Citrus aurantium for mood enhancement -
At current, a group of antidepressants and sedatives and antipsychotics is at the first line of pharmacological treatment of sleep disturbances during pregnancy, which is limited information on the safe use of these medications in pregnancy [ 13 ]. Cognitive—behavioral therapy CBT is a combination of cognitive and behavioral approaches.
CBT reduces cognitive, physical, and behavioral symptoms through the use of specific methods including relaxation, regular desensitization, cognitive reconstruction, response prevention, problem-solving, activity listing, and training of interpersonal skills [ 14 ].
The content of therapy includes identifying thoughts and beliefs, reviewing evidence, and examining cognitions and thoughts that are related to mood and behavior [ 15 ]. Cognitive—behavioral therapy for insomnia CBT-I is a structured program to identify and replace thoughts and behaviors that cause or worsen sleep disturbances with practices that promote proper sleep.
The five main components of CBT-I are cognitive restructuring, sleep consolidation, stimulus control, sleep hygiene, and relaxation techniques [ 16 ].
Herbal medicines have been used widely since old days in ancient civilizations [ 17 ]. Aromatherapy is one of the treatments that have grown increasingly in recent years compared to complementary medicine treatments [ 18 ]. According to a recent systematic review, various essential oils, such as lavender, bergamot, and chamomile, have improved sleep quality and reduced stress, pain, anxiety, depression, and fatigue [ 19 ].
These oils help individuals to relax their bodies and minds, leading to better sleep quality. Also, some aromas may increase slow-wave sleep SWS and subjective sleep quality [ 20 ]. One of the essential oils used in aromatherapy is Citrus aurantium. This essential oil is an amber-colored liquid that turns red in the presence of light.
Its smell is strong, very fragrant and its taste is bitter [ 21 ]. Citrus aurantium has central nervous system stimulating and mood-enhancing effects, as well as sedative, antispasmodic, anti-inflammatory, anti-flatulence, digestive, antihypertensive and diuretic effects [ 22 ].
Based on the literature review, limited studies have been found about the effect of Citrus aurantium on sleep quality, anxiety, and quality of life of pregnant women.
In a recent study, this essential oil was effective in reducing the anxiety of women at risk of preterm labor [ 24 ]; it was also effective in reducing anxiety during labor in another study [ 25 ].
No study has been conducted with the integration of CBT and aromatherapy. Considering that poor sleep quality has detrimental effects on mood, psychological function and overall well-being [ 26 ] and given the various studies have reported the sedative and anxiolytic effects of Citrus aurantium [ 22 ], and also CBT helps the patient to recognize and change distorted thought patterns and dysfunctional behaviors [ 14 ].
Thus, the present study aimed to evaluate the effect of cognitive—behavioral counseling with and without Citrus aurantium on sleep quality primary outcome , anxiety and quality of life secondary outcomes in pregnant women. This randomized controlled trial was conducted on 75 pregnant women referring to health centers in Tabriz, Iran from July to February The inclusion criteria included pregnant women with a gestational age of 20—24 weeks, women with poor sleep quality based on the Pittsburgh Sleep Quality Index PSQI score above 5 , having a minimum degree of secondary school, living in Tabriz, having a medical record in the health center integrated health system , lack of olfactory problems and allergy to herbal medicines by examination by the researcher, obtaining a depression score of 12 and lower according to the Edinburgh Pregnancy Depression Scale EPDS.
The exclusion criteria included pregnant women with mental illness and a history of hospitalization in a psychiatric hospital or the use of any psychiatric medication, addiction to drugs and smoking, high-risk pregnancies including diabetes, hypertension, chronic diseases, such as cardiovascular, lung, etc.
The sample size in this study was calculated using G-Power software. According to the results of the study conducted by Effati et al. Sampling began after obtaining the code of ethics from the ethics committee of Tabriz University of Medical Sciences code: IR. Sampling was performed in 6 health centers of Tabriz, Iran.
The researcher referred to health centers in Tabriz, and then briefly explained the goals and methods of the research to women with 20—24 gestational ages. If women were willing to participate in the study, they were examined in terms of inclusion and exclusion criteria and eligible individuals were selected.
Then, the PSQI and the EPDS were completed through interview with participants by the researcher and participants who scored sleep quality score higher than 5 and a depression score 12 and less, and met other inclusion criteria were included in the study after obtaining informed written consent and then the socio-demographic characteristics questionnaire, Pregnancy-Specific Anxiety Scale PSAS and Pregnancy-Specific Quality of life Questionnaire QOL-GRAV were completed through interview with participants by the researcher.
Participants were randomly allocated to three groups including the first intervention group receiving cognitive—behavioral counseling with aromatherapy with Citrus aurantium essential oil , the second intervention group receiving cognitive—behavioral counseling and placebo , and control group using the block randomization method with the block sizes of 6 and 9 and an allocation ratio of The type of intervention was written on paper and placed in opaque and sealed envelopes that numbered sequentially to conceal the allocation sequence.
The envelopes were opened in the order in which the participants entered the study and the type of group of individuals was determined. Envelopes were prepared by a person not involved in sampling, data collection and analysis.
Similar glasses of Citrus aurantium essential oil or placebo were prepared and coded with letters of A and B. The Citrus aurantium essential oil and placebo had exactly the same appearance smell, color, and shape. The intervention groups received a glass of drug or placebo in addition to counseling.
The researcher and participants of intervention groups were blinded to the type of drug received. The first and second intervention groups received 8 sessions of cognitive—behavioral counseling held in the health center in groups of 5—7 people.
The mean duration of counseling sessions was 60—90 min. Cognitive—behavioral counseling sessions were by the first author Master of Counseling in Midwifery under the supervision of the project clinical psychologist in health centers held as 2 sessions per week and lasted for 4 weeks. The content of the counseling included explaining the goals of training and acquaintance with the members, conducting a pre-test, explaining the importance of treatment, assessing the insomnia, perception of sleep and insomnia, evaluating thoughts, training relaxation, sleep health and new sleep schedules, restriction of sleep, prevention of daily naps, problem-solving skills, summarizing thoughts, reality of sleep, introducing the cycle of thought and feeling and behavior, and training thought blocking.
Due to COVID disease, the last two sessions were held online in the Zoom program due to unwillingness of pregnant women to attend the health center. The content of the counseling sessions was as follows:.
Session 1: Explaining the goals of training and acquaintance with members, conducting a pre-test, teaching how to monitor the baseline of sleep with a sleep report table, reminding the importance of treatment tasks, a complete assessment of the nature of insomnia.
