Diagnosis
The development of specific criteria for each of the different anxiety disorders has allowed reliable diagnosis of these disorders. This is important not only for identifying these conditions in clinical settings, but also for undertaking systematic research. Failure to diagnose anxiety disorders at a primary care level has been a significant problem in the past.
Epidemiology
Community surveys have shown that anxiety disorders are amongst the most common of the psychiatric disorders, and that they cause extensive suffering and interference with work and social function. The anxiety disorders account for one third of all costs of mental illness, with panic disorder being the eleventh and obsessive-compulsive disorder (OCD) the nineteenth most disabling of all medical disorders in 15 to 44 year-olds.
Neurobiology
Current methodologies have allowed the dissection of the specific neuroanatomical circuits and neurotransmitter systems involved in mediating the anxiety disorders. There are exciting parallels, for example, between the neurobiology of fear conditioning in animal models and that of clinical disorders. Furthermore, a range of psychopharmacological agents has been introduced for the treatment of anxiety disorders.
Psychotherapy
In recent years, a range of rigorous controlled research on the cognitive-behavioural psychotherapy of the anxiety disorders has been undertaken. Exposure techniques are particularly important in the successful treatment of a number of the anxiety disorders, and in the case of OCD have been shown to normalise dysfunctional brain activity.
Consumer Advocacy
In the past few decades, consumers with anxiety disorders have recognised the importance of establishing advocacy organisations to help increase awareness of these conditions, and to help fight discrimination against the mentally ill. Such groups have helped greatly to increase awareness of the anxiety disorders, and to encourage people to seek appropriate treatment.
The Mental Health Information Centre (MHIC) is conducting a research project on Mental illness and stigma in South Africa. The MHIC believes that a better understanding of stigma and consequent discrimination will lead to a better outcome for patients and their families. If you would be willing to participate in the study, please contact us on 021 9389229 or e-mail mhic@sun.ac.za
This is an important clinical, genetics and brain-imaging study conducted by the MRC Unit on Anxiety & Stress Disorders at Stellenbosch University in conjunction with researchers at Cambridge University in the UK. The study covers clinical aspects of these disorders – symptoms, illness severity, impact on the quality of your life, treatment history and childhood trauma history, while also looking at genetics and the structure of certain brain regions implicated in these conditions.
In DSM-IV (which is one of the major diagnostic tools used in practice), OCD was categorised as one of the anxiety disorders. In DSM-5 however, OCD now falls under a grouping of obsessive-compulsive and related disorders. OCD is a psychiatric disorder characterised by obsessions and/or compulsions. Obsessions are persistent, “self-generated” (i.e. not delusional or psychotic) thoughts or mental images that are time-consuming, cause significant distress or functional impairment. Compulsions, on the other hand, are repetitive mental (e.g. counting, repeating words) or behavioural (e.g. hand-washing, checking) acts that the person feels obliged to perform in an attempt to reduce the anxiety or distress or preventing some dreaded event. However, compulsions are not inherently enjoyable, are often extremely time-consuming and do not result in the completion of a useful task.
HPD is also now categorized as an obsessive-compulsive related disorder. It is characterized by recurrent pulling out of one’s hair resulting in hair loss, with repeated attempts to decrease or stop hair pulling.The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
OCD, together with other mental disorders like HPD, account for the 2nd largest portion on our national burden of disease after HIV/AIDS. The causality or “working” of these conditions is not yet fully established. It can therefore be argued that it is necessary to do research on disorders such as OCD and HPD, so that the symptomatology and the neurobiological underpinnings can be better understood and that improved treatments can be found.
– Volunteers who are right-handed and aged between 18 and 65 years
– Persons with OCD or HPD
– First-degree relatives of persons diagnosed with OCD
– Healthy controls
Participation involves attendance of 2 sessions, with the first session comprising of a screening interview, filling out of self-report questionnaires and taking a blood sample for genetic analysis. If suitable for brain imaging, participants are scanned during a subsequent session. Participants also complete a number of neuropsychological tasks in the form of computerised games. Participation is cost-free and participant information will be kept confidential.
If you want more information or want to participate, please contact: Prof Christine Lochner 021 – 938 9179, e-mail: cl2@sun.ac.za or Mr Lian Taljaard 021 – 938 9654, e-mail: liant@sun.ac.za for more information.
