and English and all possible combinations with the use of operators of OR, AND. Qualitative evaluation of the studies was performed by the consortium checklist. Results: Seven plant extracts and essential oils were evaluated in 10 clinical trial studies which met the inclusion criteria. Most of the essential oils studied in the articles had antioxidant and flavonoid compounds with anti-inflammatory, analgesic and antidepressant properties and had a beneficial effect on relieving PMS symptoms. The majority of these essential oils had no or minimal side effects. Performing meta-analysis was not possible due to the heterogeneity of the studies' methodology and the difference of effects assessment tools. Conclusion: Due to the positive effect of using plant extracts and essential oils in reducing the physical and psychological symptoms of premenstrual syndrome, it can be considered as an alternative treatment for women with premenstrual syndrome.
Chapter
Fertility is a bio-psycho-social issue and one deeply embedded in psychological and emotional processes. The mind and emotions affect the body and vice versa. We live in a society which profoundly regulates and markets the body and its processes, and places high expectations on individuals to “perform” health and wellbeing (in the same way it places high expectations on people to “perform” pregnancy and parenthood). Similarly, mental wellbeing is marketed as something that is the individual’s responsibility and falsely touted as fixable if one simply engages in specific (often cost-associated) acts of self-care. The stress and challenge of family planning, particularly if there are issues with fertility, can greatly add to the mental load which can result in stress and suboptimal emotional wellbeing. The lack of centralized communal belief systems and a secularization of culture and thought in the West may add to this. Fertility in our society is powerfully embedded in social identities and expectations, particularly of women. Those experiencing infertility and fertility treatments will encounter a range of emotional effects. Fertility should be understood from a holistic perspective, with reference to its impact on identity, self, and spirituality. This chapter explores a number of complementary therapies which might provide support and enable self-care for people adjusting to the impact of infertility on their mental and emotional wellbeing, including hypnosis, aromatherapy, music and sound, Ayurveda, and touch/massage therapies.
Article
Objective: A majority of menstruating women experience some degree of regular recurrences of diverse symptoms-commonly known as premenstrual syndrome (PMS)-during the days before menstruation. Given the multifactorial etiology of PMS, no single treatment is universally recognized as effective, and many women turn to alternative modalities, including aromatherapy. The present study investigated therapeutic effects on premenstrual symptoms using fragrance from yuzu, a Japanese citrus fruit (Citrus junos Sieb. ex Tanaka), and aromatherapy, from the perspective of autonomic nervous system function. Subjects: Seventeen women in their 20s with subjective premenstrual symptoms. Design: A single-blind randomized crossover study. Settings/location: This study was performed at a laboratory in a university in Osaka, Japan. Subjects were examined on two separate occasions in the luteal phase. Outcome measures: Using two aromatic stimulation sources (yuzu and lavender used as the control), this experiment measured heart rate variability (HRV) reflecting autonomic nerve activity and the Profile of Mood States (POMS) as a psychologic index before and after aromatic stimulation. Results: A scant 10-min inhalation of the yuzu scent significantly decreased heart rate and increased high-frequency power of HRV, reflecting parasympathetic nerve activity, in the luteal phase. Additionally, POMS tests demonstrated that inhalation of the yuzu essential oil significantly decreased three negative subscales: tension-anxiety, anger-hostility, and fatigue-common premenstrual symptoms, together with a total mood disturbance as a global measure of affective state, as long as 35 min after the aroma stimulation. These premenstrual psychoneurophysiologic effects of yuzu fragrance did not differ from those of the effects of lavender. Conclusions: The present study indicated that short-term inhalation of yuzu fragrance could alleviate premenstrual emotional symptoms, which, at least in part, is attributable to the improvement of parasympathetic nervous system activity. This study further implies that yuzu fragrance aromatherapy might serve as an anti-PMS modality, given its comparable psychoneurophysiologic effects to those of lavender, a representative relaxing scent.
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Introduction Vitex agnus-castus, also called vitex is aboriginal to the Mediterranean region, with long leaves, tender stem, flowers and ripening seeds. The aim of this study was to overview premenstrual, postmenstrual and infertility disorder of Vitex agnus-castus. Methods This review article was carried out by searching studies in PubMed, Medline, Web of Science, and IranMedex databases. The initial search strategy identified about 87 references. In this study, 43 studies were accepted for further screening, and met all our inclusion criteria (in English, full text, therapeutic effects of Vitex agnus-castus and dated mainly from the year 2009 to 2016). The search terms were Vitex agnus-castus, premenstrual, postmenstrual, infertility disorder properties and pharmacological effects. Result Vitex agnus-castus was shown to contribute to the treatment of premenstrual syndrome (PMS). Moreover, the result of the present study showed that this valuable plant is helpful in alleviation of pain resulting from postmenstrual disease. Furthermore, it was found that Vitex agnus-castus is beneficial in infertility disorder. Conclusion Vitex agnus-castus (AC) is a phytopharmaceutical compound and is shown to be widely used to treat PMS and PMDD. In addition, it was shown to be beneficial in post-menstrual cases and it can also contribute to treatment of infertility cases in both men and women. Dopaminergic compounds available in this plant help to treat premenstrual mastodynia as well as other symptoms of the premenstrual syndrome.
