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Prefrontal Oscillations in Social Anxiety Disorder (POSAD) (POSAD)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03821779
Recruitment Status : Recruiting
First Posted : January 30, 2019
Last Update Posted : November 26, 2019
Sponsor:
Information provided by (Responsible Party):
Institut National de la Santé Et de la Recherche Médicale, France

Brief Summary:
Experimental fear in rodents is correlated with slow oscillations in electrical recordings of prefrontal cortex activities. The present study aims to test whether slow prefrontal oscillations is a biomarker of pathological anxiety in human subjects.

Condition or disease Intervention/treatment Phase
Anxiety Disorders Anxiety Anxiety and Fear Behavioral: In vivo social exposure Behavioral: Social exposure in a virtual reality setting Other: EEG recording Diagnostic Test: Psychometric evaluation Diagnostic Test: Visual Analogue Scale of anxiety Not Applicable

Detailed Description:

Fear and anxiety are adaptive responses that may become excessive or inappropriate in pathological conditions, as defined as anxiety disorders in DSM-5. These disorders, including phobic disorders such as social anxiety disorder, are frequent and impairing in the general population, with an estimated lifetime prevalence of 28% and significant consequences on quality of life. Direct and indirect medical costs related to these conditions amount to 74.4 billion €/year in Europe. Despite their prevalence, debilitating nature and chronicity, the pathophysiology of anxiety disorders is poorly understood and neurobiological treatments, including pharmacotherapy, are lacking efficacy. A better understanding of the neuronal mechanisms implicated in anxiety is necessary for the conception of new approaches to treat pathological anxiety.

Anxiety is commonly modeled in animals using fear conditioning, which consists in associating a neutral stimulus (eg: a sound) with a mild electrical foot-shock. As a result of the association between sound and shock, sound presentation in isolation induces a set of conditioned behavioral responses, such as an immobilization ("freezing"). Previous studies have shown that the expression of fear responses, measured on the basis of freezing, is associated with the emergence of slow oscillations (2-6Hz) in medial prefrontal cortex (mPFC) of mice. Moreover, emergence of these oscillations in mPFC is predictive of the occurrence of freezing, and the artificial induction of 4 Hz oscillations in mPFC with optogenetics induces freezing. Finally, inhibiting neurons in mPFC during the ascending phase of this slow mPFC oscillation at the time of conditioned sound presentation is sufficient to significantly reduce fear.

Interestingly, these results obtained in mice seem to find their prolongation in humans. Recent studies using fear conditioning in human subjects have also reported the emergence of prefrontal slow oscillations between 2-6 Hz during expression of conditioned fear responses. These results suggests that common mechanisms underlie the expression of fear in humans and rodents. However, whether similar neuronal circuits and mechanisms are implicated in human anxiety disorders remains unknown.

This study aims at assessing the presence of slow mPFC oscillations during expression of anxiety in patients suffering from anxiety disorders. Beyond understanding of the neuronal mechanisms underlying anxiety expression, this study could provide a biomarker of anxiety with diagnostic and therapeutic implications.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Intervention Model Description: First phase (go-no-go) with 10 subjects in 1 arm Second phase with 20 subjets (2 arms) in a cross-over design.
Masking: None (Open Label)
Primary Purpose: Basic Science
Official Title: Study of Slow Prefrontal Cortex Oscillations During Social Exposure in Social Anxiety Disorder
Actual Study Start Date : November 12, 2019
Estimated Primary Completion Date : November 10, 2021
Estimated Study Completion Date : December 10, 2021

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Anxiety

Arm Intervention/treatment
Experimental: Group 1: Go-no-go phase

The presence of significant prefrontal oscillations in the EEG recording 2-6Hz band during in vivo social exposure (oral presentation to examiners) will be assessed in 10 subjects with social anxiety disorder. EEG will be recorded immediately before, during and after oral presentations to examiners.

Psychometric evaluation will be performed prior to experimental sessions. Rating of anxiety levels will be performed by subjects using a Visual Analogue Scale of anxiety during each of the 3 experimental periods (wainting, presentation, recovery).

Results of EEG recordings in the first 10 subjects will lead to continuation (presence of significant slow prefrontal oscillations during anxiety) or interruption (absence of signification oscillation) of the study.

