TREATMENT REFRACTORY PANIC DISORDER

这是一个指导病人为导向的研究职业发展奖的应用程序，重点是发展在治疗难治性恐慌症的研究专业知识。 候选人建议建立在她的专业知识研究恐慌症的新疗法，并获得培训，以评估“下一步”的精神药理学和认知行为治疗方法的患者谁仍然症状，尽管初步干预。惊恐障碍伴或不伴广场恐怖症是一种常见的焦虑障碍，当使用更广泛的评估缓解的措施，包括惊恐发作，预期焦虑，广场恐怖回避，功能和生活质量的措施，很明显，许多患者仍然有症状，尽管初步治疗显着受损。 然而，指导临床医生治疗这些患者的数据很少，拟议的研究被设计为以系统的方式解决这一问题的第一步。 研究计划：主要研究是一个三阶段，24周的临床试验，其中在一个阶段结束时仍有症状的患者进入下一个阶段。 第一阶段是一个为期六周的开放舍曲林治疗试验，以前瞻性地确定治疗无效。 第二阶段是一个为期六周的双盲三臂随机试验的舍曲林在继续剂量，舍曲林在提高剂量，舍曲林加氯硝西泮。 第三阶段是一项为期12周的随机单盲试验，研究认知行为治疗与舍曲林和氯硝西泮的“药物优化”的对比。工作环境：拟议的研究将在马萨诸塞州总医院进行，并将在Mark Pollack博士的指导下，在专家的咨询下，补充培训和监督研究计划。 职业发展计划：培训将强调设计和开展研究所需的技能，以评估对惊恐障碍患者的治疗干预措施，这些患者尽管接受了初步干预，但仍有症状，培训将包括在哈佛公共卫生学院进行研究方法和统计学方面的工作，以及与顾问一起监督结果评估培训、认知行为治疗培训、和策略，以研究有关恐慌治疗的结果，以初级保健和社区设置，这将奠定基础，为未来的独立调查的候选人在这方面的传输。

This is an application for a Mentored Patient-Oriented Research Career Development Award with a focus on developing expertise in the study of treatment refractory panic disorder. The candidate proposes to build upon her expertise studying novel therapeutics for panic disorder, and obtain training to assess "next-step" psychopharmacologic and cognitive-behavioral therapy approaches for patients who remain symptomatic despite initial intervention. Panic disorder with or without agoraphobia is a common anxiety disorder, and when broader measures assessing remission including panic attacks, anticipatory anxiety, agoraphobic avoidance, and functional and quality of life measures are used, it is clear that many patients remain symptomatic and significantly impaired despite initial treatment. However, there is minimal data to guide clinicians in their approach to these patients, and the proposed study is designed as an initial step in addressing this issue in a systematic manner. Research Plan: The primary study is a three phase, twenty-four week clinical trial in which patients who remain symptomatic at the end of one phase enter the next. Phase I is a six-week open sertraline treatment trial to prospectively determine treatment refractoriness. Phase II is a six-week double-blind three arm randomized trial of sertraline at continued dose, sertraline at elevated dose, and sertraline plus clonazepam. Phase III is a twelve-week randomized single-blind trial of the addition of cognitive-behavioral therapy versus "medication optimization" with sertraline and clonazepam. Environment: The proposed study will be based at the Massachusetts General Hospital and will complement a program of training and supervised research under the mentorship of Dr. Mark Pollack, with consultation from experts. Career Development Plan: Training will emphasize skills necessary for designing and carrying out studies to evaluate treatment interventions for patients with panic disorder who remain symptomatic despite initial intervention, and will include work at the Harvard School of Public Health on research methodology and statistics, and supervision with consultants regarding training in outcome assessment, cognitive-behavioral therapy training, and strategies to study the transmission of findings regarding panic treatment to primary care and community settings that will lay the foundation for future independent investigation by the candidate in this area.