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Botanical dietary supplements are increasingly popular for women's health, particularly for older women. The specific botanicals women take vary as a function of age. Younger women will use botanicals for urinary tract infections, especially Vaccinium macrocarpon (cranberry), where there is evidence for efficacy. Botanical dietary supplements for premenstrual syndrome (PMS) are less commonly used, and rigorous clinical trials have not been done. Some examples include Vitex agnus-castus (chasteberry), Angelica sinensis (dong quai), Viburnum opulus/prunifolium (cramp bark and black haw), and Zingiber officinale (ginger). Pregnant women have also used ginger for relief from nausea. Natural galactagogues for lactating women include Trigonella foenum-graecum (fenugreek) and Silybum marianum (milk thistle); however, rigorous safety and efficacy studies are lacking. Older women suffering menopausal symptoms are increasingly likely to use botanicals, especially since the Women's Health Initiative showed an increased risk for breast cancer associated with traditional hormone therapy. Serotonergic mechanisms similar to antidepressants have been proposed for Actaea/Cimicifuga racemosa (black cohosh) and Valeriana officinalis (valerian). Plant extracts with estrogenic activities for menopausal symptom relief include Glycine max (soy), Trifolium pratense (red clover), Pueraria lobata (kudzu), Humulus lupulus (hops), Glycyrrhiza species (licorice), Rheum rhaponticum (rhubarb), Vitex agnus-castus (chasteberry), Linum usitatissimum (flaxseed), Epimedium species (herba Epimedii, horny goat weed), and Medicago sativa (alfalfa). Some of the estrogenic botanicals have also been shown to have protective effects against osteoporosis. Several of these botanicals could have additional breast cancer preventive effects linked to hormonal, chemical, inflammatory, and/or epigenetic pathways. Finally, although botanicals are perceived as natural safe remedies, it is important for women and their healthcare providers to realize that they have not been rigorously tested for potential toxic effects and/or drug/botanical interactions. Understanding the mechanism of action of these supplements used for women's health will ultimately lead to standardized botanical products with higher efficacy, safety, and chemopreventive properties.
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Background: Labor is a stressful situation that may have an adverse impact. Aromatherapy is a method to control anxiety and stress of women. This study was conducted to investigate the effect of aromatherapy using essential oil of orange on women's anxiety during labor. Materials and methods: In this clinical trial study, 100 women during labor were randomly assigned to two groups: intervention group and control group. The women in the intervention group were exposed to orange essential oil, but the women in the control group were exposed to distilled water. The women's anxiety was assessed using the Spielberger inventory. Moreover, physiological parameters such as systolic and diastolic blood pressure, respiration and pulse rates were assessed in all the women before and 20 min after the intervention. The data were analyzed by Chi-square, Wilcoxon, paired t-test, and Mann-Whitney U test. Data were evaluated with the SPSS 16 program. The significance level of P < 0.05 was considered. Results: The level of anxiety of women in both intervention (P = 0.03) and control (P = 0.003) groups reduced after the intervention. However, the reduction was more in the intervention group (difference in anxiety scores after the intervention in comparison to before intervention = -3.08) in comparison to the control group (score = -1.14). No significant change was found in the physiological parameters of women in the intervention group after the intervention. Conclusions: Aromatherapy is a noninvasive and effective method to help women overcome their anxiety during labor. Orange scent can be useful in childbirth units to help women who are experiencing stress in labor.
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Considering that vaginal delivery is a painful process, the present study investigated the effects of Citrus aurantium on the severity of first-stage labor pain in primiparous women. This study was a randomized clinical trial conducted with 126 eligible primiparous patients. The pain severity of patients was measured at the time of enrolling in the study. In the intervention group, (aromatherapy) gauze squares were soaked in 4 ml of C. aurantium distillated water, and in the control group, gauze squares were soaked in 4 ml of normal saline; each gauze square was attached to the respective patients' collar. The intervention was repeated every 30 min. Pain severity was measured after the intervention at 3–4, 5–7, and 8–10 cm cervix dilatations. The two groups were standardized with regard to age, profession, education, desire to conceive, and number and severity of uterine contractions. The Bishop's score was also calculated. Before intervention, pain severity was the same for both groups, but following intervention, pain severity reduced in the intervention group at 3–4 centimeter (P < 0.05), 7–5 centimeter (P < 0.05), and 8–10 centimeter (P < 0.05) dilatations compared with that in the control group. The findings of the study revealed that aromatherapy using C. aurantium distillated water alleviates labor pain. This method is recommended because of its ease of use and low cost and because it is a non-aggressive method to reduce labor pain.
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Background: Anxiety is the most common psychological response of women to labor. Aromatherapy, i.e. the use of fragrant essential oils to stimulate the olfactory system, can create a state of calmness and help to alleviate anxiety. Objectives: The present study tried to determine the efficacy of aromatherapy with Citrus aurantium oil in reducing anxiety during the first stage of labor. Patients and methods: This randomized clinical trial was conducted on two groups of pregnant women, referred to Vali-Asr Hospital (Tuyserkan, Iran) between June and September 2013. The sample size was comprised of 63 subjects in each group. Gauzes impregnated with 4 mL of C. aurantium distillate and normal saline were attached to the collar of subjects in the aromatherapy and control groups, respectively. The gauzes were changed every 30 minutes. The levels of anxiety in both groups were measured at baseline and after the intervention at dilations of 3-4 and 6-8 cm. The participants were followed up until delivery and the first- and fifth-minute Apgar scores were recorded. Data were collected using a demographic and obstetric characteristics questionnaire, an examination and observation checklist, and Spielberger state-trait anxiety questionnaire. Data analysis was performed with independent-t, Mann-Whitney, and chi-square tests in SPSS-22. P values less than 0.05 were considered significant. Results: Before the intervention, both groups had same levels of anxiety. However, the levels of anxiety at dilations of 3-4 and 6-8 cm were significantly lower in the aromatherapy group compared with the control group. Conclusions: The results of this study confirmed aromatherapy with C. aurantium blossom oil as a simple, inexpensive, noninvasive, and effective intervention to reduce anxiety during labor.
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This study aimed to investigate the effects of inhalation of the essential oil of Citrus aurantium L. var. amara (neroli oil) on menopausal symptoms, stress, and estrogen in postmenopausal women. Sixty-three healthy postmenopausal women were randomized to inhale 0.1% or 0.5% neroli oil or almond oil (control) for 5 minutes twice daily for 5 days. Menopause-related symptoms, as determined by the Menopause-Specific Quality of Life Questionnaire (MENQOL); sexual desire visual analog scale (VAS); serum cortisol and estrogen concentrations, blood pressure, pulse, and stress VAS, were measured before and after inhalation. Compared with the control group, the two neroli oil groups showed significant improvements in the physical domain score of the MENQOL and in sexual desire. Systolic blood pressure was significantly lower in the group inhaling 0.5% neroli oil than in the control group. Compared with the control group, the two neroli oil groups showed significantly lower diastolic blood pressure and tended to improve pulse rate and serum cortisol and estrogen concentrations. These findings indicate that inhalation of neroli oil helps relieve menopausal symptoms, increase sexual desire, and reduce blood pressure in postmenopausal women. Neroli oil may have potential as an effective intervention to reduce stress and improve the endocrine system.
