Military & Military Families
This study examines whether an antibiotic, d-cycloserine (DCS), boosts the effectiveness of cognitive behavior therapy (CBT) for social anxiety. CBT has been shown to be effective for the treatment of social anxiety in children and adults, but even after treatment, approximately 40% may remain diagnosable. All participants will receive 12 weekly CBT sessions. In addition to receiving the CBT, participants will be randomly assigned (similar to a coin toss) to receive either DCS or a placebo (sugar pill). The pill will be taken 1-2 hours prior to each of the 12 CBT sessions.
- Subjects between 8 yrs of age (preadolescents) and under 55 yrs of age.
- Subjects medically healthy.
- Able to give informed consent.
- Not on psychotropic meds for a minimum of 6 weeks for fluoxetine; a minimum of 1 week for PRN benzodiazepines and beta blockers, and a minimum of 3 weeks for all other psychotropic meds.
- Subjects diagnosed with DSM IV symptoms of social phobia, generalized or specific type.
- Current major depressive disorder.
- Lifetime diagnosis of psychotic disorder, bipolar disorder, eating disorder, mental retardation, substance or alcohol dependence (other than nicotine); active suicidal ideation.
- Current or lifetime history of a neurological disorder (other than tic disorders, febrile seizures of infancy), seizure disorder.
- Any unstable medical condition.
- Use of any psychoactive substance in the past 30 days.
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
Out and About, or Stressed Out?
The holidays are an exciting time of good cheer, warm family traditions, and spending time with friends. Or, are they?
For many people, the idea of entering a crowded room and chatting up coworkers or strangers at a party, exchanging gifts with friends, traveling from home, or attending large family gatherings can produce intense anxiety, depression, or both.
Female Vets: Greater Likelihood of Suicide
The suicide rate among young (18 to 34 age group) female U.S. military veterans is nearly three times higher than among civilian women, a new study has found. Clinicians should inquire about military service among women and should recognize that suicide-prevention practices pertain to female veterans. (Psychiatric Services, 61:1177, December 2010) Read more.
The purpose of this study is to evaluate the equivalence of CPT treatment delivered remotely via telemental health (TMH) over videoconferencing or via traditional face-to face (FTF) treatment to veterans who have posttraumatic stress disorder (PTSD) from a military-related stressor (i.e., combat, sexual assault, non-combat physical assault).
- 18 years of age or older
- Literate in written English
- Fluent in spoken English
- Verified status as an OEF/OIF veteran
- Current PTSD diagnosis
- Index traumatic event related to military services
- If taking psychotropic medication, remains stable
- Under 18 years of age
- Not literate in written English
- Not fluent in spoken English
- Current uncontrolled psychotic or bipolar disorder
- Substance dependence
- Current uncontrolled suicidal or homicidal ideation
- Significant cognitive impairment that would interfere with completion of therapy tasks
If someone close to you has recently returned from deployment and shows signs of trauma or difficulty readjusting to civilian life, here are some ways you can help:
If you have recently returned from deployment and have difficulty readjusting to civilian life or have symptoms of trauma, here are some ways you can cope:
The military has made its soldiers strong and adept at handling tough situations. It can be difficult to handle symptoms of combat stress and PTSD on your own, though.
Getting help can make readjusting to civilian life easier. Confide in friends or family, and call a mental health professional, who can work with you to manage and treat your PTSD.
Remember, seeking help is a sign of strength, not weakness.
PTSD by the numbers
- Approximately 40,000 military members who have returned from Iraq or Afghanistan have been officially diagnosed with PTSD (posttraumatic stress disorder) since 2003, according to the U.S. Department of Defense.
- The rate of PTSD is three times higher among deployed military men and women exposed to combat compared to nondeployed military members, according to a study by the Naval Health Research Center.
Since October 2001, about 1.6 million U.S. troops have been deployed to Iraq and Afghanistan.
These military members and their families face unique challenges. Soldiers deal with stressors in combat that may not exist in civilian life.
Those exposed to high levels of combat are significantly more likely to experience acute stress and symptoms of posttraumatic stress disorder, or PTSD. Learn more facts.