STUDIES IN POST TRAUMATIC STRESS DISORDER (PTSD), PANIC DISORDER & SOCIAL PHO

该项目由几项临床研究组成。 旨在阐明创伤后应激障碍、惊恐的神经生物学研究 无序和社交恐惧症，并调查潜在的新 治疗这些严重的焦虑症。涉及的研究 焦虑症患者的神经内分泌和行为挑战 神经肽激动剂五肽胃泌素旨在确定其作用 正常和病理状态下外周和中枢性缩胆囊素的变化 焦虑状态。到目前为止，我们已经确定静脉注射 五肽胃泌素导致焦虑增加和症状特异性 社交恐惧症和恐慌症患者的症状 患有这些焦虑症的患者对 五肽胃泌素对健康志愿者的焦虑作用。早些时候 数据表明，患有创伤后应激障碍的患者也会 症状特定的症状(即，闪回) 静脉注射五肽胃泌素的药理挑战。 恩丹西酮，一种5-HT3拮抗剂，可以阻断引起焦虑的作用 在动物模型中应用CCK激动剂并不能减弱 焦虑症患者的五肽胃泌素。一项调查的初步结果 正在进行的研究还表明，选择性5-羟色胺治疗 重摄取抑制剂(SSRI)对惊恐障碍和 社交恐惧症，但SSRI并不能减弱 静脉注射五肽胃泌素。创伤后应激障碍患者的飞行员数据表明 加巴喷丁可能作为一种辅助药物在 慢性创伤后应激障碍的治疗。右额叶1的初步研究 赫兹重复经颅磁刺激(RTMS) 对于创伤后应激障碍的治疗是有希望的，并且是一种随机、 对照试验已经启动。1赫兹rTMS的数据显示 它能显著降低正常志愿者的大脑新陈代谢 减少抑郁症患者治疗两周后的血流量， 初步数据显示，在创伤后应激障碍患者中也有同样的效果。 这些效应与创伤后应激障碍改善的关系 症状仍有待阐明。

This project is comprised of several clinical research studies designed to elucidate the neurobiology of PTSD, panic disorder, and social phobia, and to investigate potential new treatments for these serious anxiety disorders. Studies involving neuroendocrine and behavioral challenges with the anxiogenic neuropeptide agonist pentagastrin are aimed at determining the role of peripheral and central cholecystokinin in normal and pathological anxiety states. To date, we have determined that intravenous pentagastrin leads to increased anxiety and syndrome-specific symptoms in patients with social phobia and panic disorder, and that patients with these anxiety disorders are more sensitive to the anxiogenic effects of pentagastrin than healthy volunteers. Early data suggest that patients with PTSD also develop syndrome-specific symptoms (i.e., flashbacks) upon pharmacological challenge with intravenous pentagastrin. Ondansetron, a 5-HT3 antagonist that blocks the anxiogenic effects of CCK agonists in animal models, did not attenuate the effects of pentagastrin in patients with anxiety disorders. Early results from an ongoing study also suggest that treatment with selective serotonin reuptake inhibitors (SSRIs) is therapeutic in both panic disorder and social phobia, but that SSRIs do not attenuate the effects of intravenous pentagastrin. Pilot data in patients with PTSD suggest that gabapentin may have utility as an adjunctive medication in the chronic treatment of PTSD. Preliminary studies of right frontal 1 Hz repeated transcranial magnetic stimulation (rTMS) of the brain for the treatment of PTSD are promising, and a randomized, controlled trial has been initiated. Data with 1 Hz rTMS suggest that it acutely reduces cerebral metabolism in normal volunteers and reduces blood flow in depressed patients treated for two weeks, and preliminary data suggest the same effect in patients with PTSD. The relationship of these effects to improvement in PTSD symptoms remains to be elucidated.