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The objective of the current study was to translate and test psychometric properties of the Premenstrual Symptoms Screening Tool (PSST) in Iran. Using a standard "forward-backward" procedure, the English version of PSST was translated into Persian. A random sample of university students aged 18 years and over completed the questionnaire in Tehran, Iran. Psychometric properties of the Iranian version of PSST were assessed by performing reliability (internal consistency) and validity analyses [Content Validity Ratio (CVR) and Content Validity Index (CVI)]. In all, 925 female students took part in the study. Of these, 284 (30.7 %) had premenstrual syndrome (PMS) and 119 (12.9 %) had premenstrual dysphoric disorder (PMDD). Reliability of the PSST as measured by internal consistency was found to be satisfactory (Cronbach's alpha coefficient, 0.93). The content validity as assessed by CVR and CVI were desirable (0.7 and 0.8, respectively). The Iranian version of PSST seems to be a reliable and valid measure of detecting PMS and PMDD in Iranian young female populations.
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Essential oils have been used as an alternative and complementary treatment in medicine. Citrus fragrance has been used by aromatherapists for the treatment of anxiety symptoms. Based on this claim, the aim of present study was to investigate the effect of aromatherapy with essential oil of orange on child anxiety during dental treatment. Thirty children (10 boys, 20 girls) aged 6-9 years participated in a crossover intervention study, according to the inclusion criteria, among patients who attended the pediatric department of Isfahan Dental School in 2011. Every child underwent two dental treatment appointments including dental prophylaxis and fissure-sealant therapy under orange aroma in one session (intervention) and without any aroma (control) in another one. Child anxiety level was measured using salivary cortisol and pulse rate before and after treatment in each visit. The data were analyzed using t-test by SPSS software version 18. The mean ± SD and mean difference of salivary cortisol levels and pulse rate were calculated in each group before and completion of treatment in each visit. The difference in means of salivary cortisol and pulse rate between treatment under orange odor and treatment without aroma was 1.047 ± 2.198 nmol/l and 6.73 ± 12.3 (in minutes), which was statistically significant using paired t-test (P = 0.014, P = 0.005, respectively). It seems that the use of aromatherapy with natural essential oil of orange could reduce salivary cortisol and pulse rate due to child anxiety state.
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Aims: To further explore the anti-inflammatory properties of d-Limonene. Main methods: A rat model was used to compare evolution of TNBS (2,5,6-trinitrobenzene sulfonic acid)-induced colitis after oral feeding with d-Limonene compared to ibuprofen. Peripheral levels of TNF-α (Tumor Necrosis Factor alpha) were assessed in all animals. Cell cultures of fibroblasts and enterocytes were used to test the effect of d-Limonene respectively on TNFα-induced NF-κB (nuclear factor-kappa B) translocation and epithelial resistance. Finally, plasmatic inflammatory markers were examined in an observational study of diet supplementation with d-Limonene-containing orange peel extract (OPE) in humans. Key findings: Administered per os at a dose of 10mg/kg p.o., d-Limonene induced a significant reduction of intestinal inflammatory scores, comparable to that induced by ibuprofen. Moreover, d-Limonene-fed rats had significantly lowered serum concentrations of TNF-α compared to untreated TNBS-colitis rats. The anti-inflammatory effect of d-Limonene also involved inhibition of TNFα-induced NF-κB translocation in fibroblast cultures. The application of d-Limonene on colonic HT-29/B6 cell monolayers increased epithelial resistance. Finally, inflammatory markers, especially peripheral IL-6, markedly decreased upon OPE supplementation of elderly healthy subjects submitted or not to 56 days of dietary supplementation with OPE. Significance: In conclusion, d-Limonene indeed demonstrates significant anti-inflammatory effects both in vivo and in vitro. Protective effects on the epithelial barrier and decreased cytokines are involved, suggesting a beneficial role of d-Limonene as diet supplement in reducing inflammation.
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The purpose of this study was to investigate the effects of aromatherapy on the anxiety, sleep, and blood pressure (BP) of percutaneous coronary intervention (PCI) patients in an intensive care unit (ICU). Fifty-six patients with PCI in ICU were evenly allocated to either the aromatherapy or conventional nursing care. Aromatherapy essential oils were blended with lavender, roman chamomile, and neroli with a 6 : 2 : 0.5 ratio. Participants received 10 times treatment before PCI, and the same essential oils were inhaled another 10 times after PCI. Outcome measures patients' state anxiety, sleeping quality, and BP. An aromatherapy group showed significantly low anxiety ( = 5.99, < .001) and improving sleep quality ( = -3.65, = .001) compared with conventional nursing intervention. The systolic BP of both groups did not show a significant difference by time or in a group-by-time interaction; however, a significant difference was observed between groups ( = 4.63, = .036). The diastolic BP did not show any significant difference by time or by a group-by-time interaction; however, a significant difference was observed between groups ( = 6.93, = .011). In conclusion, the aromatherapy effectively reduced the anxiety levels and increased the sleep quality of PCI patients admitted to the ICU. Aromatherapy may be used as an independent nursing intervention for reducing the anxiety levels and improving the sleep quality of PCI patients.
