Anxiety and Stress Disorders Research Unit

Current projects

The MRC Unit on Anxiety Disorders currently has 7 core projects that comprise of several specific studies:

Posttraumatic Stress Disorder
With high levels of past political and current criminal and domestic violence in South Africa, posttraumatic stress disorder (PTSD) is a particularly important anxiety disorder, deserving special attention. The Bathuthuzele Clinic focuses on investigating the impact of trauma on adolescents and the appropriate management of posttraumatic stress disorder in this population. The Unit is also conducting ongoing research on various psychiatric medications for the prevention and treatment of posttraumatic stress disorder in adults. The PTSD project focuses in particular on questions about the phenomenology, psychobiology, treatment, and community health implications of posttraumatic stress disorder in the South African context.

Studies

• Bathuthuzele Youth Stress Clinic (free screening, assessment and referral service for youth 8-17yrs that have been exposed to trauma)
• PTSD in Emergency Care Workers (prospective follow-up study)
• Rape- PTSD prophylaxis (conducted at Karl Bremer and Thuthuzela rape centres, explores effectiveness of early pharmacological intervention after rape trauma) 
• Rape- CBT (comparison of early cognitive-behavioural group therapy and repeated clinical assessments)

Obsessive-Compulsive Spectrum Disorders
Obsessive-compulsive disorder (OCD) is a chronic disorder with a prevalence of 2-3% in both developing and developed countries. A range of disorders such as Tourette's disorder, body dysmorphic disorder, hypochondriasis and trichotillomania may fall on a putative spectrum of OCD disorders. The Unit is investigating the phenomenology, neurobiology and pharmacotherapy of the obsessive-compulsive disorders. The current focus of our phenomenological study is on using factor analytic and other statistical techniques to determine the structure of OCD symptoms.  The focus of our psychobiological research is on determining the underlying neurogenetics of obsessive-compulsive disorder, by focusing on genetically homogenous populations within South Africa. The focus of our pharmacotherapy research has been treatment-refractory obsessive-compulsive disorder; many patients with OCD fail to respond to treatment with selective serotonin reuptake inhibitors - it is therefore crucial to investigate novel approaches to the treatment of refractory patients.

Studies

• Sydenham’s Chorea

Genetics of Anxiety Disorders
It has been recognised for many years that patients with anxiety disorders often have family members also suffering from these conditions. Recent advances in behavioural genetics provide the methodologies enabling scientists to search for the genetic basis for the familial transmission of the different anxiety disorders. Sociocultural circumstances in South Africa have led to the existence of relatively homogenous populations providing unique opportunities for genetics research.

Studies

• OCD Genetics
• Genetics of Anxiety Disorders

Brain Imaging
The increasing sophistication of structural and functional brain imaging techniques has led to the demonstration that specific neurocircuits are involved in the mediation of a number of the major anxiety disorders, and also that both pharmacotherapy and psychotherapy are able to normalize dysfunctional neurocircuitry in some of the anxiety disorders. This project focuses on the brain imaging of human anxiety disorders, and in particular on the interaction of psychopharmacology and functional imaging.. Brain imaging carries an enormous potential in understanding trauma and resilience. One of the most significant developments in this regard has been the acquisition of state of the art 3-Tesla Siemens Allegra Magnetic Resonance Scanner- the first of its kind in Southern Africa- by the Stellenbosch Faculty of Health Sciences, with support from UCT and Siemens. This MRI scanner, which has high spec functional perfusion, diffusion and proton spectroscopy capacities, will be housed in the newly constructed Brain Imaging Centre in the basement of the Fisan building. The BIC will include an EEG laboratory and near infra-red spectroscopy facility. Numerous projects have recently been initiated in a number of areas including substance abuse disorders, mood disorders, HIV/AIDS and schizophrenia.

• SPECT/ DAT in OCD
• NIRS (Near-Infrared Spectroscopy)

Basic Neuroscience- Animal Models of Anxiety Disorders
Other neurobiological projects of the Unit focus on animal models of anxiety. Animal models may provide a useful avenue to exploring several aspects of the psychobiology of the anxiety disorders. For example, classical work on primate models of separation anxiety has played an extremely important role in modern concepts of developmental psychopathology. Animal models of stereotypic behaviour and of extreme stress may be useful in elucidating the neurobiological mechanisms involved in anxiety disorders such as obsessive-compulsive disorder and posttraumatic stress disorder. Currently we are using neuroproteomic techniques to study depression and addictive behaviour.