Behavioral: In vivo social exposure
Subjects will be invited to give a 5 minutes oral presentation on the topic of their choice to five examiners displaying no facial emotional reaction, after a 5 minutes period of silent waiting in front of the examiners. This waiting period is prompt to elicit anticipation-type of social anxiety.

Other: EEG recording
EEG will be recorded with a standard 16-electrodes cap. Recordings will start before the 5 minutes waiting period and continue throughout oral presentation and recovery. The recovery period will be used as a baseline control

Diagnostic Test: Psychometric evaluation

Subjects will be evaluated prior to inclusion using the following assessment tools

  • Anamnestic Association for Methodology and Documentation in Psychiatry (AMDP) questionnaire
  • Mini International Neuropsychiatric Interview (MINI 6.0, for psychiatric diagnoses)
  • Liebowitz Social Anxiety Scale (LSAS)
  • Montgomery Asberg Depression Rating Scale (MADRS)
  • Brief Anxiety Scale of Tyrer (BAS)
  • State-Trait Anxiety Inventory (STAI A-B)
  • Global Assessment of Functioning (GAF)

Diagnostic Test: Visual Analogue Scale of anxiety

Subjects will be asked to rate their anxiety levels

  • immediately before (5 minutes of silent waiting),
  • during
  • and after the 5-minute oral presentation (recovery)

Experimental: Group 2.1

In group 2.1, 10 subjects will undergo 2 sessions in a cross-over design with EEG recording immediately before, during and after:

  1. "real exposure": oral presentation to a panel of examiners
  2. "virtual reality" : oral presentation to virtual examiners

Rating of anxiety levels will be performed by subjects using a Visual Analogue Scale of anxiety during each of the 3 experimental periods for each session.

Psychometric evaluation will be performed prior to experimental sessions.

Behavioral: In vivo social exposure
Subjects will be invited to give a 5 minutes oral presentation on the topic of their choice to five examiners displaying no facial emotional reaction, after a 5 minutes period of silent waiting in front of the examiners. This waiting period is prompt to elicit anticipation-type of social anxiety.

Behavioral: Social exposure in a virtual reality setting
Subjects will give a 5 minutes oral presentation on the subject of their choice to a virtual reality panel composed of 5 examiners displaying no facial emotional reaction, after a 5 minutes period of silent waiting in front of the examiners. This waiting period is expected to elicit anticipation-type of social anxiety.

Other: EEG recording
EEG will be recorded with a standard 16-electrodes cap. Recordings will start before the 5 minutes waiting period and continue throughout oral presentation and recovery. The recovery period will be used as a baseline control

Diagnostic Test: Psychometric evaluation

Subjects will be evaluated prior to inclusion using the following assessment tools

  • Anamnestic Association for Methodology and Documentation in Psychiatry (AMDP) questionnaire
  • Mini International Neuropsychiatric Interview (MINI 6.0, for psychiatric diagnoses)
  • Liebowitz Social Anxiety Scale (LSAS)
  • Montgomery Asberg Depression Rating Scale (MADRS)
  • Brief Anxiety Scale of Tyrer (BAS)
  • State-Trait Anxiety Inventory (STAI A-B)
  • Global Assessment of Functioning (GAF)

Diagnostic Test: Visual Analogue Scale of anxiety

Subjects will be asked to rate their anxiety levels

  • immediately before (5 minutes of silent waiting),
  • during
  • and after the 5-minute oral presentation (recovery)

Experimental: Group 2.2

In group 2.2, 10 subjects will undergo 2 sessions in a cross-over design with EEG recording immediately before, during and after:

  1. "virtual reality" : oral presentation to virtual examiners
  2. "real exposure": oral presentation to a panel of examiners

Rating of anxiety levels will be performed by subjects using a Visual Analogue Scale of anxiety during each of the 3 experimental periods for each session.

Psychometric evaluation will be performed prior to experimental sessions.

Behavioral: In vivo social exposure
Subjects will be invited to give a 5 minutes oral presentation on the topic of their choice to five examiners displaying no facial emotional reaction, after a 5 minutes period of silent waiting in front of the examiners. This waiting period is prompt to elicit anticipation-type of social anxiety.