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Background The current treatments for anxiety disorders and depression have multiple adverse effects in addition to a delayed onset of action, which has prompted efforts to find new substances with potential activity in these disorders. Citrus aurantium was chosen based on ethnopharmacological data because traditional medicine refers to the Citrus genus as useful in diminishing the symptoms of anxiety or insomnia, and C. aurantium has more recently been proposed as an adjuvant for antidepressants. In the present work, we investigated the biological activity underlying the anxiolytic and antidepressant effects of C. aurantium essential oil (EO), the putative mechanism of the anxiolytic-like effect, and the neurochemical changes in specific brain structures of mice after acute treatment. We also monitored the mice for possible signs of toxicity after a 14-day treatment. Methods The anxiolytic-like activity of the EO was investigated in a light/dark box, and the antidepressant activity was investigated in a forced swim test. Flumazenil, a competitive antagonist of benzodiazepine binding, and the selective 5-HT1A receptor antagonist WAY100635 were used in the experimental procedures to determine the mechanism of action of the EO. To exclude false positive results due to motor impairment, the mice were submitted to the rotarod test. Results The data suggest that the anxiolytic-like activity observed in the light/dark box procedure after acute (5 mg/kg) or 14-day repeated (1 mg/kg/day) dosing was mediated by the serotonergic system (5-HT1A receptors). Acute treatment with the EO showed no activity in the forced swim test, which is sensitive to antidepressants. A neurochemical evaluation showed no alterations in neurotransmitter levels in the cortex, the striatum, the pons, and the hypothalamus. Furthermore, no locomotor impairment or signs of toxicity or biochemical changes, except a reduction in cholesterol levels, were observed after treatment with the EO. Conclusion This work contributes to a better understanding of the biological activity of C. aurantium EO by characterizing the mechanism of action underlying its anxiolytic-like activity.
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The purpose of this study was to identify the effects of essential oil inhalation on the 24-hour ambulatory blood pressure (BP) and salivary cortisol level in 83 prehypertensive and hypertensive subjects. The experimental group (n = 28) was asked to inhale an essential oil blended with lavender, ylang-ylang, marjoram, and neroli (20 : 15 : 10 : 2), whereas the placebo group (n = 27) was asked to inhale an artificial fragrance for 24 hours and the control group received no treatment (n = 28). The SBP (P < .001) and DBP (P = .009) measured at home in the experimental group were significantly decreased compared with the placebo group and the control group after treatment. The daytime SBP during the 24-hour ambulatory BP measurement of the experimental group presented with significant decreases in comparison with the measurements of the placebo group and the control group (P < .001). There was no statistically significant difference in the nighttime SBPs. The daytime DBPs during the 24-hour ambulatory BP measurements of the experimental group presented with significant decreases in comparison with the measurements of the placebo group and the control group (P = .002). There was no significant difference in the night time DBPs. The experimental group showed significant decreases in the concentration of salivary cortisol in comparison with the concentrations of the placebo group and the control group (P = .012). In conclusion, the inhalation of an essential oil had immediate and continuous effects on the home SBP, daytime BP, and the stress reduction. Essential oils may have relaxation effects for controlling hypertension.
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We examined the sedative, anxiolytic and antidepressant effects of essential oil (EO) of leaves from Citrus limon, which has been used as one of the most popular compounds in Brazilian traditional herbal medicine. The effects of EO were demonstrated by open-field, elevated-plus-maze, rota rod, pentobarbital-induced sleeping time, and forced swimming tests in mice. In the open-field test, EO at the doses of 50, 100 and 150 mg/kg, after oral administration, significantly decreased the number of crossings, grooming, and rearing. In the elevated-plus-maze (EPM) test, EO increased the time of permanence and the number of entrances in the open arms. On the contrary, the time of permanence and the number of entrances in the closed arms were decreased. In the rota rod test, EO did not alter motor coordination and, thus, was devoid of effects, as related to controls. In the pentobarbital-induced sleeping time test, EO at the same doses significantly increased the animals sleeping time duration. Since EO, at the doses of 50, 100 and 150 mg/kg, did not show a sedative effect in the open field test, these three doses were used in the forced swimming test, producing a decrease in the immobility time, similarly to that of imipramine (positive control). However, the antidepressant effects of EO were not altered by the previous administration of paroxetine. In addition, effects of EO in the forced swimming test were totally blocked by reserpine pretreatment. In conclusion, the present work evidenced sedative and anxiolytic effects of EO that might involve an action on benzodiazepine-type receptors, and also an antidepressant effect where noradrenergic and serotoninergic mechanisms will probably play a role.
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Citrus aurantium L. is commonly used as an alternative treatment for insomnia, anxiety and epilepsy. Essential oil from peel (EOP) and hydroethanolic (70% w/v) extract (HE) from leaves were obtained. Hexanic (HF), dichloromethanic (DF) and final aqueous (AF) fractions were obtained from HE by successive partitions. Swiss male mice (35-45 g) were treated orally with 0.5 or 1.0 g/kg of these preparations 30 min before the experiments for the evaluation of the sedative/hypnotic activity (sleeping time induced by sodium pentobarbital - SPB: 40 mg/kg, i.p.), anxiolytic activity (elevated plus maze--EPM) and anticonvulsant activity (induced by pentylenetetrazole--PTZ: 85 mg/kg, sc or by maximal electroshock--MES: 50 mA, 0.11 s, corneal). The results showed that EOP (0.5 g/kg) increased the latency period of tonic seizures in both convulsing experimental models. This effect was not dose-dependent. Treatment with 1.0 g/kg increased the sleeping time induced by barbiturates and the time spent in the open arms of the EPM. Specific tests indicated that the preparation, in both doses used, did not promote deficits in general activity or motor coordination. HF and DF fractions (1.0 g/kg) did not interfere in the epileptic seizures, but were able to enhance the sleeping time induced by barbiturates. The results obtained with EOP in the anxiety model, and with EOP, HF and DF in the sedation model, are in accord with the ethnopharmacological use of Citrus aurantium L., which could be useful in primary medical care, after toxicological investigation.
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Seville orange (Citrus aurantium) extracts are being marketed as a safe alternative to ephedra in herbal weight-loss products, but C. aurantium may also have the potential to cause adverse health effects. C. aurantium contains synephrine (oxedrine), which is structurally similar to epinephrine. Although no adverse events have been associated with ingestion of C. aurantium products thus far, synephrine increases blood pressure in humans and other species, and has the potential to increase cardiovascular events. Additionally, C. aurantium contains 6',7'-dihydroxybergamottin and bergapten, both of which inhibit cytochrome P450-3A, and would be expected to increase serum levels of many drugs. There is little evidence that products containing C. aurantium are an effective aid to weight loss. Synephrine has lipolytic effects in human fat cells only at high doses, and octopamine does not have lipolytic effects in human adipocytes.