Primary Care Psychiatry and HIV/ AIDS
People with HIV/AIDS are susceptible to a range of anxiety and mood disorders. Furthermore, there is evidence that exposure to trauma and PTSD increase the odds of contracting the virus, and conversely, several studies have found that stress and psychopathology may be associated with worse immune function and a more rapid progression of HIV/AIDS. Psychopharmacology research in HIV/AIDS patients with psychiatric disorders will be undertaken.

Studies

• Perinatal Mood and Anxiety: Maternal Stress, HIV maternal
• HIV & Depression (medication trial)
• TB/ Mental Health (in conjunction with the TB Unit at Tygerberg Hospital, explores possible effects of stress in people contracting TB) 

Mental Health Information Centre
Despite the fact that psychiatric disorders are among the biggest contributors to the burden of disease in developed and developing worlds, these disorders are often stigmatised and misunderstood. The Mental Health Information Centre at the Unit was established in 1995 in order to increase public awareness of psychiatric disorders in the community and to increase early awareness and treatment of these conditions.

PTSD studies

Bathuthuzele Youth Stress Clinic
This is a specialized clinic that provides a free service to youth between the ages of 8 and 18 who have been affected by extreme violence and trauma. Services include screening and assessment, medication and psychotherapy referrals. The clinic also does research into trauma, PTSD and other trauma related issues.

Inclusion Criteria:

• Children/adolescents between 8 and 17 years old with a diagnosis of PTSD
• Duration of illness at least 3 months
• Children/adolescents must assent, & parent must give consent to any study procedures
  

A Prospective Follow-Up Study of Posttraumatic Stress Symptoms in Mortuary Workers and Emergency Care Practitioners
This study aims to assess the frequency, nature and severity of posttraumatic stress symptoms and other psychopathology resulting from work-related stressors (i.e. exposure to dead bodies and emergency medical situations) in a sample of mortuary workers and Emergency Care students, over a period of one year, beginning from pre-employment (pre-exposure). It aims to determine what socio-demographic and clinical factors predict the development of new PTSD one year following exposure and will investigate risk factors and resilience factors that might contribute to the presence and severity of posttraumatic symptomatology.

Inclusion Criteria

• Male and female police mortuary workers, who expect to remain in their respective category of employment or job description, for the duration of the twelve months.
• Male and female emergency care students enrolled at Cape Penninsula University of Technology.

Exclusion Criteria

• Mortuary workers who are employed on a part-time basis, or who do not expect to be available for assessment for the duration of the study period.

Adult Rape Prophylaxis
The Adult Rape Prophylaxis Study aims to determine whether early pharmacological intervention is effective in the preventative treatment of Post Traumatic Stress Disorder in adult rape survivors.

Inclusion Criteria

• Female victims of forced and unwanted vaginal or anal penetration within the previous 24 hours.
• 18 to 65 years of age.
• Able to comprehend or speak English at Grade 8 level.
• Must have an accessible telephone or telephone contact during the follow-up period.

Exclusion Criteria

• Pregnancy. To be eligible all subjects will need to have a negative serum pregnancy test.
• Acute intoxication with alcohol or drugs which makes obtaining informed consent within the 24-hour post-rape time window impossible.
• Any co-existing medical condition that does not permit administration of the study drugs.
• Head injury with loss of consciousness.
• History of psychotic disorder (e.g. schizophrenia), bipolar disorder, dementia, or mental retardation.

Adolescent Rape Study
The Adolescent Rape study aims to determine whether very early repeated clinical assessment is effective in reducing trauma–specific symptoms over a 1 year follow-up period in adolescents recently exposed to rape.

Inclusion Criteria

• Female victims of forced and unwanted vaginal or anal penetration within the previous 2 weeks.
• 14 to 18 years of age.
• Able to comprehend or speak English at Grade 8 level.
• Must have an accessible telephone or telephone contact during the follow-up period.