Session 2: Presenting the principles and logic of treatment, teaching the mechanism of sleep and its stages, sleep—wake cycles and underlying factors, maintenance and continuation of insomnia, relaxation training.
Session 3: Reviewing the previous session of treatment, reviewing the findings of the sleep report form, sleep hygiene training, and review the relaxation and new sleep schedule. Session 4: Restricting sleep, preventing daily naps, evaluating thoughts and teaching how to record thoughts related to insomnia and reviewing the assignments of previous sessions sleep report form and homework schedule.
Session 5: Summarizing thoughts, problem-solving skills, reviewing the sleep report form and homework and troubleshooting. Session 6: Introducing the cycle of thinking, feeling and behavior, reviewing relaxation and training not to try fall asleep and apply all the instructions of the previous sessions and reviewing the homework of the previous sessions sleep report form and homework table.
Session 7: Training thought blocking, mental imaging, troubleshooting cognitive-behavioral therapy plan, reviewing patient homework. Session 8: Reviewing and troubleshooting the cognitive—behavioral treatment plan, noting the progress of treatment according to the sleep calendar to the patients.
The participants in the first intervention group, in addition to cognitive—behavioral counseling sessions, received aromatherapy with Citrus aurantium essential oil, so that they placed 2 drops of Citrus aurantium aromatic distillate on a tissue and inhaled it through normal breathing for 15—20 min before bedtime.
The Citrus aurantium essential oil required for the study was purchased from Bu Ali Sina Medical Company of Iran and after determining the concentration by gravimetric method was used by the Faculty of Pharmacy of Tabriz University of Medical Sciences.
The safe dosage was 8 mg of Citrus aurantium essential oil in ml of distilled water. Based on the evaluations made by the pharmacist, the minimum number of drops was considered for pregnant women. The second intervention group received a placebo with the same prescription.
The content of the placebo were distilled water. A kind of aroma was used to make the placebo smell similar to Citrus aurantium essential oil when opening the lid of container; however, it didn't have the potential to stimulate the nervous system.
The control group received only routine prenatal care. Data collection tools included the socio-demographic and obstetric characteristics questionnaire, PSAS, PSQI, and QOL-GRAV, which were completed before and after the intervention through interview with participants.
The PSQI is a self-report tool scored from 0 to 21 and developed by Buysse et al. This questionnaire has seven components that include subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, and sleep disturbances, the use of sleeping medication, and daytime dysfunction.
A score above 5 indicates insomnia and poor sleep quality [ 29 ]. In a study conducted on pregnant women in Tabriz, Iran, the reliability of this tool was reported 0. A modified PSAS was used to measure pregnancy anxiety.
Its short version contains 11 questions. The answer to each question varies from not at all score 1 to very relevant score 5. Higher scores indicate a higher level of anxiety and there is no cut-off point. In a study conducted in Tabriz, Iran, Cronbach's alpha coefficient was obtained at 0.
The QOL-GRAV has 9 questions to assess the level of personal experiences of quality of life during pregnancy. Each item is scored based on the Likert scale ranging from not at all score zero and completely score five. In this questionnaire, the first six questions are scored in reverse. Persian version of QOL-GRAV has good validity and reliability, so this tool can be used to assess the quality of life of pregnant women [ 31 ].
Data were analyzed by SPSS software. The Kolmogorov—Smirnov test was used to assess the normality of quantitative data and all variables had normal distribution. Chi-square, Chi-square for trend, and Fisher's exact and independent t tests were used to evaluate the homogeneity of groups in terms of sociodemographic and obstetric characteristics.
One-way analysis of variance was used to compare the mean scores of quality of life and anxiety among the intervention groups before the intervention and ANCOVA test was used after the intervention by adjusting the baseline score and the age variable.
Figure 1 shows the study flow diagram. The socio-demographic and obstetric characteristics of the participants are presented in Table 1.
There was no statistically significant difference among the groups in terms of all socio-demographic characteristics except age variable, the effect of which was controlled by ANCOVA test. After the intervention, the quality of life score in the intervention group 1 AMD: 2.
The results of this study showed that cognitive—behavioral counseling reduced anxiety and improved quality of life but had no effect on sleep quality. The results of studies conducted by Edinger and Sampson [ 32 ] on patients at Durham Medical Center showed that cognitive—behavioral therapies improve sleep quality.
Also, the results of a study conducted by Reybarczyk [ 33 ] on older adults show that CBT is effective in reducing sleep onset time and improving sleep quality. In another study by Querstret et al.
Thus, the results are controversial. Cognitive—behavioral counseling with or without Citrus aurantium essential oil did not have an effect on quality sleep, which is probably due to differences in participants, the virtual holding of some sessions due to COVID disease, as well as the lack of regular and correct exercise at home.
Along with primary insomnia and physical conditions, pregnancy-specific sleep problems may impede treatment. It seems that CBT may not be sufficient for women with high PSQI scores.
Also, observing sleep restrictions and scheduling might be difficult during pregnancy. There is a need to perform high-quality trials for sleep-related interventions during pregnancy and implement effective programs in standard prenatal care [ 35 ].
Citrus aurantium essential oil did not have an effect on sleep quality in our study. Based on the literature review, the effect of Citrus aurantium on sleep quality has been less studied than other essential oils, such as lavender, bergamot, and chamomile [ 36 ].
In comparison with the previous studies, the results may be due to the pregnancy-specific conditions and socio-demographic differences of the participants [ 37 , 38 ].
It is recommended that future studies focus more on the above-mentioned items. The results showed that cognitive—behavioral counseling had a positive effect on pregnancy anxiety.
Many studies confirm the role of psychological therapies as a way to reduce anxiety and choose natural childbirth in pregnant women. For example, the results of a study showed that CBT methods reduce anxiety in nulliparous women [ 39 ]. Firouzbakht et al. Another study revealed that psychological education in nulliparous women with severe fear of childbirth reduces the choice of cesarean section and increases satisfaction with the experience of childbirth [ 42 ].
Cognitive reconstruction, also known as rational empiricism, helps people identify the flow of anxious thoughts using logical reasoning for practical testing the content of their anxious thoughts against the reality of their life experiences.
In other words, they test the probability of occurring that something that will happen in reality [ 43 ]. Thus, cognitive assessment of events affects the response to those events and will pave the way for changing cognitive activity [ 44 ].
The results of this study showed that cognitive—behavioral counseling has a positive effect on quality of life. In explaining these results, it can be stated that pregnancy is associated with stress, which can affect the quality of life of pregnant women.
Thus, cognitive—behavioral counseling helps pregnant women manage stress, identify stressful situations, and then teach strategies to cope with these situations. CBT equips participants with a variety of integrated techniques that they can use to reduce stress and improve quality of life [ 45 ].