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The majority of women of reproductive age experience a regular recurrence of various symptoms in the premenstrual phase. The etiopathogenesis of premenstrual symptomatology, however, remains inconclusive. The present study was proposed to evaluate whether the activity of the autonomic nervous system (ANS), which largely contributes to the relative stability of a human's internal environment, is altered during the menstrual cycle of women with premenstrual symptomatology. Thirty eumenorrheic young women participated in this study. All subjects were investigated during the follicular and late luteal phases. The ANS activity was assessed by means of heart rate variability power spectral analysis during supine rest. No intramenstrual cycle differences in the ANS activity were found in women experiencing no or small increases in premenstrual symptoms. In contrast, the sympathetic nervous system (SNS) activity significantly increased and the parasympathetic nervous system (PNS) activity apparently decreased in the late luteal phase in subjects whose premenstrual symptomatology was not unbearable, but substantially increased (> 20%) compared to the symptom-free follicular phase. The women with greater degrees of premenstrual distress possessed higher SNS activity and lower PNS activity in the late luteal phase than the women with less symptomatology. The ANS activity in the follicular phase did not differ among the subjects regardless of their premenstrual symptoms. Although causes and consequences continue to elude, the present study provides additional intriguing evidence that the altered functioning of ANS in the late luteal phase could be associated with diverse psychosomatic or behavioral symptoms appearing premenstrually.
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Premenstrual syndrome (PMS) encompasses a wide variety of cyclic and recurrent physical, emotional, and behavioral symptoms occurring during the late luteal phase of the menstrual cycle and abating shortly following the beginning of menses. Although PMS is widely recognized, its etiopathogenesis is not yet understood. The present study investigates whether the activity of the autonomic nervous system, which plays a vital role in orchestrating physiological homeostasis within the human body, is altered during the menstrual cycle of women with different degrees of premenstrual symptomatology. Sixty-two women in their 20s to 40s with regular menstrual cycles participated in this study. All subjects were examined during the follicular and late luteal phases. Cycle phase was determined by the onset of menstruation and oral temperature and was verified by concentrations of ovarian hormones, estrone, and pregnanediol in a urine sample taken early in the morning. Autonomic nervous system activity was assessed by means of heart-rate variability (HRV) power spectral analysis during supine rest. The Menstrual Distress Questionnaire was used to evaluate physical, emotional, and behavioral symptoms accompanying the menstrual cycle of the subjects. The subjects were categorized in three groups, Control, PMS, and premenstrual dysphoric disorder (PMDD) groups, depending on the severity of premenstrual symptomatology. No intramenstrual cycle difference in any of the parameters of HRV was found in the Control group, which had no or a small increase in premenstrual symptoms. In contrast, Total power and high frequency power, which reflect overall autonomic and parasympathetic nerve activity, respectively, significantly decreased in the late luteal phase from the follicular phase in the PMS group. As for the PMDD group, which had more severe symptoms premenstrually, heart-rate fluctuation as well as all components of the power spectrum of HRV were markedly decreased regardless of the menstrual cycle compared to those of the other two groups. Several theories have been proposed to explain the underlying mechanisms of PMS with its complex web of bio-psycho-social factors. Although causes and consequences continue to elude, the present study provides intriguing and novel findings that the altered functioning of the autonomic nervous system in the late luteal phase could be associated with diverse psychosomatic and behavioral symptoms appearing premenstrually. In addition, when symptoms become more severe (as seen in women with PMDD), the sympathovagal function might be more depressed regardless of the menstrual cycle.
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Objective: A majority of menstruating women experience some degree of regular recurrences of diverse symptoms-commonly known as premenstrual syndrome (PMS)-during the days before menstruation. Given the multifactorial etiology of PMS, no single treatment is universally recognized as effective, and many women turn to alternative modalities, including aromatherapy. The present study investigated therapeutic effects on premenstrual symptoms using fragrance from yuzu, a Japanese citrus fruit (Citrus junos Sieb. ex Tanaka), and aromatherapy, from the perspective of autonomic nervous system function. Subjects: Seventeen women in their 20s with subjective premenstrual symptoms. Design: A single-blind randomized crossover study. Settings/location: This study was performed at a laboratory in a university in Osaka, Japan. Subjects were examined on two separate occasions in the luteal phase. Outcome measures: Using two aromatic stimulation sources (yuzu and lavender used as the control), this experiment measured heart rate variability (HRV) reflecting autonomic nerve activity and the Profile of Mood States (POMS) as a psychologic index before and after aromatic stimulation. Results: A scant 10-min inhalation of the yuzu scent significantly decreased heart rate and increased high-frequency power of HRV, reflecting parasympathetic nerve activity, in the luteal phase. Additionally, POMS tests demonstrated that inhalation of the yuzu essential oil significantly decreased three negative subscales: tension-anxiety, anger-hostility, and fatigue-common premenstrual symptoms, together with a total mood disturbance as a global measure of affective state, as long as 35 min after the aroma stimulation. These premenstrual psychoneurophysiologic effects of yuzu fragrance did not differ from those of the effects of lavender. Conclusions: The present study indicated that short-term inhalation of yuzu fragrance could alleviate premenstrual emotional symptoms, which, at least in part, is attributable to the improvement of parasympathetic nervous system activity. This study further implies that yuzu fragrance aromatherapy might serve as an anti-PMS modality, given its comparable psychoneurophysiologic effects to those of lavender, a representative relaxing scent.
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Premenstrual syndrome (PMS) is characterized by recurrent, moderate-to-severe affective, physical, and behavioral symptoms that develop during the luteal menstrual cycle and disappear within a few days of menstruation. Premenstrual dysphoric disorder (PMDD) is a severe and disabling condition that can affect personal relationships and occupational activities. PMS occurs in 30–40% of reproductive-age females; PMDD affects 3–8% of this population. Although the etiology of PMS is unclear, several theories suggest increased sensitivity to normal hormonal changes and neurotransmitter abnormalities. The diagnostic method of PMS is the Daily Record of Severity of Problems, which women with PMS can use to self-report several symptoms and their severity. Although combined oral contraceptives and serotonergic antidepressants are effective drugs, each is a different option for treating PMS/PMDD. Serotonergic antidepressants are the drugs of choice for improving both physical and mood symptoms. Combined oral contraceptives appear to primarily improve physical symptoms. Clinicians should consider each patient's situation individually. Other treatment options include lifestyle modification, cognitive behavioral therapy, and herbal medicine (e.g., chasteberry).