Exclusion Criteria

• Pregnancy. To be eligible all subjects will need to have a negative serum pregnancy test.
• Acute intoxication with alcohol or drugs which makes obtaining informed consent within the 24-hour post-rape time window impossible.
• Any co-existing medical condition that does not permit administration of the study drugs.
• Head injury with loss of consciousness.
• History of psychotic disorder (e.g. schizophrenia), bipolar disorder, dementia, or mental retardation.

OCD SPECTRUM studies

Sydenham’s Chorea Study
Sydenham’s Chorea (SC), a condition characterized by rapid, irregular, and aimless involuntary movements, is the neurological manifestation of rheumatic fever. Sydenham’s Chorea may also lead to the development of emotional, memory and concentration problems. This study aims to assess the neuropsychological (e.g. attention deficit, perseveration) and neuropsychiatric manifestations (e.g. OCD, tics, disruptive behaviour) of SC in children aged 6 to 13 years. Since treatment response differ in patients, it is also aimed to compare the neuropsychological/ neuropsychiatric manifestations in SC children who receive intravenous immunoglobulins (IVIG) and standard pharmacological therapy with children who receive standard pharmacological therapy alone.

Chronic Sydenhams Chorea Study: Neuropsychological Deficits

Inclusion criteria

• Persistent, chronic symptoms of Sydenhams Chorea.  
• Age 11-30 years.
• Ability to read and write in English, Afrikaans or Xhosa.

Intravenous Immunoglobulins in Sydenhams Chorea: Neuropsychological Functioning at 6 Months

Inclusion criteria

• Children aged 6-12 years. 
• Diagnosis of acute Sydenhams Chorea 6 months previously, diagnosed according to the revised Jones Criteria for Acute Rheumatic Fever, and with an absence of indicators of other causes of chorea.
• Standard treatment or treatment with intravenous immunoglobulins.
• Ability to read and write in English or Afrikaans or Xhosa.

Stress in Pregnancy
This is a joint project between the Departments of Psychiatry, Obstetrics and Gynaecology, both at Stellenbosch University, the Departments of Psychiatry, and Psychology at the University of Cape Town, and the staff of the Bishop Lavis, Elsiesriver and Belville-South Maternal and Obstetric Units. The study aims to determine factors that contribute to fetal brain development in a developing world setting. Exposure to psychological trauma, alcohol, drugs, nicotine and infection contribute to abnormal brain development, and so comprise a risk factor for subsequent behavioural disorders. Such behavioural disorders have far reaching effects, impacting on subsequent education and social interactions. By identifying the precise mechanisms that contribute to abnormal fetal brain development, this project aims to inform policies to help target risk factors affecting pregnant women and their offspring.

Inclusion criteria

• Over the age of 18 years
• Healthy, low-obstetric risk,
• Women in early pregnancy

Psychobiological correlates in pregnancy
This study aims to determine the relation between selective attention to negative stimuli in pregnant women; and anxiety traits and exposure to stressful life events. 

Inclusion criteria

• Over the age of 18 years
• Healthy, low-obstetric risk,
• Women in early pregnancy

Treatment of depression in HIV sero-positive people with escitalopram: A randomised, double-blind, placebo controlled study.
The considerable burden of untreated HIV depression demands that effective and safe treatments be found that are available to all people living with HIV in the developing world, irrespective of their disease staging. Early positive indications of efficacy using SSRIs are encouraging, but remain limited. Hence this study aims to assess the efficacy and tolerability of escitalopram for the treatment of DSM-IV major depressive disorder in people with HIV infection who are on antiretroviral therapy (ARVs).  

Inclusion criteria

• Male and female outpatients with confirmed HIV positive status aged 18 to 60 years.
• A primary DSM-IV diagnosis of a current major depressive episode.
• Currently on antiretroviral treatment regime.

Exclusion criteria

• Alcohol or substance abuse/dependence in the last six months.
• History of bipolar disorder, schizophrenia, other psychotic disorders or dementia.
• Subjects who pose a suicide risk.
• Pregnant and lactating females, or sexually active women not practising an acceptable method of birth control.
• Patients with any serious or unstable medical condition.
• Subjects with AIDS who are not in the care of a primary care practitioner

TB Study
This study aims to determine the impact of stress on the contraction of tuberculosis (TB).

Inclusion Criteria

• Household contacts of confirmed TB cases
• 18 years and older.
• Ability to read and write in English or Afrikaans