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Sponsored by: |
National Institute of Mental Health (NIMH) |
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Information provided by: | National Institute of Mental Health (NIMH) |
ClinicalTrials.gov Identifier: | NCT00339079 |
This study will compare the effectiveness of cognitive behavioral therapy, antidepressant medication, and a combination of the two for treating hypochondriasis.
Condition | Intervention | Phase |
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Hypochondriasis |
Drug: Fluoxetine Behavioral: Cognitive Behavioral Therapy Other: Supportive Therapy Drug: Placebo |
Phase I Phase II |
Study Type: | Interventional |
Study Design: | Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Placebo Control, Parallel Assignment, Efficacy Study |
Official Title: | Treatment of Hypochondriasis With CBT and/or SSRI |
Estimated Enrollment: | 132 |
Study Start Date: | June 2006 |
Estimated Study Completion Date: | June 2011 |
Estimated Primary Completion Date: | June 2011 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
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1: Experimental
Cognitive behavior therapy (CBT) alone
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Behavioral: Cognitive Behavioral Therapy
CBT is based upon the cognitive and perceptual model of hypochondriasis and incorporates established behavioral techniques. There will be six 60-minute individual sessions conducted at weekly intervals. Booster sessions of 20 to 30 minutes will be conducted at Weeks 8 and 12. The introduction of boosters will make the CBT alone and medication alone arms identical in length.
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4: Placebo Comparator
Placebo pill
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Other: Supportive Therapy
The supportive therapy component of the treatment is similar to what might occur in a family physician's office. Participants will meet with the same psychiatrist throughout the study, who will offer general encouragement; review the participant's illness, physical symptoms and, adverse effects over the previous week; and monitor medication dosage accordingly. Patients will be seen at Weeks 1, 2, 3, 4, 6, 8, 10, and 12, for medication adjustment. Visits with the psychiatrist will last 30 minutes.
Drug: Placebo
Each patient will receive placebo in 10 or 20 mg pills given according to the following schedule: 10 mg/day for two weeks, 20 mg/day for two weeks, 40 mg/day for two weeks, 60 mg/day for two weeks, and 80 mg/day thereafter.
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2: Experimental
Fluoxetine alone
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Drug: Fluoxetine
Each patient will receive fluoxetine in 10 or 20 mg pills given according to the following schedule: 10 mg/day for two weeks, 20 mg/day for two weeks, 40 mg/day for two weeks, 60 mg/day for two weeks, and 80 mg/day thereafter. The maximum dose for patients who are age 60 or older will be 60 mg/day. The study psychiatrist will have the option of not increasing or lowering the dose if hypochondriacal symptoms have resolved nearly completely for the last two weeks or adverse effects thought to be due to fluoxetine have occurred.
Other: Supportive Therapy
The supportive therapy component of the treatment is similar to what might occur in a family physician's office. Participants will meet with the same psychiatrist throughout the study, who will offer general encouragement; review the participant's illness, physical symptoms and, adverse effects over the previous week; and monitor medication dosage accordingly. Patients will be seen at Weeks 1, 2, 3, 4, 6, 8, 10, and 12, for medication adjustment. Visits with the psychiatrist will last 30 minutes.
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3: Experimental
Combined CBT and fluoxetine (SSRI)
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Drug: Fluoxetine
Each patient will receive fluoxetine in 10 or 20 mg pills given according to the following schedule: 10 mg/day for two weeks, 20 mg/day for two weeks, 40 mg/day for two weeks, 60 mg/day for two weeks, and 80 mg/day thereafter. The maximum dose for patients who are age 60 or older will be 60 mg/day. The study psychiatrist will have the option of not increasing or lowering the dose if hypochondriacal symptoms have resolved nearly completely for the last two weeks or adverse effects thought to be due to fluoxetine have occurred.
Behavioral: Cognitive Behavioral Therapy
CBT is based upon the cognitive and perceptual model of hypochondriasis and incorporates established behavioral techniques. There will be six 60-minute individual sessions conducted at weekly intervals. Booster sessions of 20 to 30 minutes will be conducted at Weeks 8 and 12. The introduction of boosters will make the CBT alone and medication alone arms identical in length.
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Hypochondriasis is one of the most difficult psychiatric disorders to treat. People with hypochondriasis believe that real or imagined physical symptoms are signs of serious illnesses, despite medical reassurance and other evidence to the contrary. Symptoms of the disorder include a preoccupation with fear of an illness; a persistent fear of having a serious illness, despite medical reassurance; and misinterpretation of symptoms. Some individuals with hypochondriasis recognize that their fear of having a serious illness may be excessive, unreasonable, or unfounded. Episodes of hypochondriasis usually last from months to years, with equally long periods of remission. Cognitive behavioral therapy (CBT) and the antidepressant drug fluoxetine (FLX) have both been shown to be effective treatments for hypochondriasis. However, the relative efficacy of a combined approach has yet to be determined. This study will compare the effectiveness of cognitive behavioral therapy, antidepressant medication, and a combination of the two for treating hypochondriasis.
Participants in this double-blind study will first report to the study site for two sessions to determine eligibility for participation. Eligible individuals will then be randomly assigned to receive one of the following four treatments for 12 weeks: CBT only; FLX only; CBT plus FLX; or a placebo pill. All participants receiving medication will also receive supportive therapy. Treatment response will be assessed at Week 12, and participants who have shown improvement will continue in the study for an additional 12 weeks. Participants who have not responded to treatment will be removed from the study and will receive open treatment. Participants assigned to receive medication or placebo will take medication once daily for the full 24 weeks. Participants assigned to CBT only or CBT plus FLX will receive CBT weekly for the first 8 weeks, then biweekly until Week 12, and then monthly until week 24. Outcomes will be assessed at study visits at Weeks 6, 12, 24, and 48, and over the phone at Week 36.
Ages Eligible for Study: | 21 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria
Exclusion Criteria
A) Taking psychoactive medications for psychiatric indications (i.e., DSM-IV psychiatric disorders) who prefer not to discontinue these medications or for whom discontinuation would be clinically inadvisable B) Taking medications that may interact adversely with fluoxetine: theophylline, certain anti-arrhythmic, warfarin, codeine, monoamine oxidase inhibitors, coumadin, digitoxin, flecainide, linazeline (Zyvox), or vinblastine C) This will not prevent partcipants taking stable doses for at least three months of medications prescribed for non-psychiatric indications, e.g. antidepressants for chronic pain, sedating antidepressants or anti-anxiety agents for insomnia, anti-convulsants for pain, from participating in the study. Participants will be allowed to remain on propanol during this study but will have their blood pressure and pulse monitored every four weeks. Use of tricyclic drugs concomitantly will result in exclusion from the study, unless the dose of tricyclic drugs is low (i.e. 10 mg for patients on doxepin or amitriptyline for sleep). Ascertained by patient report and the judgment of the study psychiatrist.
Contact: Nyryan V. Nolido, MA | 617-525-8403 | nnolido@partners.org |
Contact: Jessica R. Jones, BA | 617-525-8404 | jjones21@partners.org |
United States, Massachusetts | |
Brigham and Women's Hospital | Recruiting |
Boston, Massachusetts, United States, 02115 | |
Contact: Nyryan V. Nolido, MA 617-525-8403 nnolido@partners.org | |
Contact: Jessica R. Jones, BA 617-525-8404 jjones21@partners.org | |
Principal Investigator: Arthur J. Barsky, MD | |
United States, New York | |
Columbia Medical Center, New York Psychiatric Institute | Recruiting |
New York City, New York, United States, 10032 | |
Contact: Brian Fallon, MD 212-543-5487 baf1@columbia.edu | |
Contact: Emily Doherty, BA doherty@nyspi.cpmc.columbia.edu | |
Principal Investigator: Brian Fallon, MD |
Principal Investigator: | Arthur J. Barsky, MD | Brigham and Women's Hospital and Harvard Medical School |
Principal Investigator: | Brian Fallon, MD | Columbia Medical Center |
Responsible Party: | Brigham and Women's Hospital ( Arthur J. Barsky, MD ) |
Study ID Numbers: | R01 MH71688, DSIR 83-ATAS |
Study First Received: | June 16, 2006 |
Last Updated: | October 30, 2008 |
ClinicalTrials.gov Identifier: | NCT00339079 |
Health Authority: | United States: Federal Government |
Fluoxetine Hypochondriasis Mental Disorders Somatoform Disorders Serotonin |
Neurotransmitter Agents Neurotransmitter Uptake Inhibitors Serotonin Agents Molecular Mechanisms of Pharmacological Action Therapeutic Uses Physiological Effects of Drugs |
Psychotropic Drugs Antidepressive Agents, Second-Generation Central Nervous System Agents Serotonin Uptake Inhibitors Antidepressive Agents Pharmacologic Actions |