Through training muscle relaxation and diaphragmatic breathing, people are taught to control their daily stress, and through negative thinking and thinking power, people are taught to recognize and control their negative cognitive symptoms [ 46 ].
The effect of cognitive—behavioral counseling with aromatherapy on sleep quality in pregnant women was examined for the first time.
In this regard, standard and valid questionnaires were used to assess the consequences and the native language of pregnant women was used during counseling sessions to communicate more with women and these cases can be considered as the study strengths.
All women participating in this study were literate, so this can affect the generalizability of results in illiterate women. Also, we only included pregnant women with a gestational age of 20—24 weeks.
The future studies should be conducted on women in the first and third trimesters of pregnancy. It is recommended to hold several sessions of cognitive—behavioral counseling for those who support these women husbands and other family members.
Also, the effect of CBT-I should be also assessed in future studies. It is also recommended to investigate the effect of cognitive—behavioral counseling on other populations such as women of childbearing age. Based on the findings of the study, it is concluded that cognitive—behavioral counseling with or without aromatherapy with Citrus aurantium essential oil can reduce anxiety and improve quality of life during pregnancy, but had no effect on the quality of sleep of pregnant women and its subdomains.
Further studies are required to develop a protocol to guide pregnant women with sleep problems. VandenBerg KA. State systems development in high-risk newborns in the neonatal intensive care unit: identification and management of sleep, alertness, and crying.
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For an overview of the odor quality ratings see Table 1. The helplessness induction was successful. A model using odor pleasantness and odor unpleasantness as predictors 1 explained TABLE 5. Parameters for regression model with odor pleasantness and unpleasantness as predictors.
The current study aimed at investigating whether the odor of limonene would be especially potent in preventing the induction of negative mood by a learned helplessness procedure.
However, the present results indicate that limonene, like the control odors vanillin, diethyl phthalate , was ineffective at preventing negative mood, even though the current design achieved a statistical power of 0.
Moreover, the observed null effect is independent of the application of a bonferroni-correction. Thus, the current results are in line with Toet et al. In detail, the more pleasant the odors were rated, the less successful in terms of a smaller decrease in happiness the helplessness induction was.
Moreover, it is possible to assume that these differences in perceived odor pleasantness actually caused the mood stabilizing effect instead of happiness affecting odor pleasantness : Odor pleasantness was rated the same prior and after the helplessness induction.
Therefore, the respective pleasantness judgment can be considered as having been evident before any changes in mood occurred.
Taken together, this pattern indicates that mood lifting effects of limonene and vanillin can primarily be attributed to their pleasantness and not to their specific aromatic profile or chemical structure.
These results are in line with studies showing effects of pleasant odors on the autonomic nervous system congruent with positive mood e. Thus, odors might indeed work as mood enhancers, as long as they are perceived as pleasant.
As learned helplessness, which was utilized within the current study to induce negative mood, is regarded as an etiologic model for depression, the current work especially underlines the close connectivity between odors and emotions in the context of depression Pause et al.
Our results further suggest that being exposed to pleasant odors might attenuate the experience of negative mood in a situation typically involved in the development of depressive symptomatology. Pleasant odors might therefore be an additional support in the treatment of depressive symptoms.
It could be speculated that specific mood enhancing effects of limonene might have been prevented by its potentially irritating properties Larsen et al. However, a reduction in perceived intensity over the course of the experiment suggests that the participants showed perceptual habituation.
Habituation indicates that the olfactory properties of limonene dominated, as trigeminal stimulation should rather have led to sensitization Hummel and Kobal, ; Hummel, It could be argued that the generalizability of the current results might be somewhat limited due to an overrepresentation of females within the sample.
However, according to previous studies, gender does not modulate the effects of pleasant and unpleasant odors on mood Marchand and Arsenault, , rendering a similar gender bias within the current results unlikely. Further, as women were equally distributed among the odor groups, possible odor effects could not have been confounded by gender.
So far, research examining the potential of odors — and citrus odors in particular — to prevent negative mood has yielded inconclusive results. The current data suggest that such conflicting results might be related to odor pleasantness judgments varying between individuals and from study to study, rendering the respective odors either effective or ineffective mood enhancers.
Therefore, the current study is in line with studies showing that judgments about an odor are more important in determining the response to it than its biochemical properties De Araujo et al.
The current study indicates that odor pleasantness and not limonene itself has a mood enhancing effect. Odor effects in humans are provoked by the individual perception of a particular odor, and not by the intrinsic properties of the odor. Thus, the study highlights the necessity to evaluate the odor judgments of the participants in aromatherapy research.
All authors listed, have made substantial, direct and intellectual contribution to the work, and approved it for publication. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The authors would like to thank Jakob Madel for his assistance during language editing. Adolph, D. Different time course of emotion regulation towards odors and pictures: are odors more potent than pictures?
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Citrus aurantium for mood enhancement claims that citrus essential oils exert enhancrment lifting Citrus aurantium for mood enhancement. Controlled studies, however, have yielded moood results. Notably, studies so Replenishing after workout did enyancement control for odor pleasantness, although pleasantness is a critical determinant of emotional responses to odors. Negative mood was induced within 78 participants using a helplessness paradigm unsolvable social discrimination task. During this task, participants were continuously mean duration: The study highlights the necessity to evaluate odor judgments in aromatherapy research. The strong association of odors with emotions, both on the neurophysiological and on the experience level e.Sleep airantium is very common during pregnancy. Non-pharmacological treatments are a priority to improve the sleep pattern. Emhancement study aimed to determine the effect of enhqncement counseling ejhancement or without Citrus aurantium essential oil on sleep quality primary outcome and anxiety and quality of life secondary outcomes.
This randomized controlled Citrrus was Citgus on 75 pregnant women in Tabriz, Iran. Participants were enhanxement assigned to the Citrus aurantium for mood enhancement aurnatium control groups.
The aurxntium intervention group received 8 sessions of cognitive—behavioral counseling and aromatherapy with Citrus aurantium essential oil 15—20 min before bedtime. The second intervention group enhanceement cognitive—behavioral Cellulite reduction supplements and aromatherapy with placebo and the control group received only routine Citrrus care.
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Cognitive—behavioral counseling reduced anxiety and improved quality of life. However, further trials are Belly fat burner workout to reach a definitive conclusion.
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Sleep disturbances may snhancement associated with adverse pregnancy outcomes, Belly fat burner secrets as anxiety, preeclampsia, Citrus aurantium for mood enhancement, preterm delivery, and longer first and second stage of labor [ enhancemet ].
