Combined Treatment for Generalized Anxiety Disorder (GAD)
23. desember 2016 oppdatert av: Paul Crits-Christoph, University of Pennsylvania
The purpose of this study is to conduct a preliminary evaluation of the efficacy of combined medication and psychotherapy for generalized anxiety disorder (GAD).
The general goals of the current study are to conduct a late stage treatment development study.
The goal of this stage of research is to provide a preliminary answer to the question and to gather data to estimate intervention parameters (e.g., effect size, attrition rates, response rates) that would assist in planning further research.
Studieoversikt
Status
Fullført
Forhold
Intervensjon / Behandling
Detaljert beskrivelse
The specific aims of this study are to collect preliminary data relevant to the following hypotheses:
- Primary Hypothesis: Acute phase improvement for combined cognitive behavioral therapy (CBT) plus medication will be superior to medication alone.
- Secondary Hypotheses: Combined CBT plus medication will be superior to medication alone on a number of secondary outcome measures, including the core feature of GAD (worry), depressive symptoms, functional impairment, and quality of life.
- Additional Exploratory Aim: We will explore the comparative relapse rates for the combined CBT plus medication treatment and the medication alone treatment condition at 6-month follow-up.
Studietype
Intervensjonell
Registrering (Faktiske)
69
Fase
- Fase 2
Kontakter og plasseringer
Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.
Studiesteder
-
-
Pennsylvania
-
Philadelphia, Pennsylvania, Forente stater, 19104
- University of Pennsylvania, 3535 Market Street, Suite 650
-
-
Deltakelseskriterier
Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
18 år og eldre (Voksen, Eldre voksen)
Tar imot friske frivillige
Nei
Kjønn som er kvalifisert for studier
Alle
Beskrivelse
Inclusion Criteria:
- GAD diagnosis by structured interview
- Hamilton Anxiety Scale score of 18 or less
- Clinical Global Impressions Scale score of at least 4
- Hamilton Depression Scale score of 18 or less
- Hamilton Depression Scale suicide item score less than 2
- Use of an effective form of contraception throughout the s
Exclusion Criteria:
- Hypersensitivity to venlafaxine XR
- History of seizures
- Episode of major depressive disorder in the previous 6 months
- History of any psychotic illness, bipolar disorder, or dementia
- Substance abuse and dependence during the past 6 months
- Other anxiety disorders with the exception of social phobia as long as GAD is primary
- Regular use of anxiolytics or antidepressants within 7 days of study onset
- Use of fluoxetine or monoamine oxidase inhibitors within 28 days of study onset (low dose usage of benzodiazepines will not prevent participation)
- Use of other psychotic medication besides benzodiazepines
Studieplan
Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
|---|---|
|
Eksperimentell: Combined Treatment
Patients who receive combined cognitive behavioral therapy (CBT) plus medication (venlafaxine XR, flexibly dosed between 75-225 mg/day) treatment for GAD.
CBT was once/week sessions for 12 weeks.
Medication continued for the full 6 months.
|
This cognitive behavioral therapy for GAD has a cognitive restructuring component and an applied relaxation component.
Patients will be educated about the nature of anxiety and be trained in the recognition and monitoring of situational, physiological, cognitive, and behavioral cues associated with anxious responding.
They will be guided through copings skill rehearsals in addition to imaginal and in vivo exposure to anxiety cues.
This cognitive behavioral treatment will consist of 1 to 1.5 hour sessions of psychotherapy, which will be held once weekly over a period of 12 weeks.
Venlafaxine XR, 75-225 mg/d, oral administration.
14 days at 75 mg/d, 150 mg/d for the remaining 6 months, 225 mg/3 for patients unimproved at week 6, tapered at 75 mg/week (this intervention is provided by protocol 709012).
Andre navn:
|
|
Aktiv komparator: Venlafaxine XR 75-225 mg alone
These patients receive only medication treatment for GAD.
Patients take venlafaxine (flexibly dosed from 75-225 mg/day) as part of NCT00183274 and are assessed over a 6 month period.
Medication continued for the full 6 months.
|
Venlafaxine XR, 75-225 mg/d, oral administration.
14 days at 75 mg/d, 150 mg/d for the remaining 6 months, 225 mg/3 for patients unimproved at week 6, tapered at 75 mg/week (this intervention is provided by protocol 709012).