Brain imaging research in the past has largely been focused on looking at regional differences in activity in the brain. So for example, researchers demonstrated that in the brains of people with SAD, there might be more activity in the amygdala (a part of the brain involved in anxiety) than would be expected in people without the disorder. While this work remains important, such regional differences only represent part of the picture!
Functional connectivity research is a recent method of brain analysis that allows scientists to examine how multiple, widespread connections in the brain result in these regional differences in activity. Groups of these connections form what are known as ‘neural networks’ and several of such networks have so far been detected. There is some evidence that one network in the brain (called the default mode network) may play a role in how social information is processed (social information includes our perceptions and thoughts about other people and how they perceive us).
We are interested in networks in the brains of SAD sufferers and whether they differ from those without the disorder. We want to investigate whether network differences can be linked to how people with SAD process social information. We also want to see the effect of treatment (using an established treatment for SAD – moclobemide) on these networks.
As part of our research, we soon plan to recruit 15 volunteers with SAD and 15 volunteers without SAD (for comparison) to take part in a study that aims to begin in January 2015. All participants will undergo two types of brain scan (FDG PET/CT and fMRI) and a series of psychological tests. SAD volunteers will then receive an 8-9 week course of moclobemide followed by repeat testing and scanning. Excluding the initial (screening) visit, SAD participants will need to attend 8 study visits over the course of 9 weeks, while control participants will need to attend 4 study visits over the course of 1-2 weeks. Participants will be reimbursed for their food and travel costs.
• Over the age of 18
• Fluent in English (the psychological tests are only available in English)
• Right-handed (left-handed people’s brains are different)
• Not pregnant or breastfeeding
• No dominant psychiatric conditions other than Social Anxiety Disorder (SAD participants)
• No significant psychiatric conditions at all (volunteers without SAD)
• Not currently on any medications for a psychiatric condition, or willing to temporarily interrupt medications to participate in the study.
• Not on any medications that might interfere with moclobemide (SAD participants)
• No previous or current medical conditions that directly affect the brain, (including previous head injury with loss of consciousness or brain surgery), no metal implants in the skull, no diabetes (affects the scan)
• Able to lie still in a scanner for up to an hour at a time
If you are interested (either as a SAD participant or as someone without SAD), please speak to any of the investigators:
Prof Christine Lochner (cl2@sun.ac.za ): Tel: 021 – 938 9179
Dr Alex Doruyter (doruyter@sun.ac.za): Tel: 021 – 938 5290
Do you suffer from gambling disorder (also known as compulsive or pathological gambling) or do you use methamphetamine (‘tik’) regularly?
You can take part in an important new study on the condition that is conducted by the MRC Unit on Anxiety & Stress Disorders at the Universities of Stellenbosch and Cape Town.
The study covers many aspects of these conditions – symptoms, illness severity and impact on the quality of life, while also looking at genetics and the structure of certain brain regions that are implicated.
Gambling disorder (GD) is characterized by the inability to resist gambling despite severe disruption to work, social and family life. Individuals with GD may continually chase their losses, hide their behaviour, tell lies about where they go, how much they spend or owe, accumulate debt, or even resort to theft or fraud to continue gambling. There is no single known cause of GD, but there is evidence suggesting involvement of both genetic and environmental factors.
“Tik” is highly addictive and one of the most common drugs used in the Western Cape. Chronic tik abusers show symptoms that can include violent behaviour, anxiety, confusion and sleep disturbances. They can also display a number of psychotic features, including paranoia, “hearing voices” (auditory hallucinations), mood disturbances and disturbed thinking (i.e. “delusions”, e.g. the sensation of insects creeping on the skin, called “formication”). MUD is also accompanied by functional and molecular changes in the brain.
• Should be between 18 and 65 years old
• Right-handed
• Diagnosed with or suspect they have one of the above conditions
• Preferably not be on any chronic psychiatric medication at the time of participation
3 sessions:
1) Undergoing a screening interview and diagnostic assessment , filling out of self-report questionnaires and taking a blood sample for genetic analysis.
2) If suitable for the study, participants undergo brain scanning during the next session.
3) Completion of a number of computerized and paper-and-pen brain tasks.
Participation is cost-free.
This is not a treatment study. However, if you interested in treatment, options will be discussed with you, and referral arranged.
If you want more information or want to participate, please contact:
Prof Christine Lochner, tel: 021 – 938 9179, e-mail: cl2@sun.ac.za
Dr Samantha Brooks: e-mail: drsamanthabrooks@gmail.com