Dritsa et al. reported that pregnant women with sleep disturbances have poor physical function [ 9 aurantiuj and social health, and physical pain Cjtrus limitations of daily activity Soccer nutrition for female athletes in these individuals [ 10 ].
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Cognitive—behavioral therapy CBT is Beauty and skincare products combination of cognitive and aurantiuk approaches.
CBT reduces cognitive, physical, and behavioral Cognitive function exercises through the use enhancfment specific mpod including relaxation, regular desensitization, cognitive reconstruction, ayrantium prevention, problem-solving, activity enhancmeent, and training of interpersonal skills [ 14 ].
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Cognitive—behavioral therapy for insomnia CBT-I is a Citrus aurantium for mood enhancement program to mokd and replace thoughts and behaviors that cause or worsen sleep disturbances with practices that promote proper sleep. Aurantiuum five main Citrus aurantium for mood enhancement of Moid Citrus aurantium for mood enhancement cognitive restructuring, sleep consolidation, stimulus Citrks, sleep hygiene, and relaxation techniques [ 16 ].
Herbal medicines have been used widely since old days in ancient civilizations [ 17 ]. Aromatherapy is one of the treatments that have grown increasingly vor recent years aurantuum to enhncement medicine treatments [ 18 ].
According to a recent enhajcement review, various essential oils, such as lavender, bergamot, and chamomile, have improved sleep Citrus aurantium for mood enhancement ofr reduced stress, pain, anxiety, depression, and fatigue [ enhancemeht ].
These oils help individuals to enhancemeht their enhancemrnt and minds, leading to better sleep quality. Also, some aromas may increase Immune-boosting meal plans sleep SWS and subjective sleep quality [ 20 ].
Ennhancement of the essential oils used in aromatherapy is Citrus aurnatium. This jood oil is an amber-colored liquid that turns red in the presence of light. Its smell is strong, very fragrant and its taste is bitter [ 21 ].
Citrus aurantium has central nervous system stimulating and mood-enhancing effects, as well as sedative, antispasmodic, anti-inflammatory, anti-flatulence, digestive, antihypertensive and diuretic effects [ 22 ]. Based on the literature review, limited studies have been found about the effect of Citrus aurantium on sleep quality, anxiety, and quality of life of pregnant women.
In a recent study, this essential oil was effective in reducing the anxiety of women at risk of preterm labor [ 24 ]; it was also effective in reducing anxiety during labor in another study [ 25 ].
No study has been conducted with the integration of CBT and aromatherapy. Considering that poor sleep quality has detrimental effects on mood, psychological function and overall well-being [ 26 ] and given the various studies have reported the sedative and anxiolytic effects of Citrus aurantium [ 22 ], and also CBT helps the patient to recognize and change distorted thought patterns and dysfunctional behaviors [ 14 ].
Thus, the present study aimed to evaluate the effect of cognitive—behavioral counseling with and without Citrus aurantium on sleep quality primary outcomeanxiety and quality of life secondary outcomes in pregnant women.
This randomized controlled trial was conducted on 75 pregnant women referring to health centers in Tabriz, Iran from July to February The inclusion criteria included pregnant women with a gestational age of 20—24 weeks, women with poor sleep quality based on the Pittsburgh Sleep Quality Index PSQI score above 5having a minimum degree of secondary school, living in Tabriz, having a medical record in the health center integrated health systemlack of olfactory problems and allergy to herbal medicines by examination by the researcher, obtaining a depression score of 12 and lower according to the Edinburgh Pregnancy Depression Scale EPDS.
The exclusion criteria included pregnant women with mental illness and a history of hospitalization in a psychiatric hospital or the use of any psychiatric medication, addiction to drugs and smoking, high-risk pregnancies including diabetes, hypertension, chronic diseases, such as cardiovascular, lung, etc.
The sample size in this study was calculated using G-Power software. According to the results of the study conducted by Effati et al.
Sampling began after obtaining the code of ethics from the ethics committee of Tabriz University of Medical Sciences code: IR.
Sampling was performed in 6 health centers of Tabriz, Iran. The researcher referred to health centers in Tabriz, and then briefly explained the goals and methods of the research to women with 20—24 gestational ages. If women were willing to participate in the study, they were examined in terms of inclusion and exclusion criteria and eligible individuals were selected.
Then, the PSQI and the EPDS were completed through interview with participants by the researcher and participants who scored sleep quality score higher than 5 and a depression score 12 and less, and met other inclusion criteria were included in the study after obtaining informed written consent and then the socio-demographic characteristics questionnaire, Pregnancy-Specific Anxiety Scale PSAS and Pregnancy-Specific Quality of life Questionnaire QOL-GRAV were completed through interview with participants by the researcher.
Participants were randomly allocated to three groups including the first intervention group receiving cognitive—behavioral counseling with aromatherapy with Citrus aurantium essential oilthe second intervention group receiving cognitive—behavioral counseling and placeboand control group using the block randomization method with the block sizes of 6 and 9 and an allocation ratio of The type of intervention was written on paper and placed in opaque and sealed envelopes that numbered sequentially to conceal the allocation sequence.
The envelopes were opened in the order in which the participants entered the study and the type of group of individuals was determined. Envelopes were prepared by a person not involved in sampling, data collection and analysis.
Similar glasses of Citrus aurantium essential oil or placebo were prepared and coded with letters of A and B. The Citrus aurantium essential oil and placebo had exactly the same appearance smell, color, and shape. The intervention groups received a glass of drug or placebo in addition to counseling.
The researcher and participants of intervention groups were blinded to the type of drug received. The first and second intervention groups received 8 sessions of cognitive—behavioral counseling held in the health center in groups of 5—7 people.
The mean duration of counseling sessions was 60—90 min. Cognitive—behavioral counseling sessions were by the first author Master of Counseling in Midwifery under the supervision of the project clinical psychologist in health centers held as 2 sessions per week and lasted for 4 weeks.
The content of the counseling included explaining the goals of training and acquaintance with the members, conducting a pre-test, explaining the importance of treatment, assessing the insomnia, perception of sleep and insomnia, evaluating thoughts, training relaxation, sleep health and new sleep schedules, restriction of sleep, prevention of daily naps, problem-solving skills, summarizing thoughts, reality of sleep, introducing the cycle of thought and feeling and behavior, and training thought blocking.
Due to COVID disease, the last two sessions were held online in the Zoom program due to unwillingness of pregnant women to attend the health center. The content of the counseling sessions was as follows:. Session 1: Explaining the goals of training and acquaintance with members, conducting a pre-test, teaching how to monitor the baseline of sleep with a sleep report table, reminding the importance of treatment tasks, a complete assessment of the nature of insomnia.
