Funktionell och strukturell neuroanatomi hos patienter med social fobi efter kognitiv-beteendeterapi eller SSRI-preparat givet som enskild eller kombinerad behandling
Tidsperiod: 2014-01-01 till 2016-12-31
Projektledare: Tomas Furmark
Medarbetare: Ulrika Wallenquist, Wallenquist Ulrika
Budget: 3 216 000 SEK
Social anxiety disorder (SAD) is a disabling psychiatric condition associated with personal suffering and high societal costs. Even though serotonin reuptake inhibitors (SSRIs) and cognitive-behavior therapy (CBT) are helpful, many sufferers do not respond sufficiently to state-of-the-art treatment. The general aim of this project is to identify the specific neural mechanisms mediating symptom improvement in the treatment of SAD. Firstly, we will evaluate whether psychological expectancies alter the outcome of SSRI pharmacotherapy. Socially anxious patients will receive the SSRI escitalopram but half of them will be led to believe that it is an ineffective drug. Treatment effects will be evaluated by positron emission tomography, targeting the serotonin transporter protein that is thought to be crucially involved in anxiety. Treatment-induced changes in neural activation patterns, as well as gray and white matter structural integrity, will be further assessed with magnetic resonance imaging. Secondly, treatment effects on brain function and structure will be evaluated in the same way, using neuroimaging techniques, in SAD patients allocated to combined therapy (SSRI+CBT, placebo+CBT) vs. monotherapy (SSRI or CBT alone). The influence of genetic polymorphisms will also be studied. The project seeks answers on how treatment of anxiety should be designed to be effective, and particularly on the neurobiological factors that determine whether therapy succeeds or fails.