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Premenstrual syndrome (PMS) is triggered by hormonal events ensuing after ovulation. The symptoms can begin in the early, mid, or late luteal phase and are not associated with defined concentrations of any specific gonadal or non-gonadal hormone. Women with PMS experience affective or somatic symptoms that cause severe dysfunction in social or occupational realms. Although evidence for a hormonal abnormality has not been established, the symptoms of the premenopausal disorders are related to the production of progesterone by the ovary. The progesterone metabolites may bind to a neurosteroid-binding site on the membrane of the neurotransmitters. Thus, ovulation suppression is an area of focus for diagnostic and treatment options. Many treatment studies have focused on suppression of ovulation with gonadotropin-releasing hormone analogs (GnRHa), high doses of transdermal estrogen, and bilateral oophorectomy all have positive evidence as treatment options for prevention of PMS. However, because of these limitations and their substantial intensive care, these do not appear to be appropriate methods for conventional treatment of PMS. Serotonergic antidepressants, selective serotonin reuptake inhibitors, are well-established, highly effective, and first-line pharmacologic therapy.
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ABSTRACT An evidence-based systematic review of bitter orange (Citrus aurantium) by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.
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To satisfy the need in personality research for factorially univocal measures of each of the 5 domains that subsume most English-language terms for personality traits, new sets of Big-Five factor markers were investigated. In studies of adjective-anchored bipolar rating scales, a transparent format was found to produce factor markers that were more univocal than the same scales administered in the traditional format. Nonetheless, even the transparent bipolar scales proved less robust as factor markers than did parallel sets of adjectives administered in unipolar format. A set of 100 unipolar terms proved to be highly robust across quite diverse samples of self and peer descriptions. These new markers were compared with previously developed ones based on far larger sets of trait adjectives, as well as with the scales from the NEO and Hogan personality inventories. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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A must-have health companion for herbalists, naturopaths, complementary medicine practitioners and students "Recommended evidence-based reference on Complementary Medicines" National Pharmacy Board 2010 Herbs and Natural Supplements, 3rd Edition: An evidence-based guide presents evidence-based information on the 130 most popular herbs, nutrients and food supplements used across Australia and New Zealand. This exhaustive textbook is organised alphabetically by each herb or nutrient's common name. Herbs and nutrients are then accompanied by critical information such as daily intake, main actions and indications, adverse reactions, contraindications and precautions, safety in pregnancy and more. This new edition of Herbs and Natural Supplements has been expanded with new chapters on pregnancy and wellness. It also features 10 new monographs for Arginine, Dunaliella, Elde, Goji, Pelargonium, Prebiotics, Red Yeast Rice, Rhodioloa, Shatavari and Taurine.
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Premenstrual depression, postnatal depression and climacteric depression are related to changes in ovarian hormone levels and can be effectively treated by hormones. It is unfortunate that psychiatrists have not accepted this form of treatment and this paper is an attempt to simplify this treatment, which should include transdermal estrogens, possibly testosterone and, if the woman has a uterus, also progestogen. A balance is often necessary between these three hormones. Transdermal estrogens in the appropriate dose will suppress ovulation and suppress the cyclical hormonal changes that produce premenstrual depression. Estrogens also have a mood-enhancing effect in postnatal depression and the depression in the transitional phase of the menopause. It is possible to add transdermal testosterone which will improve mood, energy and libido. The problem is the progestogen as these women are often progestogen-intolerant. Progestogen should be used in the lowest dose and for the shortest duration necessary to prevent endometrial hyperplasia or the return of premenstrual syndrome-type symptoms if the women are progestogen-intolerant. The use of estrogens for depression in these women does not exclude the use of antidepressants. Hormone-responsive depression cannot be diagnosed by measuring hormone levels but can only be diagnosed by a careful history relating depression to the menstrual cycle, pregnancies and the perimenopausal years. These appropriate questions should prevent the endocrine condition of premenstrual depression being misdiagnosed as bipolar disorder and the woman given inappropriate treatment.
Article
Nobiletin isolated from citrus peels up-regulates synaptic transmission and improves memory impairment in rodents. This study investigated the antidepressant-like effect of nobiletin in the forced swimming test (FST) and tail suspension test (TST) in mice. Additionally, the monoaminergic mechanisms involved in the antidepressant-like effect of nobiletin in mice were also assessed. Nobiletin (25, 50 and 100mg/kg, p.o.) decreased the immobility time in both the FST and TST without locomotor alterations in the open-field test (OFT). The anti-immobility effect of nobiletin (50mg/kg, p.o.) was completely prevented by the pretreatment of mice with WAY 100635 (0.1mg/kg, s.c., a serotonin 5-HT(1A) receptor antagonist), cyproheptadine (3mg/kg, i.p., a serotonin 5-HT(2) receptor antagonist), prazosin (62.5μg/kg, i.p., an α(1)-adrenoceptor antagonist), SCH23390 (0.05mg/kg, s.c., a dopamine D(1) receptor antagonist) or sulpiride (50mg/kg, i.p., a dopamine D(2) receptor antagonist). On the other hand, the pretreatment of mice with yohimbine (1mg/kg, i.p., an α(2)-adrenoceptor antagonist) or propranolol (5mg/kg, i.p., a β-adrenoceptor antagonist) did not block the antidepressant-like effect of nobiletin in the TST. Taken together, the data demonstrated that nobiletin produced an antidepressant-like effect that seems to be dependent on its interaction with the serotonergic, noradrenergic and dopaminergic systems. Thus, the present study suggests the therapeutic potential of this dietary flavonoid for the treatment of depression.
