Social stress often leads to drug craving and relapse in cocaine-dependent populations. Currently there are no FDA approved medications for the treatment of cocaine dependence. Therefore, biomedical research studies aimed at investigating the brain mechanisms responsible for controlling emotional responses to social stress could have a significant impact on the development of effective therapeutic treatment strategies for cocaine-dependent individuals.
The study will involve a randomized controlled trial (RCT) with subjects ages 13-18 years (who have experienced sexual assault) randomized to receive Risk Reduction through Family Therapy (RRFT) or Treatment As Usual. Youth will be recruited from 2 local child advocacy centers and the interventions are psychosocial in nature. Follow-up assessments will be conducted at multiple time points through 18-month post entry.
The goal of this pilot study is to determine if, in substance dependent individuals, a single session of transcranial magnetic brain stimulation (TMS) over a brain region involved in craving (medial prefrontal cortex) can lower an individual's craving and brain response to drug-related cues. This study involved a screening visit, followed by two visits which involve brain imaging (using functional MRI) and brain stimulation (using TMS). There is also an additional Magnetic resonance spectroscopy (MRS) substudy with a unique consent form which invites participants back for a third MRI scanning visit in which we will measure the concentration of glutamate in the mediap prefrontal cortex before and after a session of TMS.
This study is testing the efficacy of Prolonged Exposure for PTSD (PE) relative to treatment-as-usual in Veterans with severe and persistent mental illness (SMI; schizophrenia, schizoaffective disorder, bipolar disorder, severe unipolar disorder) treated at the Charleston VAMC.
The purpose of this study is to use a treatment called repetitive Transcranial Magnetic Stimulation (rTMS) and brain imaging technique called functional magnetic resonance imaging (fMRI) to investigate the causes of depressive symptoms among nicotine dependent cigarette smokers. Participation in this study will involve 3 visits: a screening/training visit and 2 experimental visits. During the screening/training visit, you will provide biological samples to confirm your eligibility to participate and fill out questionnaires, learn the tasks that you will be performing on during the experimental visits, and become familiar with the tools you will be using and environment you will be in during the experimental visits. On each experimental visit, you will undergo fMRI scanning while performing the tasks practiced at training and receive either rTMS or a control rTMS treatment.
Our recently completed study has provided the first evidence that administration of the medication propranolol, following exposure to cocaine cues, can alter drug-associated memories and reduce craving and other drug cue-elicited responses in cocaine addicted persons. The proposed research will use two methods to increase the memory altering effects of propranolol observed in our recently completed study, and document lasting effects not only on craving and cue-elicited reactions, but also on cocaine use. Positive findings will set the stage for a formal clinical trial that could lead to significantly improved treatment outcomes for this treatment-resistant addiction.
The main goal of current study is to compare changes in PTSD symptoms following Prolonged Exposure therapy (PE) combined with either a 40 IU dose of intranasal oxytocin or placebo. This will allow us to assess the potential benefits of augmenting PE with oxytocin. Prior to 8 of the 10 weekly therapy sessions (sessions 2-9), subjects will receive oxytocin or placebo.
The goal of this study is to document the phenomenology and longitudinal course of illness in patients with sleep panic disorder, narcolepsy (associated with fear-induced cataplexy), sleep paralysis, PTSD, nightmare disorder (not associated with PTSD), and sleep seizures disorders. Subjects will complete questionnaires, complete semi-structured interview, and be guided to complete a timeline of life events and illness episodes, etc. A second visit will ensure completion of timeline information and allow clinicians to have information to plot on a life chart to view the longitudinal course of illness.
Future Direction: The current available treatments for PTSD are not fully effective for cognitive symptoms of PTSD and have high drop-out and poor engagement, two factors found to be most indicative of overall return to functioning for patients with PTSD. Successful completion of this pilot clinical trial may build a platform for future large scale double-blind, placebo-controlled studies using either atomoxetine or psycho-stimulants or other cognitive enhancing medications. The response inhibition related measurements are sensitive to psychotropic medications. Therefore it is advantageous for us to use GNG and Stop Signal approaches to investigate individual treatments response in our future research. We believe GNG and Stop signal approaches together with pharmacogenetic approach will provide valuable information to direct future individualized medicine.
The 'dual burden' of (a) loss of a fellow service member in the context of (b) experiencing repeated extreme life threat is unique to military combat personnel and a core characteristic of combat-related Prolonged Grief Disorder (PGD), a disorder as prevalent as Post-traumatic stress disorder and associated with functional impairment, disability, and suicidality. Effective treatments for depression and PTSD have proven less than adequate in treating PGD when each is offered in isolation; and simply combining these 12-16 week treatment regimens into a 24-36 week treatments is not a viable approach, particularly with a population predisposed to avoiding extended mental health care. The proposed project addresses the need for a Veteran/ military specific treatment of PGD, and uses technology to deliver this treatment in a format that is far more likely to be accepted by military personnel and Veterans. This study will impact clinical practice by providing the first evidence for effective treatment PGD in Veterans.