The primary aim of this study is to assess the safety and tolerability of one 25 mg dose of psilocybin in participants with anorexia nervosa based on adverse events (AEs), changes in vital signs, electrocardiograms (ECGs) and clinical laboratory tests. The secondary objectives are to explore the efficacy of a single 25 mg dose of psilocybin on eating disorder symptoms and behaviors, body image, anxiety, food related obsessions and rituals, and body weight.
Because there are no proven treatments that normalize core symptoms in adult anorexia nervosa, a disorder with high chronicity, many individuals seek out alternative approaches to care. Recent evidence has suggested that anxiety, obsessive compulsive disorder, and diminished reward or motivation play key roles in the development and maintenance of dysfunctional eating, and poor outcome. In recent years, a growing number of studies have demonstrated the safety and preliminary efficacy of psilocybin in clinical trials for a range of psychiatric illnesses including treatment resistant depression, obsessive compulsive disorder, addiction, and anxiety. Psilocybin may represent a promising new treatment for anorexia nervosa. However, no studies have tested psilocybin in this eating disorder population. Accordingly, this study aims to establish the safety, tolerability and dosing of psilocybin in adult patients with anorexia nervosa, as well as gather pilot data on possible efficacy. For this study, the investigators will recruit adults who currently have a DSM-V diagnosis of anorexia nervosa. Participants will undergo medical and psychological screening and those who are deemed eligible will partake in a maximum of 7 study visits, lasting from 4-8 weeks. On dosing day, participants will receive a single 25 mg dose of psilocybin along with psychotherapeutic support, which includes preparation and integration sessions surrounding the experience. There will be a follow-up period of one month following the psilocybin session during which a range of psychological measures (questionnaires and interviews) will be collected.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
16
Psilocybin-assisted psychotherapy
Altman Clinical and Translational Research Institute
La Jolla, California, United States
Incidence and occurrence of changes in AEs
Time frame: Baseline to Day 28
Incidence and occurrence of changes in AEs
Time frame: Day 1 to Day 28
Incidence of clinically important changes in ECG parameters
Time frame: Baseline to Day 1
Incidence of clinically important changes in ECG parameters
Time frame: Baseline to Day 7
Incidence of clinically important changes in ECG parameters
Time frame: Baseline to Day 28
Incidence of clinically important changes in laboratory tests
Time frame: Baseline to Day 1
Incidence of clinically important changes in laboratory tests
Time frame: Baseline to Day 7
Incidence of clinically important changes in laboratory tests
Time frame: Baseline to Day 28
Incidence of clinically significant changes in vital signs
Time frame: Baseline to Day 1
Incidence of clinically significant changes in vital signs
Time frame: Baseline to Day 7
Incidence of clinically significant changes in vital signs
Time frame: Baseline to Day 28
Incidence of changes in the Columbia-Suicide Severity Rating Scale (C-SSRS) at each post-Baseline visit
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The C-SSRS will be used to assess suicide potential or tendency as a study entry criteria and monitored throughout the study.
Time frame: Baseline to Day 28
Change in Eating Disorder Examination (EDE) scores for Dietary Restraint, Eating Concern, and Shape Concern
The EDE is a structured clinical interview (investigator rated) and is used to measure the severity of the characteristic psychopathology of eating disorders. The four EDE subscales (Dietary Restraint, Eating Concern, Weight Concern, and Shape Concern) are rated on a 7-point forced-choice format (0-6), with higher scores reflecting greater severity or frequency.
Time frame: Baseline to Day 28
Change in weight (kg)
Time frame: Baseline to Day 7 and Day 28
Change in trait anxiety and state anxiety total scores on the Spielberger State-Trait Anxiety Inventory (STAI)
The STAI consists of self-report scales for measuring "state" and "trait" anxiety. It consists of 40 items scored by a 4 point Likert scale. 20 questions refer to state anxiety, and 20 to trait anxiety thus each section is scored between 20 and 80. Higher scores indicate greater anxiety.
Time frame: Baseline to Day 1, Day 7, and Day 28
Change in Physical Appearance State and Trait Anxiety Scale (PASTAS) trait total score and state score
The PASTAS is a self-reported 16-item measure that assesses anxiety about physical appearance. Each question is rated on a Likert scale from 0 to 4, indicating that the individual feels anxious, tense or nervous about a specific body part or general overweightness. There is a minimum score on each scale 0 and a maximum score of 64, where higher scores indicated greater severity in anxiety.
Time frame: Baseline to Day 1, Day 7, and Day 28
Change in Body Image State Scale (BISS) total score
The BISS is a self-report questionnaire that has six items used to assess an individual's evaluative and affecting body image state at a given moment in time. The six items are: 1) dissatisfaction with physical appearance, 2) dissatisfaction with body size and shape, 3) dissatisfaction with weight, 4) feelings of physical unattractiveness, 5) current feeling about one's look relative to how one usually feels, and 6) evaluation of one's appearance relative to how the average person looks. Each item is evaluated on a 9-point bipolar Likert like scale and higher scores indicate more positive body image.
Time frame: Baseline to Day 28
Change in Yale Brown Cornell Eating Disorder Scale (YBC-EDS-SRQ)
This self-report scale consists of 65 items and 19 question items related to eating disorder preoccupations and rituals. There is an emphasis on comparison between current state (last two weeks) and worst state, the one month where the participant believed their eating disorder to be the most severe. The scoring includes a preoccupations subtotal, rituals subtotal and total score.
Time frame: Baseline to Day 1, Day 7, and Day 28
Change in Eating Disorder Inventory (EDI) total score
The EDI is a self-report questionnaire. It consists of 91 items organized into 12 primary scales rated on a 0-4 point scoring system, consisting of 3 eating disorder specific scales and 9 general psychological scales that are highly relevant to, but not specific to, eating disorders. It yields six composite scores: one that is eating disorder specific (i.e., Eating Disorder Risk) and five that are general integrative psychological constructs (i.e., Ineffectiveness, Interpersonal Problems, Affective Problems, Overcontrol, General Psychological Maladjustment). A computer-based scoring program generates a detailed clinical profile and scoring report for each participant.
Time frame: Baseline to Day 1, Day 7, and Day 28
Change in Eating Disorder Examination Questionnaire Short Form (EDE-QS) total scores
The EDE-QS is a self-report questionnaire. It consists of 32 items that assess the core symptoms of eating disorders and range of eating-related psychopathology. The EDE-QS is based closely on the EDE interview. Scores range from 0 to 36 and higher scores indicate greater eating disorder symptoms.
Time frame: Baseline to Day 1, Day 7, and Day 28