Article
During the reproductive years, most of menstruating women experience symptoms of premenstrual syndrome (PMS), which is incapacitating in up to 10% of cases. According to complicated etiology, various therapeutic approaches have been proposed. Because PMS is a chronic situation, special attention should be paid to the side-effects of pharmacological interventions. Herbal medicine is a recent favorable therapeutic approach owing to fewer side-effects. We aimed to determine the effect of Ginkgo biloba L. on the symptoms of PMS. This was a single-blind, randomized, placebo-controlled trial conducted from November 2007 to April 2008. The students with PMS, living in dormitories of a medical university (Tehran), who met the inclusion criteria entered the study. The students filled out the daily symptom rating forms in two consecutive menstrual cycles. After we verified the PMS diagnosis in 90 students, the participants were randomly assigned to experiment and placebo groups and took G. biloba L. tablets (containing 40 mg leaf extracts) or placebo three times a day from the 16th day of the menstrual cycle to the 5th day of the next cycle. Data were collected using daily symptom rating forms. Eighty-five (85, 94.4%) participants completed the study. The two groups were similar in terms of demographic characteristics and baseline overall severity of symptoms. After the intervention, there was a significant decrease in the overall severity of symptoms and physical and psychologic symptoms in both Ginkgo (23.68%) and placebo (8.74%) groups (p < 0.001). However, the mean decrease in the severity of symptoms was significantly more in the Ginkgo group compared to the placebo group (p < 0.001). G. biloba L. can reduce the severity of PMS symptoms. Further research on active ingredients and also the efficacy and safety of various doses and treatment durations of Ginkgo are required.
Article
Premenstrual symptoms are distressing for up to 20% of reproductive-aged women and are associated with impairment in interpersonal or workplace functioning for at least 3-8%. Typical symptoms of premenstrual syndrome and the severe form, premenstrual dysphoric disorder, include irritability, anger, mood swings, depression, tension/anxiety, abdominal bloating, breast pain and fatigue. The symptoms recur monthly and last for an average of 6 days per month for the majority of the reproductive years. For women with premenstrual dysphoric disorder, the symptoms can be as disabling as major depressive disorder. It has been estimated that affected women experience almost 3000 days of severe symptoms during the reproductive years. Until two decades ago, there were no effective treatments for severe premenstrual syndrome. Even in 2000, almost three-quarters of women in the USA with premenstrual disorders either did not seek help or sought treatment unsuccessfully from at least three clinicians for over 5 years. This review will focus on the epidemiology, diagnosis, treatment outcomes, quality of life and burden of illness for premenstrual disorders.
Article
Citral, myrcene and limonene (100 and 200 mg/kg body wt., i.p.), constituents of essential oils from Lippia alba chemotypes, decreased not only the number of crossings but also numbers for rearing and grooming, as measured by the open-field test in mice. Although muscle relaxation detected by the rota rod test was seen only at the highest doses of citral (200 mg/kg body wt.) and myrcene (100 and 200 mg/kg body wt.), this effect was observed even at the lowest dose of limonene (50 mg/kg body wt.). Also, citral and myrcene (100 and 200 mg/kg body wt.) increased barbiturate sleeping time as compared to control. Limonene was also effective at the highest dose, and although citral did not increase the onset of sleep, it increased the duration of sleep, which is indicative of a potentiation of sleeping time. Citral (100 and 200 mg/kg body wt.) increased 2.3 and 3.5 times, respectively, the barbiturate sleeping time in mice. Similar effects were observed for myrcene and limonene at the highest dose (200 mg/kg body wt.) which increased the sleeping time around 2.6 times. In the elevated-plus maze, no effect was detected with citral up to 25 mg/kg body wt., while at a high dose it decreased by 46% the number of entries in the open arms. A smaller but significant effect was detected with limonene (5 mg/kg body wt.). While myrcene (10 mg/kg body wt.) decreased only by 22% the number of entries in the open arms, this parameter was decreased by 48% at the highest dose. Our study showed that citral, limonene and myrcene presented sedative as well as motor relaxant effects. Although only at the highest dose, they also produced a potentiation of the pentobarbital-induced sleeping time in mice, which was more intense in the presence of citral. In addition, neither of them showed an anxiolytic effect, but rather a slight anxiogenic type of effect at the higher doses.
Article
This study was to develop an aromatherapy hand massage program, and to evaluate the effects of lavender aromatherapy on cognitive function, emotion, and aggressive behavior of elderly with dementia of the Alzheimer's type. The Research design was a nonequivalent control group non-synchronized quasiexperimental study. Lavender aromatherapy was administrated to experimental group I for 2 weeks, jojoba oil massage was administrated to experimental group II for 2 weeks, and no treatment was administrated to the control group for 2 weeks. Data was analyzed using the chi(2)-test, ANOVA, repeated measures of ANCOVA and ANCOVA in the SPSS program package. 1. Experimental group I did not show significant differences in cognitive function in relation to the experimental group II and control group. 2. Experimental group I showed significant differences in emotion and aggressive behavior in relation to the experimental group II and control group. A Lavender aromatherapy hand massage program is effective on emotions and aggressive behavior of elderly with dementia of the Alzheimer's type.
Article
In a previous study, we found that olfactory stimulation with scent of grapefruit oil (SGFO) excites the sympathetic nerve innervating the white adipose tissue in rats. Here we further examined the effects of SGFO in rats and observed that olfactory stimulation with SGFO excited the sympathetic nerves innervating the brown adipose tissue and adrenal gland and inhibited the parasympathetic gastric nerve. Local anesthesia of the nasal mucosa with xylocaine or anosmic treatment using ZnSO4 eliminated the autonomic changes caused by SGFO. Moreover, stimulation with SGFO elevated the plasma glycerol level, and treatment with either ZnSO4 or an intraperitoneal injection of diphenhydramine, a histamine H1 receptor-antagonist, abolished the glycerol elevation by SGFO. Furthermore, a 15-min exposure to SGFO three times a week reduced food intake and body weight. Finally, limonene, a component of grapefruit oil, induced responses similar to those caused by SGFO, and diphenhydramine eliminated the glycerol response to limonene. Thus, the scent of grapefruit oil, and particularly its primary component limonene, affects autonomic nerves, enhances lipolysis through a histaminergic response, and reduces appetite and body weight.
