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Jung-Won Shin,1,&ast; Seonyeop Kim,2,&ast; Yoon Jung Shin,2 Bomi Park,2 Sunyoung Park2 1Department of Neurology, Memory Center, Bundang CHA Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea; 2Graduate School of Clinical Counselling Psychology, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea&ast;These authors contributed equally to this workCorrespondence: Jung-Won Shin, Department of Neurology, CHA Bundang Medical Center, CHA University, 59 Yatap-Dong, Bundang-Gu, Seongnam-si, Gyeonggi-do, 463-712, Republic of Korea, Tel +82-31-780-5058, Email limitsum@gmail.comPurpose: Acceptance and Commitment Therapy (ACT) is part of the third wave of cognitive behavior therapy, and has six core components: acceptance, cognitive defusion, self as context, being present, values, and committed behavior. This study aimed to examine the efficacy of ACT for insomnia compared with cognitive behavior therapy for insomnia (CBT-I) in patients with chronic primary insomnia.Methods: The study recruited patients with chronic primary insomnia from a university hospital between August 2020 and July 2021. Thirty patients were enrolled and randomly assigned to receive either ACT (n = 15) or CBT-I (n = 15). Interventions were performed over four weeks, with four sessions of face-to-face therapy and four sessions of online therapy. The outcomes were measured using a sleep diary and a questionnaire.Results: Post-intervention, the ACT and CBT-I groups had significantly improved sleep quality, insomnia severity, depression, beliefs about sleep, sleep onset latency (SOL), and sleep efficacy (SE) (p < 0.05). However, anxiety was significantly reduced in the ACT group (p = 0.015), but not in the CBT-I group.Conclusion: ACT had a significant effect on primary insomnia and secondary symptoms, especially anxiety related to insomnia. These findings suggest that ACT could be a potential intervention for individuals who do not respond to CBT-I, who have high anxiety regarding sleep problems.Keywords: insomnia, cognitive behavior therapy, acceptance and commitment therapy

The use of anesthetics is inevitable to suppress seizure activity in refractory status epilepticus (RSE). Hypotension, which is a critical side effect observed when treating RSE using a higher dosage of anesthetics that enhance γ-aminobutyric acid (GABA) activity, often requires vasopressor agents. Concomitant treatment with N-methyl-D-aspartate (NMDA) receptor antagonists, such as ketamine, could be effective in prolonged refractory SE, while maintaining stable blood pressure owing to the blockage of catecholamine reuptake in the systemic circulation. We report two cases of patients who had RSE with hemodynamic instability treated promptly with an early combination of ketamine and low-dose midazolam. The combination treatment effectively suppressed epileptic discharge with less hemodynamic side effects; moreover, a low dose of midazolam was required when combined with ketamine therapy. The initial combination of a third-line therapy that blocks NMDA receptors with enhanced GABAergic activity could be useful in RSE. Further studies are necessary in many variable etiologies of SE.

Objectives: This study evaluated the effects of Guibi-tang (GBT) on neuronal apoptosis and cognitive impairment induced by beta amyloid (Aβ), (1-42) injection in the hippocampus of ICR mice. Methods: Aβ (1-42) was injected unilaterally into the lateral ventricle using a Hamilton syringe and micropump (2 ㎍/3 ㎕, 0.6 ㎕/min). Water extract of GBT was administered orally once a day (500 ㎎/㎏) for 3 weeks after the Aβ (1-42) injection. Acquisition of learning and retention of memory were tested using the Morris water maze. Neuronal damage and Aβ accumulation in the hippocampus was observed using cresyl violet and Congo red staining. The anti-apoptotic effect of GBT was evaluated using TUNEL labeling in the hippocampus. Results: GBT significantly shortened the escape latencies during acquisition training trials. GBT significantly increased the number of target headings to the platform site, the swimming time spent in the target quadrant, and significantly shortened the time for the 1st target heading during the retention test trial. GBT significantly attenuated the reduction in thickness and number of CA1 neurons, and Aβ accumulation in the hippocampus produced by Aβ (1-42) injection. GBT significantly reduced the number of TUNEL-labeled neurons in the hippocampus. Conclusion: These results suggest that GBT improved cognitive impairment by reducing neuronal apoptosis and Aβ accumulation in the hippocampus. GBT may be a beneficial herbal formulation in treating cognitive impairment including Alzheimer’s disease.

All other ethical bodies that approved our study in the various centers. (DOCX 12 kb)

Correlations among the questionnaire parameters (full details). Table S2. Univariate analysis for a significant functional deterioration. (DOCX 34 kb)

Correlations among the questionnaire parameters (full details). Table S2. Univariate analysis for a significant functional deterioration. (DOCX 34 kb)

Receiver-operating characteristic curve analysis for predicting in-hospital death based on STESS and EMSE combinations. (DOCX 17 kb)

Receiver-operating characteristic curve analysis for predicting in-hospital death based on STESS and EMSE combinations. (DOCX 17 kb)