Andre navn:
|
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
Hamilton Anxiety Rating Scale (HAM-A)
Tidsramme: Data collected as part of protocol 709012 at baseline, week 2, 4, 6, 8, 12, 16, 20, and 24
|
The HAM-A was used to measure the severity of anxiety symptoms.
The scale consists of 14 items; each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0-56, where <17 indicates mild severity, 18-24 mild to moderate and 25-30 moderate to severe anxiety.
This measure was conducted by research psychiatrists trained and highly experienced in the use of these scales.
The evaluators were blind to group assignment.
|
Data collected as part of protocol 709012 at baseline, week 2, 4, 6, 8, 12, 16, 20, and 24
|
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
Hospital Anxiety Depression Scale (HAD)-Anxiety Score
Tidsramme: Data collected as part of protocol 709012 at baseline, week 2, 4, 6, 8, 12, 16, 20, and 24
|
The HAD was used to assess patients' report of anxiety and depressive symptoms.
Each item on the questionnaire is scored from 0-3 and this means that a person can score between 0 and 21 for either anxiety or depression.
A higher score indicates greater anxiety.
|
Data collected as part of protocol 709012 at baseline, week 2, 4, 6, 8, 12, 16, 20, and 24
|
|
Hospital Anxiety Depression Scale (HAD)-Depression Score
Tidsramme: Data collected as part of protocol 709012 at baseline, week 2, 4, 6, 8, 12, 16, 20, and 24
|
The HAD was used to assess patients' report of anxiety and depressive symptoms.
Each item on the questionnaire is scored from 0-3 and this means that a person can score between 0 and 21 for either anxiety or depression.
A higher score indicates greater depression.
|
Data collected as part of protocol 709012 at baseline, week 2, 4, 6, 8, 12, 16, 20, and 24
|
|
Hamilton Rating Scale for Depression (HAM-D)-17-item Score
Tidsramme: Data collected as part of protocol 709012 at baseline, week 12, and week 24
|
The 17-item version of the HAM-D was used to assess severity of depressive symptoms.
Eight items are scored on a 5-point scale, ranging from 0 = not present to 4 = severe.
Nine are scored from 0-2.The total score is the sum of the 17 items, with a range from 0 to 50.
A higher scores indicates greater depression.
The ratings were conducted by research psychiatrists trained and highly experienced in the use of these scales.
The evaluators were blind to group assignment.
|
Data collected as part of protocol 709012 at baseline, week 12, and week 24
|
|
Clinical Global Impression (CGI)-Severity Score
Tidsramme: Data collected as part of protocol 709012 at baseline, week 2, 4, 6, 8, 12, 16, 20, and 24
|
The Clinical Global Impression - Severity scale (CGI-S) is a 7-point scale (1=normal; 7 = extremely ill) that requires the clinician to rate the severity of the patient's illness at the time of assessment, relative to the clinician's past experience with patients who have the same diagnosis.
The ratings were conducted by research psychiatrists trained and highly experienced in the use of these scales.
Evaluators were blind to group assignment.
|
Data collected as part of protocol 709012 at baseline, week 2, 4, 6, 8, 12, 16, 20, and 24
|
|
Clinical Global Impression (CGI)-Improvement Score
Tidsramme: Data collected as part of protocol 709012 at baseline, week 2, 4, 6, 8, 12, 16, 20, and 24
|
The Clinical Global Impression - Improvement scale (CGI-I) is a 7 point scale (1= very much improved; 7 = very much worse) that requires the clinician to assess how much the patient's illness has improved or worsened relative to a baseline state at the beginning of the intervention.
The ratings were conducted by research psychiatrists trained and highly experienced in the use of these scales.
Evaluators were blind to group assignment.
|
Data collected as part of protocol 709012 at baseline, week 2, 4, 6, 8, 12, 16, 20, and 24
|
|
Quality of Life Subscale of the General Health Questionnaire (GHQ)
Tidsramme: Data collected as part of protocol 709012 at baseline, week 12, and week 24
|
The General Health Questionnaire (GHQ) is a psychometric screening tool to identify common psychiatric conditions.
Patients completed the 12 quality of life questions (each on a 0 to 3 scale) on this questionnaire.
Scores on the 12 items were added up to create summary score (range = 0 to 36).