Session 2: Presenting the principles and logic of treatment, teaching the mechanism of sleep and its stages, sleep—wake cycles and underlying factors, maintenance and continuation of insomnia, relaxation training. Session 3: Reviewing the previous session of treatment, reviewing the findings of the sleep report form, sleep hygiene training, and review the relaxation and new sleep schedule.
Session 4: Restricting sleep, preventing daily naps, evaluating thoughts and teaching how to record thoughts related to insomnia and reviewing the assignments of previous sessions sleep report form and homework schedule. Session 5: Summarizing thoughts, problem-solving skills, reviewing the sleep report form and homework and troubleshooting.
Session 6: Introducing the cycle of thinking, feeling and behavior, reviewing relaxation and training not to try fall asleep and apply all the instructions of the previous sessions and reviewing the homework of the previous sessions sleep report form and homework table.
Session 7: Training thought blocking, mental imaging, troubleshooting cognitive-behavioral therapy plan, reviewing patient homework. Session 8: Reviewing and troubleshooting the cognitive—behavioral treatment plan, noting the progress of treatment according to the sleep calendar to the patients.
The participants in the first intervention group, in addition to cognitive—behavioral counseling sessions, received aromatherapy with Citrus aurantium essential oil, so that they placed 2 drops of Citrus aurantium aromatic distillate on a tissue and inhaled it through normal breathing for 15—20 min before bedtime.
The Citrus aurantium essential oil required for the study was purchased from Bu Ali Sina Medical Company of Iran and after determining the concentration by gravimetric method was used by the Faculty of Pharmacy of Tabriz University of Medical Sciences.
The safe dosage was 8 mg of Citrus aurantium essential oil in ml of distilled water. Based on the evaluations made by the pharmacist, the minimum number of drops was considered for pregnant women. The second intervention group received a placebo with the same prescription.
The content of the placebo were distilled water. A kind of aroma was used to make the placebo smell similar to Citrus aurantium essential oil when opening the lid of container; however, it didn't have the potential to stimulate the nervous system. The control group received only routine prenatal care.
Data collection tools included the socio-demographic and obstetric characteristics questionnaire, PSAS, PSQI, and QOL-GRAV, which were completed before and after the intervention through interview with participants. The PSQI is a self-report tool scored from 0 to 21 and developed by Buysse et al.
This questionnaire has seven components that include subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, and sleep disturbances, the use of sleeping medication, and daytime dysfunction.
A score above 5 indicates insomnia and poor sleep quality [ 29 ]. In a study conducted on pregnant women in Tabriz, Iran, the reliability of this tool was reported 0.
A modified PSAS was used to measure pregnancy anxiety. Its short version contains 11 questions. The answer to each question varies from not at all score 1 to very relevant score 5. Higher scores indicate a higher level of anxiety and there is no cut-off point.
In a study conducted in Tabriz, Iran, Cronbach's alpha coefficient was obtained at 0. The QOL-GRAV has 9 questions to assess the level of personal experiences of quality of life during pregnancy.
: Citrus aurantium for mood enhancement| Efeitos comportamentais em ratos após inalação do óleo essencial de Citrus aurantium L. | Reg Anesth Pain Med, ; Bagdy, E. Boker A, Brownell L, Donen N - The Amsterdam preoperative anxiety and information scale provides a simple and reliable measure of preoperative anxiety. Psychiatry Res. g -1 , which is a common reference compound. in experimental anxiety models in mice. Stay informed of issues for this journal through your RSS reader. |
| Mood Enhancing Essential Oil - Spa Cenvaree | The results Citrus aurantium for mood enhancement our jood suggest that the orange essential aurantuim, Citrus aurantium for mood enhancement the concentration of 2. P-synephrine has an affinity aurantjum ß-3 receptors enhancemenr therefore enhances lipolysis Digestive health benefits explained thermogenesis. All measurements were performed between and h in the animal testing room. Shahrekord University, Medicinal Plants Research CenterShahrekord,Iran Shahrekord University Iran Shahrekord,Iran Shahrekord University, Medicinal Plants Research CenterShahrekord,Iran. Then, immediately prior to the experiment, participants rated the quality of the treatment odor regarding intensity, pleasantness, unpleasantness and familiarity. |
| Top bar navigation | Traditionally, it is believed that ANS activity is balanced between the PNS and SNS branches, exhibiting an inverse relationship [ 12 ]. Rev Bras Farmacogn 18 : Google Scholar Karimi A, Moradi O, Shahoei R. Senses 26, — The study highlights the necessity to evaluate odor judgments in aromatherapy research. The quality and the quantity of sleep vary in different periods of pregnancy. |
| Related products | In this sense, considering the relation between smell and emotions, and the strong effect of fragrances on emotional states Van Toller, , the present study aimed at assessing a possible anxiolytic effect on rats exposed to the inhalation of OEO, evaluated in experimental models of anxiety. In order to do so, we considered the following aspects: different behavioral parameters in the open-field, the number of entries in the open arms and the time spent in each arm of the elevated plus maze EPM , time of active social interaction TSI and the determination of the phytochemical profile of the essential oil. Were used months old male Wistar rats weighing g. The animal laboratory of the Department of Psychobiology - UNIFESP supplied the animals. The temperature was kept at 20 ± 2 °C, and water and food were provided ad libitum. All tests were carried out between and p. All procedures were conducted in accordance with the animal scientific procedures. The OEO was supplied from International Flavors and Fragrance IFF Ltda. It was obtained from the orange peel, C. Diazepam was acquired from Roche. The OEO was analyzed by gas chromatography. The quantification of the oil constituents was calculated from the GC with a flame ionization detector. CG analysis was carried out on an Agilet-HP gas chromatograph with a FID detector and a COV-1 capillary column 30 m x 0. Groups with 12 rats each were used. The animals were placed individually in acrylic boxes and treated as follows: different groups were exposed to the inhalation of OEO 1. All the procedures were carried out for 7 min. immediately before the tests, as described by Almeida et al. The open-field test was originally proposed as a measure of emotionality, with the animals being exposed to excessive light or noise. The rats were individually placed in the center of the open-field, which was circular, divided into 3 concentric circles subdivided by straight line segments into 19 equal parts measuring 80 cm of diameter and 30 cm of height. The lighting was equivalent to 3 light bulbs of 60 watts placed cm above the floor of the open-field. We recorded the behavioral parameters regarding locomotion in the center of the arena and its peripheral walls; frequency of rearing number of times the animals stood on their hind limbs , freezing total motionless time and the number of fecal boluses