Behavioral: Social exposure in a virtual reality setting
Subjects will give a 5 minutes oral presentation on the subject of their choice to a virtual reality panel composed of 5 examiners displaying no facial emotional reaction, after a 5 minutes period of silent waiting in front of the examiners. This waiting period is expected to elicit anticipation-type of social anxiety.

Other: EEG recording
EEG will be recorded with a standard 16-electrodes cap. Recordings will start before the 5 minutes waiting period and continue throughout oral presentation and recovery. The recovery period will be used as a baseline control

Diagnostic Test: Psychometric evaluation

Subjects will be evaluated prior to inclusion using the following assessment tools

  • Anamnestic Association for Methodology and Documentation in Psychiatry (AMDP) questionnaire
  • Mini International Neuropsychiatric Interview (MINI 6.0, for psychiatric diagnoses)
  • Liebowitz Social Anxiety Scale (LSAS)
  • Montgomery Asberg Depression Rating Scale (MADRS)
  • Brief Anxiety Scale of Tyrer (BAS)
  • State-Trait Anxiety Inventory (STAI A-B)
  • Global Assessment of Functioning (GAF)

Diagnostic Test: Visual Analogue Scale of anxiety

Subjects will be asked to rate their anxiety levels

  • immediately before (5 minutes of silent waiting),
  • during
  • and after the 5-minute oral presentation (recovery)




Primary Outcome Measures :
  1. Change in power of slow oscillations in prefrontal EEG recordings during anticipation relative to baseline [ Time Frame: During the 5 minutes before oral presentation and during the 1 hour rest period ]

    The change in power of PFC 2-6 Hz oscillations between the 5-minutes waiting period before oral presentation and the recovery period will be computed as a ratio.

    Detection of exaggerated 2-6Hz oscillations in prefrontal cortex during anxious anticipation is the primary aim of this study.



Secondary Outcome Measures :
  1. Duration of prefrontal slow oscillations epochs during anticipation [ Time Frame: During the 5 minutes before oral presentation ]
    Time-frequency analysis will be performed to determine the duration of 2-6Hz prefrontal oscillations epochs and total duration of these oscillations within experimental period. Significant oscillatory epochs will be defined using power ratios. These metrics will be used in order to assess the neurobiological and clinical relevance of this biomarker.


Other Outcome Measures:
  1. Change in power of slow oscillations in prefrontal EEG recordings during presentation relative to baseline [ Time Frame: During the 5 minutes oral presentation and during the 1 hour rest period. ]
    The change in power of PFC 2-6 Hz oscillations between the 5-minutes oral presentation and the recovery period will be computed as a ratio.

  2. Duration of prefrontal slow oscillations epochs during presentation [ Time Frame: During the 5 minutes oral presentation ]
    Time-frequency analysis will be performed to determine the duration of 2-6Hz prefrontal oscillations epochs and total duration of these oscillations within experimental period. Significant oscillatory epochs will be defined using power ratios.

  3. Correlation between prefrontal slow oscillations power during anticipation and anxiety score [ Time Frame: During the 5 minutes before oral presentation ]
    Correlation will be calculated between PFC 2-6 Hz oscillations power and the visual Analogue anxiety score during the 5 minutes period before presentation.

  4. Correlation between prefrontal slow oscillations power during presentation and anxiety score [ Time Frame: During the 5 minutes oral presentation ]
    Correlation will be calculated between PFC 2-6 Hz oscillations power and the visual Analogue anxiety score during presentation.

  5. Correlation between prefrontal slow oscillations duration during anticipation and anxiety score [ Time Frame: During the 5 minutes before oral presentation ]
    Correlation will be calculated between PFC 2-6 Hz oscillations duration and the visual Analogue anxiety score during the 5 minutes period before presentation.

  6. Correlation between prefrontal slow oscillations duration during presentation and anxiety score [ Time Frame: During the 5 minutes oral presentation ]
    Correlation will be calculated between PFC 2-6 Hz oscillations duration and the visual Analogue anxiety score during presentation.