Article
Citrus aurantium L. is popularly used to treat anxiety, among other indications suggesting central nervous system action. Previous studies showed anxiolytic effect in the essential oil from peel in mice evaluated on the elevated plus maze [Carvalho-Freitas, M.I.R., Costa, M., 2002. Anxiolytic and sedative effects of extracts and essential oil from Citrus aurantium L. Biological and Pharmaceutical Bulletin 25, 1629-1633.]. In order to better characterize the activity of the essential oil, it was evaluated in two other experimental models: the light-dark box and the marble-burying test, respectively related to generalized anxiety disorder and to obsessive compulsive disorder. Mice were treated acutely by oral route 30 min (single dose) or once a day for 15 days (repeated doses) before experimental procedures. In light-dark box test, single treatment with essential oil augmented the time spent by mice in the light chamber and the number of transitions between the two compartments. There were no observed alterations in the parameters evaluated in light-dark box after repeated treatment. Otherwise, single and repeated treatments with essential oil were able to suppress marble-burying behavior. At effective doses in the behavioral tests, mice showed no impairment on rotarod procedure after both single and repeated treatments with essential oil, denoting absence of motor deficit. Results observed in marble-burying test, related to obsessive compulsive disorder, appear more consistent than those observed in light-dark box.
Article
This study examined the effect of aromatherapy-massage in healthy postpartum mothers. A quasi-experimental between-groups design was used. Mothers who received aromatherapy-massage were compared with a control group who received standard postpartum care. Thirty-six healthy, first-time mothers with vaginal delivery of a full-term, healthy infant participated in this study. Sixteen mothers received a 30-minute aromatherapy-massage on the second postpartum day; 20 mothers were in the control group. All mothers completed the following four standardized questionnaires before and after the intervention: 1) Maternity Blues Scale; 2) State-Trait Anxiety Inventory; 3) Profile of Mood States (POMS); and 4) Feeling toward Baby Scale. In the aromatherapy-massage group, posttreatment scores significantly decreased for the Maternity Blues Scale, the State-Anxiety Inventory, and all but one of the Profile of Mood States subscales. Posttreatment scores in the intervention group significantly increased in Profile of Mood States-Vigor subscale and the Approach Feeling toward Baby subscale. Scores in the intervention group significantly decreased in Conflict Index of Avoidance/Approach Feeling toward Baby subscale. Our results suggest that aromatherapy-massage might be an effective intervention for postpartum mothers to improve physical and mental status and to facilitate mother-infant interaction.
Article
A variety of instruments have been used in an attempt to operationalize DSM-IV criteria for premenstrual dysphoric disorder (PMDD) and to understand clinically significant premenstrual syndrome (PMS). The objectives of this research were to devise a simple user friendly screening tool to identify women who suffer from severe PMS/PMDD and who are likely to benefit from treatment. Five hundred and nineteen women, between the ages of 18 and 55 yrs, who were seen at a primary care facility completed "The Premenstrual Symptoms Screening tool" (PSST). The PSST reflects and 'translates' categorical DSM-IV criteria into a rating scale with degrees of severity. The results are in line with reported prevalence rates from several recent large prospective studies. We believe that the PSST applies a necessary degree of measure of severity and impact of premenstrual symptoms, establishes quickly if women qualify for PMDD, and is less time consuming and more practical than two cycles of prospective charting. This fast simple tool is an effective screening tool and an important starting point for further assessment.
Article
To assess the efficacy of an aromatic essential oil (1% Zingiber officinale and 0.5% Citrus sinesis) massage among the elderly with moderate-to-severe knee pain. Fifty-nine older persons were enrolled in a double-blind, placebo-controlled experimental study group from the Community Centre for Senior Citizens, Hong Kong. The intervention was six massage sessions with ginger and orange oil over a 3-week period. The placebo control group received the same massage intervention with olive oil only and the control group received no massage. Assessment was done at baseline, post 1-week and post 4 weeks after treatment. Changes from baseline to the end of treatment were assessed on knee pain intensity, stiffness level and physical functioning (by Western Ontario and McMaster Universities Osteoarthritis index) and quality of life (by SF-36). There were significant mean changes between the three time-points within the intervention group on three of the outcome measures: knee pain intensity (p=0.02); stiffness level (p=0.03); and enhancing physical function (p=0.04) but these were not apparent with the between-groups comparison (p=0.48, 0.14 and 0.45 respectively) 4 weeks after the massage. The improvement of physical function and pain were superior in the intervention group compared with both the placebo and the control group at post 1-week time (both p=0.03) but not sustained at post 4 weeks (p=0.45 and 0.29). The changes in quality of life were not statistically significant for all three groups. The aroma-massage therapy seems to have potential as an alternative method for short-term knee pain relief.
  • K A Yonkers
  • P S O'brien
  • E Eriksson
K.A. Yonkers, P.S. O'Brien, E. Eriksson, Premenstrual syndrome, Lancet 371 (9619) (2008) 1200-1210.
Non-contraceptive oestrogencontaining preparations for con-trolling symptoms of premenstrual syndrome
  • B Naheed
  • P O'brien
  • O Uthman
  • F O'mahony
B. Naheed, P. O'Brien, O. Uthman, F. O'Mahony, Non-contraceptive oestrogencontaining preparations for con-trolling symptoms of premenstrual syndrome, Cochrane Database Syst. Rev. 3 (2017 Mar 3), http://dx.doi.org/10.1002/ 14651858 CD010503.
Mosby's 2014 Nursing Drug Reference
  • L Skidmore-Roth
L. Skidmore-Roth, Mosby's 2014 Nursing Drug Reference, Elsevier Health Sciences, 2013.
Clinician's Complete Reference to Complementary/alternative Medicine
  • D Novey
  • Donald W Novey
D. Novey, Donald W. Novey (Ed.), Clinician's Complete Reference to Complementary/alternative Medicine, Mosby Inc, 2000.
PDR for Herbal Medicines: Physician's Desk Reference (PDR)
  • T P Staff
T.P. Staff, PDR for Herbal Medicines: Physician's Desk Reference (PDR), (2004).
  • N Heydari
N. Heydari et al. Complementary Therapies in Clinical Practice 32 (2018) 1-5