for 5 min. Candland and Campbell, In order to minimize the possible influence of circadian alterations, we observed the animals between and p. This procedure is based on the observation that animals tend to reduce or even suppress their interaction with other animals under conditions of new environments or excessive light. The device we used was the same as described above for the open-field behavioral test. Pairs of rats with up to 10 g difference in weight were placed in the center of the arena for us to quantify their activities of active social interaction: grooming, sniffing, biting or having a sexual behavior toward the other animal. We recorded the social interaction of the animals for 5 minutes between and p. as described by File and Hyde , irrespectively of the place in the arena where the animals were. The maze consists of two open arms and two closed arms by 30 cm high walls. Each arm measures 50 cm of length by 10 cm of width and contains a central square of 10 x 10 cm. The maze was 60 cm above the floor. We placed the animals in the maze and recorded the number of times they entered the open and closed arms, as well as how long they stayed there within 5 min. In order to evaluate their level of emotionality, we considered their number of entries in the open arms and the time they remained there: the higher the number, the lower their level of emotionality Pellow et al. Student's t test was used to analyze the behavioral parameters observed in the open-field, as well as the one-way ANOVA, followed by the Tukey's and the Duncan's tests, to analyze the data we obtained in the TSI and the EPM, respectively. The chromatographic analysis of the OEO showed a phytochemical profile that confirms the presence of the main classes of components characteristic of the species Citrus aurantium L. The animals previously exposed to the inhalation of OEO 2. The time of rearing or freezing were not changed Figure 2B. The time of active social interaction of the animals exposed to the inhalation of OEO 2. This time difference was even greater than that between the animals in the OEO and the animals in the standard group that received diazepam Figure 3. The data indicate that the numbers of entries into the open and closed arms in the EPM were not significantly changed by inhalation of OEO Fig. On the other hand, the OEO 2. Essential oils, especially those of citrus fragrances, are popularly used as therapies for their effects on mood states and depression Rovesti and Colombo, ; Agra et al. The results of our study suggest that the orange essential oil, at the concentration of 2. Such response might be correlated with the activation of the olfactory system by the volatile components present in the oil, which suggests a possible central action. We should highlight the fact that anxiolytic drugs lessen fear and inhibit the exploratory activity of animals Jones et al. Different studies point to a potential antidepressant effect in rats exposed to citrus fragrances Komori et al. Similar results were obtained with rats previously exposed to the inhalation of rose essential oil and submitted to the EPM, since it was observed an increase both in the number of times they entered the open arms and the time they remained there. The anxiolytic action was attributed to the presence of the components citronellol and 2-phenethyl alcohol Almeida et al. Considering that anxious rats do not socialize with one another, the results we obtained with the animals exposed to the inhalation of OEO 2. These results corroborate those obtained in the EPM. The decrease in the level of emotionality of the animals was also observed in the open-field evaluations, since they presented a decrease in the number of fecal droppings when compared with the animals in the control group. That response might be correlated with a low level of emotionality of the animals, since rats exposed to anxiogenic situations present a larger number of fecal droppings in the open-field Pal et al. On the other hand, the OEO did not affect the sensory-motor function of the animals. There were no alterations in their general activity and exploratory ability, as both the rearing and freezing times remained the same as those in the control group. Our data are in line with the effects observed in a clinical study carried out with women exposed to an orange-scented environment. The subjects showed a decrease in their levels of anxiety-state, a mood improvement and an increase in their levels of calmness, factors that were attributed to a possible behavioral and physiological effect Lehrner et al. The scents of orange and lavender have the property to alter emotional states and reduce anxiety Lehrner et al. In conclusion it has been shown that the exposure to the orange essential oil can actually contribute to the treatment of psychiatric disorders, as well as reduce psychological stress safely, without the typical adverse effects of conventional medications Perry and Perry, The authors are grateful to Associação Fundo de Incentivo à Psicofarmacologia AFIP for the financial support. Open menu Brazil. Revista Brasileira de Farmacognosia. About the journal Editorial Board Instructions to authors Contact. Português Español. Open menu. table of contents « previous current next ». Abstract Resumo English Resumo Portuguese. Text EN Text English. PDF Download PDF English. Essential oil; Citrus aurantium; Rutaceae; orange oil; anxiety; inhalation; plus-maze. ARTIGO Behavioral effects of essential oil of Citrus aurantium L. inhalation in rats Efeitos comportamentais em ratos após inalação do óleo essencial de Citrus aurantium L. Leite I I Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Botucatu , Ed. Ciências Biomédicas, São Paulo-SP, Brazil II Laboratório de Tecnologia Farmacêutica, Universidade Federal da Paraíba, Caixa Postal , João Pessoa-PB, Brazil ABSTRACT The orange essential oil OEO and its components obtained from Citrus aurantium L. RESUMO O óleo essencial de laranja OEL e seus constituintes obtidos da Citrus aurantium L. MATERIAL AND METHODS Animals Were used months old male Wistar rats weighing g. Chemicals The OEO was supplied from International Flavors and Fragrance IFF Ltda. Analysis of the essential oil The OEO was analyzed by gas chromatography. Treatment Groups with 12 rats each were used. Open-field behavioral test The open-field test was originally proposed as a measure of emotionality, with the animals being exposed to excessive light or noise. Social interaction test This procedure is based on the observation that animals tend to reduce or even suppress their interaction with other animals under conditions of new environments or excessive light. Elevated plus-maze test The maze consists of two open arms and two closed arms by 30 cm high walls. Statistical analysis Student's t test was used to analyze the behavioral parameters observed in the open-field, as well as the one-way ANOVA, followed by the Tukey's and the Duncan's tests, to analyze the data we obtained in the TSI and the EPM, respectively. RESULTS Identification of constituents of OEO The chromatographic analysis of the OEO showed a phytochemical profile that confirms the presence of the main classes of components characteristic of the species Citrus aurantium L. Agra MF, Silva KN, Basílio IJLD, França PF, Barbosa-Filho JM Survey of medicinal plants used in the region Northeast of Brazil. Rev Bras Farmacogn 18 : Almeida RN, Motta SC, Brito FC, Catallani B, Leite JR Anxiolytic like effects of rose oil inhalation on the elevated plus maze test in rats. Pharmacol Biochem Behav