Karen Cassiday, PhD
Owner and Clinical Director
Anxiety and Agoraphobia Treatment Center, Ltd.
Dr. Cassiday discusses parents who often sabotage their children's development of self-esteem and self-confidence, but believe they are fostering a more caring relationship.
Ten years after the 9/11 terrorist attacks many people continue to struggle with symptoms of anxiety, stress and even posttraumatic stress disorder, or PTSD.
OCD burdened a bright young woman for more than 10 years. Read all about her recovery and her advice to others who are suffering in Working Toward Compassion and Moderation.
This study will test the hypothesis of whether an antagonist at the corticotropin releasing factor type 1 receptor (i.e. GSK561679) is superior to placebo in reducing symptoms of PTSD. The study is being conducted at 2 sites in the United States: a site at Emory University, and one at Mount Sinai School of Medicine. About 150 women outpatients aged 21 to 65 who currently suffer from PTSD will be enrolled. Study participation could last for up to about 12 weeks.
1. Women between the ages of 21 and 65
2. Fulfills DSM-IV criteria for a primary diagnosis of Post-traumatic stress disorder (PTSD)
3. Duration of PTSD is at least 3 months
4. Able to read and speak English
5. For women of reproductive age, must use of an effective birth control method or abstinence for the duration
6. Clinician-administered PTSD Scale score at Screening and Randomization visits of ≥ 50 on the CAPS
7. For women who have a history of peptic ulcer disease (PUD) with known etiology, evidence of effective treatment was provided with full eradication of ulcers and symptoms must be provided.
1. Lifetime diagnosis of a psychotic disorder (including schizophrenia), disorder, bipolar disorder, or obsessive compulsive disorder.
2. Current or past month participation in another clinical trial in which she is or will be exposed to an investigational or non-investigational drug or device.
3. A current significant unstable medical illness or organic brain impairment, including stroke, CNS tumor, demyelinating disease, cardiac, pulmonary, gastrointestinal, renal or hepatic impairment that would likely interfere with the action, absorption, distribution, metabolism, or excretion of GSK561679.
4. Patients who in the investigator’s judgment pose a current suicidal or homicidal risk
5. Substance abuse or dependence within the past 90 days, or testing positive for illegal substances.
6. Current diagnosis of anorexia or bulimia nervosa.
7. A documented history of hepato-biliary disease including evidence of current hepatitis infection, or clinically significant hepatic enzyme elevation including any one of the following enzymes greater than 1.5 times the upper limit of normal (ULN) value (ALT, AST, ALP, total or direct bil > 1.5 x ULN, unless consistent with presumed or diagnosed Gilbert’s disease
8. Taking systemic corticosteroids within 2 weeks of the Randomization Visit
9. Treatment with any other psychoactive medication within 2 weeks of Screening visit, including psychoactive herbal or nutritional treatment.
10. Likely need for more than 2 weeks of regular NSAID use or any use of aspirin.
11. Taking any medication with with a narrow therapeutic index, that are metabolized via the cytochrome P450 3A4 or 2C9 pathway (e.g. warfarin), or transported via OATP1B1 or P-gp, within 2 weeks (or 5 half-lives, whichever is longer) prior to the Randomization Visit.
12. Taking any products that are potent inducers or inhibitors of the cytochrome P450 3A4 pathway for 2 weeks (or 5 half lives, whichever is longer) prior to the Randomization Visit.
13. Stool positive for occult blood.
14. Pregnancy or lactation*
15. Participants who, in the opinion of the investigator, would be noncompliant with the visit schedule or study procedures (e.g. illiteracy, planned vacations, or planned hospitalizations during the study).
16. Previous treatment with CRF1 receptor antagonist
17. Any laboratory abnormality that in the investigator’s judgment is considered to be clinically significant (e.g. blood pressure, ECG, TSH, LFT, etc.)
18. Patients who are receiving exposure-based psychotherapy that targets PTSD symptoms
19. Current or planned litigation or other actions related to secondary gain regarding the traumatic event
This study uses functional magnetic resonance imaging (fMRI) to learn how the brain functions in adolescents receiving fluoxetine (Prozac) or cognitive behavioral therapy (CBT) for anxiety or depression in children/adolescents. All participants will receive interviews to assess how they are doing in general, including his or her general mood, degree of nervousness and behavior. Each participant and one of his or her parents will be interviewed separately and together.
Age: 8 to 17
Consent: Can give consent/assent. (Parents will provide consent; minors will provide assent.)
IQ: All subjects will have IQ greater than 70 (Assessment relies on WASI)
SUBJECTS WITH AN ANXIETY DISORDER
Diagnosis: Current Diagnosis of Social Phobia, Separation Anxiety, or Generalized Anxiety Disorder (Based on K-SADS)
Symptom Severity: Score greater than 9 on PARS (This score was used to enroll subjects in previous trial demonstrating efficacy of an SSRI in pediatric anxiety.)
Clinical Impairment: CGAS less than 60
SUBJECTS WITH A MOOD DISORDER
Diagnosis: Current Diagnosis of Major Depression (Based on K-SADS (juveniles) or SCID (adults))
Clinical Impairment: CGAS less than 60 (juveniles) GAS less than 70 (adults)
Symptom Severity: CDRS Score greater than 39 (juveniles) (This score was used to enroll subjects in previous trials demonstrating efficacy of an SSRI in pediatric depression.)
Consent: Can give consent/assent.
IQ: All subjects will have IQ greater than 70. Assessment relies on WASI.
Any serious medical condition or condition that interferes with fMRI scanning, and for patients electing medication, any condition that increases risk of SSRI treatment. All patients will have complete physical examination. Healthy volunteer participants will be medication-free and have no current serious medical conditions, based on a review of their medical history.
Current use of any psychoactive substance; current suicidal ideation; current diagnosis of attention deficit hyperactivity disorder (ADHD) of sufficient severity to require pharmacotherapy. These factors could complicate treatment with an SSRI. No subject on medication will be accepted into the trial. Subjects will not be taken off of medications to enter the trial.
Current diagnoses: Tourette's, OCD, posttraumatic distress disorder, conduct disorder. These factors may be effected by SSRI treatment, influencing ability to detect effects on anxiety/depression
Past or current history of mania, psychosis, or pervasive developmental disorder. These factors may be effected by SSRI treatment, influencing ability to detect effects on anxiety/depression
Recent use of an SSRI: All subjects must have been free of any SSRI use for at least one month (fluoxetine six months) and must not have been treated with an SSRI for their current depressive episode. This is designed to exclude subjects who have failed a trial of an SSRI for their current episode of major depression.
HEALTHY ADULT SUBJECTS
Any current psychiatric diagnosis. Assessment relies on SCID.
SUBJECTS WITH AN ANXIETY DISORDER
Current Major Depressive Disorder
Cynthia M. Bulik, PhD, FAED
William and Jeanne Jordan Distinguished Professor of Eating Disorders
Department of Psychiatry
University of North Carolina at Chapel Hill School of Medicine
Professor of Nutrition in the Gillings School of Global Public Health
Director of the UNC Eating Disorders Program
With implications for anxiety disorders, substantial data indicate that structural, cellular, and molecular differences exist between the male and female brain regions, specifically the hippocampus, amygdala, and prefrontal cortex, important for cognition, memory, and affect. (Biology of Mood & Anxiety Disorders. 2012, 2:3) Read more.