  7. Correlation between prefrontal slow oscillations power during anticipation and trait anxiety [ Time Frame: During the 5 minutes before oral presentations (PFC oscillations power) and prior to inclusion (STAI-B rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations power during the 5 minutes before presentation and STAI-B scores

  8. Correlation between prefrontal slow oscillations power during presentation and trait anxiety [ Time Frame: During the 5 minutes oral presentation (PFC oscillations power) and prior to inclusion (STAI-B rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations power during presentation and STAI-B scores

  9. Correlation between prefrontal slow oscillations duration during anticipation and trait anxiety [ Time Frame: During the 5 minutes before oral presentation (PFC oscillations duration) and prior to inclusion (STAI-B rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations duration during the 5 minutes before presentation and STAI-B scores

  10. Correlation between prefrontal slow oscillations duration during presentation and trait anxiety [ Time Frame: During the 5 minutes oral presentation (PFC oscillations duration) and prior to inclusion (STAI-B rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations duration during presentation and STAI-B scores

  11. Correlation between prefrontal slow oscillations power during anticipation and state anxiety [ Time Frame: During the 5 minutes before oral presentation (PFC oscillations power) and prior to inclusion (STAI-A rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations power during the 5 minutes before presentation and STAI-A scores

  12. Correlation between prefrontal slow oscillations power during presentation and state anxiety [ Time Frame: During the 5 minutes oral presentation (PFC oscillations power) and prior to inclusion (STAI-A rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations power during presentation and STAI-A scores

  13. Correlation between prefrontal slow oscillations duration during anticipation and state anxiety [ Time Frame: During the 5 minutes before oral presentation (PFC oscillations duration) and prior to inclusion (STAI-A rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations duration during the 5 minutes before presentation and STAI-A scores

  14. Correlation between prefrontal slow oscillations duration during presentation and state anxiety [ Time Frame: During the 5 minutes oral presentation (PFC oscillations duration) and prior to inclusion (STAI-A rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations duration during presentation and STAI-A scores

  15. Correlation between prefrontal slow oscillations power during anticipation and levels of social anxiety [ Time Frame: During the 5 minutes before oral presentation (PFC oscillations power) and prior to inclusion (LSAS rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations power during the 5 minutes before presentation and LSAS scores

  16. Correlation between prefrontal slow oscillations power during presentation and levels of social anxiety [ Time Frame: During the 5 minutes oral presentation (PFC oscillations power) and prior to inclusion (LSAS rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations power during presentation and LSAS scores

  17. Correlation between prefrontal slow oscillations duration during anticipation and levels of social anxiety [ Time Frame: During the 5 minutes before oral presentation (PFC oscillations duration) and prior to inclusion (LSAS rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations duration during the 5 minutes before presentation and LSAS scores

  18. Correlation between prefrontal slow oscillations duration during presentation and levels of social anxiety [ Time Frame: During the 5 minutes oral presentation (PFC oscillations duration) and prior to inclusion (LSAS rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations duration during presentation and LSAS scores

  19. Correlation between prefrontal slow oscillations power during anticipation and levels of general anxiety [ Time Frame: During the 5 minutes before oral presentation (PFC oscillations power) and prior to inclusion (BAS rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations power during the 5 minutes before presentation and BAS scores

  20. Correlation between prefrontal slow oscillations power during presentation and levels of general anxiety [ Time Frame: During the 5 minutes oral presentation (PFC oscillations power) and prior to inclusion (BAS rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations power during presentation and BAS scores

  21. Correlation between prefrontal slow oscillations duration during anticipation and levels of general anxiety [ Time Frame: During the 5 minutes before oral presentation (PFC oscillations duration) and prior to inclusion (BAS rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations duration during the 5 minutes before presentation and BAS scores

  22. Correlation between prefrontal slow oscillations duration during presentation and levels of general anxiety [ Time Frame: During the 5 minutes oral presentation (PFC oscillations duration) and prior to inclusion (BAS rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations duration during presentation and BAS scores

  23. Correlation between prefrontal slow oscillations power during anticipation and depression levels [ Time Frame: During the 5 minutes before oral presentation (PFC oscillations power) and prior to inclusion (MARDS rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations power during the 5 minutes before presentation and MADRS scores

  24. Correlation between prefrontal slow oscillations power during presentation and depression levels [ Time Frame: During the 5 minutes oral presentation (PFC oscillations power) and prior to inclusion (MARDS rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations power during presentations and MADRS scores