Barbosa-Filho JM, Cunha RM, Dias CS, Athayde-Filho PF, Silva MS, Cunha EVL, Machado MIL, Craveiro AA, Medeiros IA GC-MS Analysis and cardiovascular activity of the essential oil of Ocotea duckei. Candland DK, Campbell BA Development of fear in the rat as measured by behavior in the open-field. J Comp Physiol Psychol Carvalho-Freitas MIR, Costa M Anxiolytic and sedative effects of extracts and essential oil from Citrus aurantium L. Biol Pharm Bull 25 : De-Souza MM, Garbeloto M, Denez K, Eger-Mangrich I Avaliação dos efeitos centrais dos florais de Bach em camundongos através de modelos farmacológicos específicos. Rev Bras Farmacogn 16 : Ferronatto R, Marchesan ED, Pezenti E, Bednarski F, Onofre SB Atividade antimicrobiana de óleos essenciais produzidos por Baccharis dracunculifolia D. e Baccharis uncinella D. Rev Bras Farmacogn 17 : File SE, Hyde JR Can social interaction be used to measure anxiety? Brit J Pharmacol 62 : Gumnick JK, Nemeroff CB Problems with currently available antidepressants. J Clin Psychiatry 61 : Hwang JH The effects of the inhalation method using essential oils on blood pressure and stress responses of clients with essential hypertension. Taehan Kanho Hakhoe Chi A visita no pré-operatório e a utilização de pré-medicação são os métodos mais populares para se atingir esse objetivo, mas o papel da pré-medicação ansiolítica permanece incerto e os efeitos colaterais no pós-operatório podem partir de uma pré-medicação de rotina. Citrus aurantium é usado como medicina alternativa em alguns países para tratar a ansiedade. Recentemente, o papel ansiolítico dessa planta medicinal foi estabelecido em um estudo realizado em modelo animal. O objetivo deste estudo foi avaliar o efeito ansiolítico da flor de Citrus aurantium sobre a ansiedade pré-operatória. MÉTODOS: Foram estudados 60 pacientes ASA I submetidos a uma pequena cirurgia. Em um desenho randomizado e duplo-cego, dois grupos de 30 pacientes receberam uma das seguintes MPA oral duas horas antes da indução da anestesia: 1 Citrus aurantium destilado 1 mL. kg-1 Grupo C ; 2 solução salina 1 mL. kg-1 como placebo Grupo P. A ansiedade foi medida antes e após pré-medicação com o Inventário de Ansiedade Traço-Estado IDATE e a Escala de Ansiedade e Informação Pré-Operatória de Amsterdam APAIS antes da operação. CONCLUSÕES:Citrus aurantium pode mostrar-se eficaz na redução da ansiedade pré-operatória em cirurgias de pequeno porte. La visita en el preoperatorio y la utilización de premedicación, son los métodos más populares para alcanzar ese objetivo, pero el rol de la premedicación ansiolítica permanece como incierto y los efectos colaterales en el postoperatorio pueden originarse de una premedicación de rutina. El Citrus aurantium es usado como medicina alternativa en algunos países para tratar la ansiedad. Recientemente, el papel ansiolítico de esa planta medicinal quedó establecido en un estudio realizado en un modelo animal. El objetivo de este estudio, fue evaluar el efecto ansiolítico de la flor del Citrus aurantium sobre la ansiedad preoperatoria. MÉTODOS: Fueron estudiados 60 pacientes ASA I sometidos a una pequeña operación. En un proyecto randomizado y doble ciego, dos grupos de 30 pacientes recibieron una de las siguientes MPA oral dos horas antes de la inducción de la anestesia: 1 Flor del Citrus aurantium destilado 1 mL. kg-1 Grupo C ; 2 solución salina 1 mL. La ansiedad se midió antes y después de la premedicación con el Inventario de Ansiedad Trazo-Estado IDATE , y la Escala de Ansiedad e Información Preoperatoria de Ámsterdam APAIS antes de la operación. I MD; Associate Professor of Anesthesiology, Anesthesiology Department, Shahrekord University of Medical Sciences, Shahrekord, Iran. II MD; Assistant Professor of Anesthesiology, Medicinal Plants Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran. III PhD; Professor of Pharmacology, Medicinal Plants Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran. IV MA; Lecturer of Nursing, Medicinal Plants Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran. V MD; General Practitioner, Medicinal Plants Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran. VI Pharmacy Student, Shiraz University of Medical Sciences, International Branch, Shiraz, Iran. kg -1 C-group ; 2 Saline solution 1 mL. kg -1 as placebo P-group. Keywords: Citrus ; Flowers; Preoperative Care; Anxiety; Ambulatory Surgical Procedures. There is no doubt that people awaiting surgery experience anxiety 1 This phenomenon is closely related to fear from a new unfamiliar environment, fear of surgery and death 2. Related to this large number of preoperative anxious patients, preoperative anxiety could influence on the course and outcomes of surgical treatments 3. The correlation between preoperative anxiety and some complications such as postoperative pain, postoperative intravenous sedation, or more anesthetic requirements have been established by some studies Maranets et al. Reducing anxiety is very important before operation. Several methods have been suggested towards reducing or controlling this psychological problem related to operation. Pre-anesthesia assessment in an outpatient clinic as well as visit during hospitalization in the evening just before surgery may reduce preoperative anxiety 8. Besides the advantages of preoperative visit and reassurance of the patient before surgery, premedication with anxiolytic and sedative drugs may reduce preoperative anxiety 9. On the other hand, the role of anxiolytic premedication remains unclear and postoperative side-effects may result from routine premedication Citrus aurantium , commonly known as sour orange or bitter orange local name in Iran: Nareng is produced in Northern and Southern Iran. Traditionally, Citrus aurantium is used as an alternative medicine in some countries to treat anxiety, insomnia and as an anticonvulsant, suggesting depressive action upon the central nervous system CNS In an anxiety model study, Citrus aurantium was able to enhance the sleeping time induced by barbiturates. In animal model, this sedative effect was in accordance with traditional use of citrus aurantium In spite of traditional use of Citrus aurantium for reducing anxiety and its sedative effect in animal model 12 , we believe that preoperative anxiolytic effect of Citrus aurantium blossom has not been studied so far. The present study was designed to assess the effect of Citrus aurantium blossom on preoperative anxiety in patients scheduled for elective minor surgery. Ethical approval for this study Ethical Committee No. Yousefi on February 9, Written informed consent was obtained from 60 consecutive outpatients, aged year, ASA physical status I scheduled for lower limb minor operation under general anesthesia. Preoperative visit was done by an anesthetist the day before operation. Exclusion criteria were coexisting CNS diseases, malignancy, a variety of neuropsychological disorders, use of medications including drugs related to surgery, and any history of smoking or opium addiction, as well as any cardiovascular disease. None of the patients had previous anesthesia and surgical experiences as well as any history of hospitalization. Routine sedative premedication was not offered to patients participating in this study, instead premedication with either Citrus aurantium blossom distillate CABd or placebo was assumed for two groups of study two hours before operation. Patients enrolled in this study were assigned into two groups of 30 each; using a computer-base random allocation and double blind manner. Fresh petals and stamens of Citrus aurantium blossoms were collected