Higher scores indicate worse health.
|
Data collected as part of protocol 709012 at baseline, week 12, and week 24
|
|
Penn State Worry Questionnaire (PSWQ)
Tidsramme: Data collected as part of protocol 709012 at baseline, week 12, and week 24
|
The Penn State Worry Questionaire is a 16-item inventory that aims to measure the trait of worry, using Likert rating from 1 (not at all typical of me) to 5 (very typical of me).
A total score is calculated (range = 16 to 80), with higher scores indicating greater worry.
|
Data collected as part of protocol 709012 at baseline, week 12, and week 24
|
|
Physical Component Score of the 12-Item Short Form Survey (SF-12)
Tidsramme: Data collected as part of protocol 709012 at baseline, week 12, and week 24
|
The Short Form (12) Health Survey is a 12-item, patient-reported survey of patient health.
Physical and Mental Health Component Scores (PCS & MCS) are computed using the scores of twelve questions and range from 0 to 100, where a zero score indicates the lowest level of health measured by the scales and 100 indicates the highest level of health.
|
Data collected as part of protocol 709012 at baseline, week 12, and week 24
|
|
Mental Component Score of the 12-item Short Form Survey (SF-12)
Tidsramme: Data collected as part of protocol 709012 at baseline, week 12, and week 24
|
The Short Form (12) Health Survey is a 12-item, patient-reported survey of patient health.
Physical and Mental Health Component Scores (PCS & MCS) are computed using the scores of twelve questions and range from 0 to 100, where a zero score indicates the lowest level of health measured by the scales and 100 indicates the highest level of health.
|
Data collected as part of protocol 709012 at baseline, week 12, and week 24
|
|
Clinical Response Rate
Tidsramme: Data collected as part of protocol 709012 at baseline, week 2, 4, 6, 8, 12, 16, 20, and 24
|
Clinical response on the HAM-A was defined as a 50% or greater reduction from baseline to last value with the 24-week open label medication phase.
|
Data collected as part of protocol 709012 at baseline, week 2, 4, 6, 8, 12, 16, 20, and 24
|
|
50 Percent or Greater Reduction in PSWQ Score
Tidsramme: Data collected as part of protocol 709012 at baseline, week 12, and week 24
|
Clinically significant change was defined on the PSWQ as an estimated (based on linear mixed effects model) endpoint score of less than 50.9.
This score was calculated using the PSWQ normative data provided by Gillis, Haaga, and Ford (1995) and the baseline PSWQ mean and standard deviation (SD) from the current sample.
The PSWQ mean and SD from the normative and current GAD samples were entered into the Jacobson et al. (1984) formula "c" for clinically significant change.
This method provides a cutoff indicating whether or not the level of functioning by a patient is statistically more likely to be in the functional rather than the dysfunctional population.
|
Data collected as part of protocol 709012 at baseline, week 12, and week 24
|
Samarbeidspartnere og etterforskere
Det er her du vil finne personer og organisasjoner som er involvert i denne studien.
Sponsor
Samarbeidspartnere
Etterforskere
- Hovedetterforsker: Paul Crits-Christoph, PhD, University of Pennsylvania
Studierekorddatoer
Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.
Studer hoveddatoer
Studiestart
1. oktober 2006
Primær fullføring (Faktiske)
1. mars 2008
Studiet fullført (Faktiske)
1. mars 2008
Datoer for studieregistrering
Først innsendt
7. februar 2008
Først innsendt som oppfylte QC-kriteriene
7. februar 2008
Først lagt ut (Anslag)
21. februar 2008
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
16. februar 2017
Siste oppdatering sendt inn som oppfylte QC-kriteriene
23. desember 2016
Sist bekreftet
1. desember 2016
Mer informasjon
Begreper knyttet til denne studien
Nøkkelord
Ytterligere relevante MeSH-vilkår
- Psykiske lidelser
- Patologiske prosesser
- Sykdom
- Angstlidelser
- Fysiologiske effekter av legemidler
- Nevrotransmittere agenter
- Molekylære mekanismer for farmakologisk virkning
- Psykotropiske stoffer
- Nevrotransmitter opptakshemmere
- Membrantransportmodulatorer
- Antidepressive midler
- Antidepressive midler, andre generasjon
- Serotonin og Noradrenalin gjenopptakshemmere
- Venlafaksinhydroklorid
Andre studie-ID-numre
- 802307
- 5R34MH072678-02 (U.S. NIH-stipend/kontrakt)
Plan for individuelle deltakerdata (IPD)
Planlegger du å dele individuelle deltakerdata (IPD)?
NEI
Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .