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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT04239339
Other study ID # H-18038352
Secondary ID
Status Completed
Phase Phase 4
First received
Last updated
Start date April 28, 2020
Est. completion date October 30, 2022

Study information

Verified date November 2023
Source Rigshospitalet, Denmark
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The aim of this project is: - To apply a pharmacological tool of selective serotonin (5-hydroxytryptamine, 5-HT system) reuptake inhibition in healthy humans. Specifically: - To investigate how sub-chronic administration of 20 mg of escitalopram affects cognitive performance ('cold' cognition) and social-emotional functioning ('hot' cognition) compared with placebo; and - To investigate how sub-chronic administration of 20 mg of escitalopram affects functional brain activation during a paradigm of reinforcement learning following drug administration compared with placebo, and how activation relates to cognitive performance and social-emotional functioning.


Description:

The aim of this project is: - To apply a pharmacological tool of selective serotonin (5-hydroxytryptamine, 5-HT system) reuptake inhibition in healthy humans. Specifically: - To investigate how sub-chronic administration of 20 mg of escitalopram affects cognitive performance ('cold' cognition) and social-emotional functioning ('hot' cognition) compared with placebo; and - To investigate how sub-chronic administration of 20 mg of escitalopram affects functional brain activation during a paradigm of reinforcement learning following drug administration compared with placebo, and how activation relates to cognitive performance and social-emotional functioning. Serotonin is a monoamine neurotransmitter implicated in diverse cognitive and affective brain functions. Serotonin has a significant role in the regulation of cognition and mood, including emotional appraisal, perception and flexible behaviour, with 5-HT receptors found in the cortex, amygdala and hippocampus. The investigators have previously shown that in healthy human experimental studies, acute dietary tryptophan depletion induces 'waiting' impulsivity and impulsive behaviours, impairs goal-directed behaviour and shifts behavioural control toward habitual responding when appetitive, but goal-directed when aversive. Reduced availability of forebrain serotonin has also shown to impair a range of cognitive processes, such as psychomotor processing, episodic memory, attention and executive function. Recently, the research team have shown that using an acute and clinically relevant dose (20 mg) of escitalopram impaired learning and cognitive flexibility, but improved response inhibition in healthy humans, suggesting a dissociation of effects possibly mediated by differential modulation of brain serotonin levels in distinct functional neural circuits. The investigators now aim to investigate the effects of sub-chronic administration of 20 mg of escitalopram (i.e. three weeks) in healthy volunteers using sophisticated neuropsychological testing (Cambridge Neuropsychological Test Automated Battery and EMOTICOM) and functional magnetic resonance imaging (fMRI). Whereas 'cold' cognition refers to the use of non-emotional processing (e.g. episodic memory; spatial working memory), 'hot' cognition is emotion-laden and used in response to stimuli with affective salience (e.g. decision-making under high levels of risk of uncertainty). It has been suggested that cognitive-emotional effects, such as the re-appraisal and re-evaluation of emotions underlying learning mechanisms, may mediate improvements in mood associated with SSRI treatment. This project will help further the understanding of the role of serotonin in the regulation of cognitive and emotional processes, as well the neural correlates underlying reinforcement learning, in healthy humans.


Recruitment information / eligibility

Status Completed
Enrollment 66
Est. completion date October 30, 2022
Est. primary completion date October 30, 2022
Accepts healthy volunteers Accepts Healthy Volunteers
Gender All
Age group 18 Years to 45 Years
Eligibility Inclusion Criteria: - Healthy volunteer (male or female) between 18 and 45 years. Exclusion Criteria: - Current or former primary psychiatric disorder (DSM IV Axis I or WHO ICD-10 diagnostic classification). - Current or previous neurological disease, severe somatic disease, or the consumption of drugs likely to influence the test results. - Non- fluent in Danish or pronounced visual or auditory impairments. - Current or past learning disability. - Pregnancy (females). - Lactation (females). - Contraindications for MRI (pacemaker, metal implants, etc.). - Allergy to the ingredients in the administered drug. - Abnormal ECG (e.g. prolonged QT syndrome). - Dizzy when changing from supine to upright position (e.g. postural orthostatic tachycardia syndrome). - Mild hypotension (blood pressure below 100/70 mmHg) or hypertension (blood pressure above 140/90 mmHg). - Head injury or concussion resulting in loss of consciousness for more than 2 min. - Alcohol or drug abuse. - Drug use other than tobacco and alcohol within the last 30 days. - Hash > 50 x lifetime. - Drugs > 10 x lifetime (for each substance). - Nicotine addiction. - Current psychoactive medication. - Severe physical impairments affecting eyesight or motor performance. - Hamilton-6 depression scale score > 5.

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Escitalopram 20 mg
20mg daily for approximately 3 weeks.
Placebo
Placebo daily for approximately 3 weeks.

Locations

Country Name City State
Denmark Neurobiology Research Unit Copenhagen

Sponsors (3)

Lead Sponsor Collaborator
Rigshospitalet, Denmark Lundbeck Foundation, University of Cambridge

Country where clinical trial is conducted

Denmark, 

References & Publications (8)

Bland AR, Roiser JP, Mehta MA, Schei T, Boland H, Campbell-Meiklejohn DK, Emsley RA, Munafo MR, Penton-Voak IS, Seara-Cardoso A, Viding E, Voon V, Sahakian BJ, Robbins TW, Elliott R. EMOTICOM: A Neuropsychological Test Battery to Evaluate Emotion, Motivation, Impulsivity, and Social Cognition. Front Behav Neurosci. 2016 Feb 24;10:25. doi: 10.3389/fnbeh.2016.00025. eCollection 2016. — View Citation

Homberg JR. Serotonin and decision making processes. Neurosci Biobehav Rev. 2012 Jan;36(1):218-36. doi: 10.1016/j.neubiorev.2011.06.001. Epub 2011 Jun 12. — View Citation

Meneses A. Are 5-HT(1B/1D) and 5-HT(2A/2B/2C) receptors involved in learning and memory processes? IDrugs. 1999 Aug;2(8):796-801. — View Citation

Park SB, Coull JT, McShane RH, Young AH, Sahakian BJ, Robbins TW, Cowen PJ. Tryptophan depletion in normal volunteers produces selective impairments in learning and memory. Neuropharmacology. 1994 Mar-Apr;33(3-4):575-88. doi: 10.1016/0028-3908(94)90089-2. — View Citation

Sahakian BJ, Morris RG, Evenden JL, Heald A, Levy R, Philpot M, Robbins TW. A comparative study of visuospatial memory and learning in Alzheimer-type dementia and Parkinson's disease. Brain. 1988 Jun;111 ( Pt 3):695-718. doi: 10.1093/brain/111.3.695. — View Citation

Worbe Y, Palminteri S, Savulich G, Daw ND, Fernandez-Egea E, Robbins TW, Voon V. Valence-dependent influence of serotonin depletion on model-based choice strategy. Mol Psychiatry. 2016 May;21(5):624-9. doi: 10.1038/mp.2015.46. Epub 2015 Apr 14. — View Citation

Worbe Y, Savulich G, de Wit S, Fernandez-Egea E, Robbins TW. Tryptophan Depletion Promotes Habitual over Goal-Directed Control of Appetitive Responding in Humans. Int J Neuropsychopharmacol. 2015 Feb 5;18(10):pyv013. doi: 10.1093/ijnp/pyv013. — View Citation

Worbe Y, Savulich G, Voon V, Fernandez-Egea E, Robbins TW. Serotonin depletion induces 'waiting impulsivity' on the human four-choice serial reaction time task: cross-species translational significance. Neuropsychopharmacology. 2014 May;39(6):1519-26. doi: 10.1038/npp.2013.351. Epub 2014 Jan 2. — View Citation

Outcome

Type Measure Description Time frame Safety issue
Other Emotion Recognition Other Outcome 1: Detection threshold decreasing Happy - Intensity Morphing Outcome variables have been grouped a priori into carefully defined cognitive domains. 3 Years
Other Emotion Recognition Other Outcome 2: Detection threshold decreasing Sad - Intensity Morphing Outcome variables have been grouped a priori into carefully defined cognitive domains. 3 Years
Other Emotion Recognition Other Outcome 3: Detection threshold decreasing Anger - Intensity Morphing Outcome variables have been grouped a priori into carefully defined cognitive domains. 3 Years
Other Emotion Recognition Other Outcome 4: Detection threshold decreasing Fear - Intensity Morphing Outcome variables have been grouped a priori into carefully defined cognitive domains. 3 Years
Other Emotion Recognition Other Outcome 5: Detection threshold decreasing Disgust - Intensity Morphing Outcome variables have been grouped a priori into carefully defined cognitive domains. 3 Years
Other Emotion Recognition Other Outcome 6: D' Happy - Emotion Recognition Task Outcome variables have been grouped a priori into carefully defined cognitive domains. 3 Years
Other Emotion Recognition Other Outcome 7: D' Sad - Emotion Recognition Task Outcome variables have been grouped a priori into carefully defined cognitive domains. 3 Years
Other Emotion Recognition Other Outcome 8: D' Fear - Emotion Recognition Task Outcome variables have been grouped a priori into carefully defined cognitive domains. 3 Years
Other Emotion Recognition Other Outcome 9: D' Anger - Emotion Recognition Task Outcome variables have been grouped a priori into carefully defined cognitive domains. 3 Years
Other Activity Level Score 3 Years
Other Behavioural Inhibition/ Behavioural Avoidance Scale Score 3 Years
Other The Compulsive Personality Assessment Scale Score 3 Years
Other Sexuality Questionnaire Score 3 Years
Other Edinburgh Handedness Inventory Score 3 Years
Other Revised NEO Personality Questionnaire Score 3 Years
Other Family History Assessment Module Score 3 Years
Other Positive Life Events Score 3 Years
Other Stressful Life Events Score 3 Years
Other State and Trait Aggression Questionnaire -Trait Score 3 Years
Other Barret Impulsivity Scale-Trait Score 3 Years
Other The Penn State Worry Questionnaire- Trait Score 3 Years
Other The Penn State Worry Questionnaire- State Score 3 Years
Other The Self-Control Scale- Trait Score 3 Years
Other The Self-Control Scale- State Score 3 Years
Other State- Trait Anxiety Inventory- Trait Score 3 Years
Other The Warwick-Edinburgh Mental Well-being Scale -Trait Score 3 Years
Other The Warwick-Edinburgh Mental Well-being Scale -State Score 3 Years
Other Mindful Attention and Awareness Scale -Trait Score 3 Years
Other Mindful Attention and Awareness Scale -State Score 3 Years
Other The Intolerance of Uncertainty Scale - Trait Score 3 Years
Other The Intolerance of Uncertainty Scale - State Score 3 Years
Other Verran Snyder-Halpern (VSH) Sleep Scale Score 3 Years
Primary Learning Primary Outcome 1: Mean errors Stage 1 (Learning) - Probability Reversal Learning. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 years
Primary Learning Primary Outcome 2: Mean errors Stage 2 (Reversal) - Probability Reversal Learning. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Primary Learning Primary Outcome 3: Learning Rate in Reward Trial - Reinforcement Learning. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Primary Learning Primary Outcome 4: Learning Rate in Punishment Trials - Reinforcement Learning. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Primary Inhibition Primary Outcome 1: Stop Signal Reaction Time - Interleaved Stop Signal Task/Go-NoGo. Outcome variables have been grouped a priori into carefully defined cognitive domains. 3 Years
Primary Executive Function Primary Outcome 1: Extra Dimensional Set Errors -3Dimensional Intra/Extra Dimensional Shift. Outcome variables have been grouped a priori into carefully defined cognitive domains. 3 Years
Primary Reinforcement Behaviour Model A model comparison will be conducted to determine the winning model of reinforcement behaviour using one, a combination of, or all these parameters. The winning model will be a single outcome model.
Reward Learning Rate
Punishment Learning Rate
Reinforcement Sensitivity
Stimulus Stickiness
3 Years
Primary Social Cognition Primary Outcome 1: Proportion of offers accepted - Ultimatum Game Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Primary Social Cognition Primary Outcome 2: Agent Guilt Score - Moral Emotions Task. 3. Agent Shame Score ---------- Moral Emotions Task Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Primary Social Cognition Primary Outcome 3: Agent Shame Score - Moral Emotions Task. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Primary Emotion Recognition Primary Outcome 1: Affective bias in decreasing condition - EMOTICOM Intensity Morphing. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Primary Emotion Recognition Primary Outcome 2: Affective bias for D' - EMOTICOM Emotion Recognition Task. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Primary Emotion Recognition Primary Outcome 3: Detection threshold decreasing - EMOTICOM Intensity Morphing. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Primary Emotion Recognition Primary Outcome 4: D'Prime for Emotion Recognition - EMOTICOM Emotion Recognition Task. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Primary Biofluids: Serum Escitalopram levels 3 Years
Primary PET Imaging: Cerebral (particularly hippocampal) presynaptic density, as measured with 11 C-UCB-J-PET. Collected in a sub-sample of participants. 3 Years
Secondary Learning Secondary Outcome 1: Stage 1 Reward-Stay/Lose-Shift behaviour - Probability Reversal Learning. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Learning Secondary Outcome 2: Stage 2 Reward-Stay/ Lose-Shift behaviour - Probability Reversal Learning. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Learning Secondary Outcome 3: Pre Extra Dimension Set Errors - 3Dimensional Intra/Extra Dimensional Shift. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Learning Secondary Outcome 4: Proportion of Stays - Sequential Model-Based/Model-Free. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Inhibition Secondary Outcome 1: Go reaction time - Interleaved Stop Signal Task/Go-NoGo. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Inhibition Secondary Outcome 2: Go omission error rate - Interleaved Stop Signal Task/Go-NoGo. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Inhibition Secondary Outcome 3: Go commission error rate - Interleaved Stop Signal Task/Go-NoGo. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Inhibition Secondary Outcome 4: No-Go error rate - Interleaved Stop Signal Task/Go-NoGo. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Executive Function Secondary Outcome 1: Total Errors Adjusted - 3Dimensional Intra/Extra Dimensional Shift. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Executive Function Secondary Outcome 2: Strategy Score - CANTAB Spatial Working Memory. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Social Cognition Secondary Outcome 1: Fairness Sensitivity---------- Ultimatum Game Outcome variables have been grouped a priori into carefully defined cognitive domains. 3 Years
Secondary Emotion Recognition Secondary Outcome 1: Detection threshold increasing - EMOTICOM Intensity Morphing. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Emotion Recognition Secondary Outcome 2: Affective bias in increasing condition - EMOTICOM Intensity Morphing. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Emotion Recognition Secondary Outcome 3: Affective bias for Hit Rate - EMOTICOM Emotion Recognition Task. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Emotion Recognition Secondary Outcome 4: Hit Rate for Emotion Recognition - EMOTICOM Emotion Recognition Task. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Faces and geometric figure discrimination Outcome 1: Accuracy - Faces fMRI paradigm Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Faces and geometric figure discrimination Outcome 2: Response Speed - Faces fMRI paradigm. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Memory Outcome 1: Total Errors Adj - CANTAB Paired Associates Learning Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Memory Outcome 2: First Trial Memory Score - CANTAB Paired Associates Learning. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Memory Outcome 3: Between Search Errors - CANTAB Spatial Working Memory. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Attention Outcome 1: Target Sensitivity (A') - CANTAB Rapid Visual Processing. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Attention Outcome 2: Latency - CANTAB Rapid Visual Processing Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Attention Outcome 3: Probability of False Alarms - CANTAB Rapid Visual Processing Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Risky Decision Making Outcome Outcome 1. Quality of Decision Making - EMOTICOM Cambridge Gamble Task. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Risky Decision Making Outcome 2: Risk Adjustment - EMOTICOM Cambridge Gamble Task Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Risky Decision Making Outcome 3: Overall Proportion Bet - EMOTICOM Cambridge Gamble Task Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Risky Decision Making Outcome 4: Deliberation Time - EMOTICOM Cambridge Gamble Task. Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Psychomotor Speed Outcome 1: Simple reaction time - CANTAB Reaction Time Task Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Psychomotor Speed Outcome 2: Five Choice reaction time - CANTAB Reaction Time Task Outcome variables have been grouped a priori into carefully defined cognitive domains. FDR correction, for multiple comparisons, using the Benjamin Hochberg procedure will be applied to the outcomes within each cognitive domain. 3 Years
Secondary Neural Activations and Correlations - Reinforcement Learning fMRI paradigm Imaging outcomes will be FWE corrected using Random Field Theory as implemented in SPM12. 3 Years
Secondary Neural Activations and Correlations - Faces fMRI paradigm Imaging outcomes will be FWE corrected using Random Field Theory as implemented in SPM12. 3 Years
Secondary Resting State fMRI Imaging outcomes will be FWE corrected using Random Field Theory as implemented in SPM12. 3 Years
Secondary Structural VBM Imaging outcomes will be FWE corrected using Random Field Theory as implemented in SPM12. 3 Years
Secondary Diffusion Tensor Imaging 3 Years
Secondary Profile of Mood State Score 3 Years
Secondary Beck Depression Inventory-II Score 3 Years
Secondary State-Trait Anxiety Inventory Scale -State Score 3 Years
Secondary State and Trait Aggression Questionnaire-State Score 3 Years
Secondary Baret Impulsivity Scale-State Score 3 Years
Secondary Visual Analogue Scale Score 3 Years
Secondary Interpersonal Reactivity Index Score 3 Years
Secondary Obsessive- Compulsive Inventory Score 3 Years
Secondary Brief Symptom Checklist Score 3 Years
Secondary Pittsburgh Sleep Quality Index Score 3 Years
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