from adult sour orange plants, existing in south Iran, at Medicinal Plants Research Center of Shahrekord University of Medical Sciences. Citrus aurantium blossom distillate CABd was obtained by steam distillation and then protected until pharmacological assays. CABd was standardized based on measurement of linalool, total phenolic and flavonoid compounds as follows:. Linalool concentration was determined by a reversed phase HPLC method C18 column, Agilent, Germany An ultraviolet UV detector was used with wavelength of nm to obtain the chromatograph corresponding to linalool. Mobile phase consisted of 0. Flow rate was 1. min -1 and injection volume was µL. A standard curve was drawn using the area under the curves resulted from different doses of linalool. The experiment was repeated for three times and the amount of linalool in the sample was determined using this standard curve. The amount of total phenolic compounds in CABd was determined colorimetrically with the Folin-Ciocalteu reagent, using the method described by Kim A solution of 5 mL CABd or Gallic acid standard phenolic compound was mixed with Folin Ciocalteu reagent diluted with distilled water and aqueous Na 2 CO 3 4 mL, 1 M. The mixtures were allowed to stand for 15 min and the total phenols were determined by colorimetry at nm. A standard curve was prepared using 0, 50, , , , and mg. Total phenol values were expressed in terms of Gallic acid equivalent mg. g -1 , which is a common reference compound. The experiment was repeated for three times. The amount of total flavonoids in the CABd was determ ined using colorimetric method as described by Chang A solution of 0. Then the absorbance of the reaction mixture was measured at nm with a double beam spectrophotometer Unico UV, Japan. The calibration curve was prepared using Rutin solutions at concentrations of 25 to ppm in methanol. Total flavonoids were expressed in terms of Rutin equivalent mg. The retention time of linalool with the condition described in Methods section was 2. The amount of linalool in the sample was 10 ppm part per million. Total phenolic contents of CABd were 33 ± 0. g -1 equivalent to Gallic acid and the total flavonoids in CABd were 29 ± 0. gr -1 equivalent to Rutin. The average amounts of total flavonoid and phenolic compounds were 29 ± 0. g -1 Rutin and 33 ± 0. gr -1 Gallic acid , respectively. The linalool concentration in the sample was 10 ppm. Finally, the concentrations of total flavonoid, phenolic compound and linalool in CABd were 29 mg. mL -1 and 0. mL -1 , respectively. Preoperatively, all patients were admitted to the same holding area near the operating room while waiting for outpatient surgery. For all subjects the environment, the nursing staff and the anesthesiologist as well as the psychologist were the same in the holding area. As a baseline, preoperative anxiety was assessed using both State-Trait Anxiety Inventory STAI-state and Amsterdam Preoperative Anxiety and Information Scale APAIS by an expert psychologist. Heart rate HR and blood pressure BP were also obtained two hours before operation just before premedication in the holding area by a nurse anesthetist. Then subjects of the two groups received oral CABd 1 mL. kg -1 as test C - group or Saline solution 1 mL. kg -1 as placebo P - group , respectively; according to a computer based randomization just after collecting the baseline values. Two hours later right before inducing anesthesia anxiety was assessed using the same methods by other anesthesiologist and psychologist who were blinded to the groups and patients' baseline values. The State-Trait Anxiety Inventory STAI is a item self report measure that contains 20 items measuring state anxiety and 20 items measuring trait anxiety 2. Total scores for state and trait sections separately range from 20 to 80 with higher scores denoting higher levels of anxiety. Amsterdam Preoperative Anxiety and Information Scale APAIS consist of 6 questions and ranged from In this study, we used state component of STAI rage and sum C component of APAIS range to evaluate preoperative anxiety. Both heart rate HR and blood pressure BP , which have been widely used as dependent variables in behavioral studies to alter levels of anxiety and are frequently cited as physiological indices of stress in psychology, aviation medicine, and anesthesia 2 were obtained in two steps as baseline and just before induction of general anesthesia. Regarding the normal distribution of variables, the data between groups were analyzed using Chi-Square and independent t tests and the data within groups were analyzed using paired t test. Sixty patients were enrolled and completed the study. Chi-Square test demonstrated no significant difference among male and female distribution between groups. According to independent t test no significant differences were seen between groups in terms of age, baseline values of STAI-state, APAIS, and baseline hemodynamic values. Table I. Hemodynamic variables except pulse rate in group P , were not changed within the two groups after pre-medication when paired t test was used. Tables II and III. Preoperative anxiety is not only an unpleasant emotional state but may lead to significant psychological and physiological disorders The main finding of this study is that the anxiolytic effect of Citrus aurantium blossom distillate CABd when used orally was highly significant as measured by STAI-state and APAIS. Both STAI-state and APAIS were decreased by CABd. On the other hand, neither STAI-state nor APAIS was changed in the placebo group. We found no studies related to the effect of CABd on preoperative anxious situation or even anxiolytic effect of this herbal medicine in human in the literature review. Only a few studies reported that some similar components of citrus may reduce anxiety 17, Lehrner et al. Although the main components of the essential oil in their study, demonstrated by gas chromatography, was in part different from that obtained in our study, the essential similar component was limonene, a flavonoid compound, which could be addressed as anxiolytic component. The main component of CABd in our study was not similar to that of Carvalho and Costa They obtained d-limonene In their study, sleeping time induced by pentobarbital, anxiolytic activity, and anticonvulsant activity were evaluated in mice model. Chemical analysis of flowers of Sour orange has been previously reported by an investigation as flavonoids, which are its main constituents Flavonoids are complex chemical molecules that may act as ligands for benzodiazepine recept ors The notion that flavonoids may be agonists of benzodiazepine receptors, suggest that the flavonoid, which was extracted from the CABd in our study, might behave as an agonist of benzodiazepine receptors and reduce preoperative anxiety. The phenolic component threshold toxicity level has been confirmed between and mg. L -1 , as stated in other studies, the concentration components of CABd used in our study was too low to induce toxicity in the patients |
| Ciências Biomédicas, São Paulo-SP, Brazil. Nakamura FY, Pereira LA, Cal Abad CC, Cruz IF, Flatt AA, Esco MR, Loturco I. The medicinal use of essential oils has been known since the early times Umezu et al. The effects of brewed and boiled flowers and leaves of the family of rutaceae have been studied to treat nervous system disorders [6]. Plants Res. The maze consists of two open arms and two closed arms by 30 cm high walls. Reduced olfactory sensitivity in subjects with depressive symptoms. |
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