  25. Correlation between prefrontal slow oscillations duration during anticipation and depression levels [ Time Frame: During the 5 minutes before oral presentation (PFC oscillations duration) and prior to inclusion (MARDS rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations duration during the 5 minutes before presentation and MADRS scores

  26. Correlation between prefrontal slow oscillations duration during presentation and depression levels [ Time Frame: During the 5 minutes oral presentations (PFC oscillations duration) and prior to inclusion (MARDS rating) ]
    Correlation will be calculated between PFC 2-6 Hz oscillations duration during presentation and MADRS scores



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


Layout table for eligibility information
Ages Eligible for Study:   20 Years to 50 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Social anxiety disorder as defined in DSM-5
  • Full understanding of the protocol
  • Obtaining informed consent from study subjects before or at inclusion at the latest
  • Being registered in the french national health insurance service (Sécurité Sociale) (or equivalent)

Exclusion Criteria:

  • Active medical co-morbidity including severe hypertension, cardiac insufficiency, Raynaud syndrome, diabetes mellitus, renal insufficiency, adrenal insufficiency, Cushing syndrome and epilepsy
  • Severe neurological co-morbidity, including but not limited to Parkinson's disease and multiple sclerosis
  • Long-term corticotherapy
  • History of significant head injury, defined by loss of consciousness
  • Being diagnosed with another major psychiatric condition (DSM5) including bipolar disorder and schizophrenia or substance/alcohol use disorder; with the exception of major depressive disorder and nicotine use disorder
  • Suicidal risk evaluated as moderate to high in the MINI questionnaire
  • initiation of a psychotropic treatment or change in the dose of ongoing psychotropic treatment within 3 days prior to each visit and including:

    1. antidepressant treatments with selective serotonin recapture inhibitors, serotonin and norepinephrine inhibitors, alpha2-presynaptic adrenoreceptors (mirtazapine, mianserin), tricyclic
    2. anxiolytic drugs including benzodiazepines and anti-histamine
    3. antipsychotic drugs
  • Acute alcohol intake 2 days prior to each visit (inclusion, experimental sessions)
  • Pregnancy or breastfeeding.
  • Ongoing hospitalization without consent (decision of a third-party: medical, justice)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03821779


Contacts
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Contact: Bruno Aouizerate, MD-PhD +33(0) 5 56 56 17 98 bruno.aouizerate@u-bordeaux.fr
Contact: Cyril Herry, PhD 33(0)5 57 57 37 26 cyril.herry@inserm.fr

Locations
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France
GENPHASS, SANPSY, CHU de Bordeaux Recruiting
Bordeaux, France, 33076
Contact: Pierre Philip, MD-PhD    +33 5 57 82 01 73    pierre.philip@chu-bordeaux.fr   
Contact: Jacques Taillard, MS       jacques.taillard@chu-bordeaux.fr   
Sponsors and Collaborators
Institut National de la Santé Et de la Recherche Médicale, France
Investigators
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Principal Investigator: Olivier Doumy, MD Centre Hospitalier Charles Perrens, Bordeaux; INRA NutriNeuro, Bordeaux; Université de Bordeaux, France
Principal Investigator: Alexandra Bouvard, MD Centre Hospitalier Charles Perrens, Bordeaux; Université de Bordeaux, France
Study Director: Cyril Herry, PhD Neurocentre Magendie, Inserm U1215, Bordeaux, France
Principal Investigator: Cyril Dejean, PhD Neurocentre Magendie, Inserm U1215, Bordeaux, France
Principal Investigator: Thomas Bienvenu, PhD Centre Hospitalier Charles Perrens, Bordeaux; Neurocentre Magendie, Inserm U1215, Bordeaux, France
Principal Investigator: Jacques Taillard, MS GENPHASS, CHU de Bordeaux
Study Chair: Bruno Aouizerate, MD-PhD Centre Hospitalier Charles Perrens, Bordeaux; INRA NutriNeuro, Bordeaux; Université de Bordeaux, France
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Responsible Party: Institut National de la Santé Et de la Recherche Médicale, France
ClinicalTrials.gov Identifier: NCT03821779    
Other Study ID Numbers: C17-25
First Posted: January 30, 2019    Key Record Dates
Last Update Posted: November 26, 2019
Last Verified: November 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Anxiety Disorders
Phobia, Social
Mental Disorders
Phobic Disorders