The primary objective of this study is to investigate the safety, feasibility, and tolerability of psilocybin treatment in individuals with functional impairment due to psychiatric symptoms. The secondary objective of this study is to determine whether individuals with functional impairments due to psychiatric symptoms will experience statistically significant symptom reduction and functional improvement from baseline symptom measurements (Visit 3) to 1-week (Visit 7), 4-weeks (Visit 8), and 6-weeks (Visit 9) post dosing. The investigators will recruit individuals with mood, anxiety, trauma, addictive, or related symptomatology, and who have functional impairment associated with these symptoms. A DSM-5 diagnosis is not required (nor is it an exclusion). The investigators will allow for comorbidity and only exclude based on psychological and physiological safety considerations. Critically, this approach will allow us to assess the tolerability of our interventions in individuals who would typically be excluded from efficacy studies due to various comorbid DSM-5 conditions. The investigators will employ an open-label study where participants will be given one dose of oral psilocybin 25mg. The investigators will also have follow-up visits at 1, 4, and 6 weeks and an optional long-term follow-up at 3, 6, and 12 months.
In this Phase 1b proof-of-concept clinical trial, the investigators aim to investigate the safety, feasibility, and tolerability of treatment of oral psilocybin in participants with functional impairment due to depressive, anxiety, trauma addictive, or other psychiatric symptomatology, allowing for comorbidity and diagnostic complexity to mirror potential real-world clinical scenarios. Secondarily, The investigators will assess improvement in functional status and symptomatology. The investigators will employ an open-label study design, with participants receiving one dose of oral psilocybin. This is an open-label clinical trial with a single treatment arm and no blinding. All participants will receive 25 mg of oral psilocybin. All dosing will be accompanied by non-directive support before, during, and after treatment sessions.The rationale for conducting this study lies in recognizing that the narrow inclusion and exclusion criteria commonly employed in clinical trials may raise issues of external validity. While previous research has predominantly focused on specific diagnostic categories, our study aims to address these limitations by exploring the safety, feasibility, and tolerability of psilocybin in a heterogeneous population. This study also recognizes the importance of symptom-related functional impairment as a cross-cutting construct relevant to all diagnostic categories.This is a Phase 1b open-label clinical trial to determine the feasibility, tolerability and safety of psilocybin to reduce psychiatric symptoms in participants experiencing functional impairment. Participants will receive one dose of oral psilocybin (25mg). Follow-up visits for assessments and measures at 1-week, 4-week, and 6-week post psilocybin dosing. Long-term follow-up visits assessments and measures for participants who consent to long-term follow-up (reassessments of study measures) for 3-month, 6-month, and 12-month post dosing. Psilocybin (4-hydroxy-N,N-dimethyltryptamine) occurs in nature in many species of mushrooms, including the genera Psilocybe, Conocybe, Gymnopilus, Panaeolus, and Strophparia. Its chemical formula is C12H17N2O4P. Psilocybin is a potent agonist at 5-HT2A/C receptors; potency of binding by related compounds to these receptors correlates with human potency as hallucinogens. Psilocybin is currently a Schedule I substance. Psilocybin will be orally administered in this study. Psilocybin will be administered in an opaque, size 2 gelatin capsule with approximately 180 ml of water to be orally ingested at Visit 5. The dose of psilocybin will be 25 mg. Descriptives for all safety measures (e.g., C-SSRS total and subscale scores, vitals, documented adverse events) will be compiled at all assessment intervals. Classification of adverse events will follow institute and regulatory body guidelines. Subsequent summary descriptives may focus on safety indices surrounding the dosing session and 1-week, 4 weeks, and 6-weeks after dosing. In addition, The investigators will perform descriptives and non-parametric analysis screen failure rates (including analysis of ineligibility), drop out rates pre and post dosing to determine feasibility and tolerability.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
50
Psilocybin will be administered in an opaque, size 2 gelatin capsule with approximately 180 ml of water to be orally ingested at Visit 5. The dose of psilocybin will be 25 mg.This is an open-label clinical trial with a single treatment arm. This is an open-label clinical trial with no blinding.
Connecticut Mental Health Center - Yale School of Medicine
New Haven, Connecticut, United States
RECRUITINGColumbia-Suicide Severity Rating Scale (C-SSRS)
Range 0 to 25, higher score indicating more suicidal risk
Time frame: 6 weeks
Adverse Events Log
This log is cumulative and captures adverse events (including serious adverse events) of all participants throughout the study.
Time frame: 6 weeks
World Health Organization Disability Assessment Schedule 2.0
Scores range from 0 to 100 (where 0 = no disability; 100 = full disability).
Time frame: 6 weeks
Diagnostic Interview for Anxiety, Mood, and Obsessive-Compulsive and Related Neuropsychiatric Disorders (Self-report and Clinician Administered)
no score range
Time frame: screening
Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-SPQ)
no score range
Time frame: screening
Yale-Brown Obsessive-Compulsive Scale-Second Edition (Y-BOCS-II) Symptom Checklist and Severity Scale
Each item is rated from 0 (no symptoms) to 4 (extreme symptoms). A score of 0-7 is considered nonclinical. Scores ranging between 8 and 15 are considered mild. Scores between 16 and 23 are considered moderate and scores between 24-31 and 32-40 are considered severe and extreme, respectively.
Time frame: 6 weeks
Montgomery-Asberg Depression Scale (MADRS)
Total score ranging from 0 to 6 indicates that the patient is in the normal range (no depression), a score ranging from 7 to 19 indicates "mild depression," 20 to 34 indicates "moderate depression," a score of 35 and greater indicates "severe depression," and a total score of 60 or greater indicates "very severe depression".
Time frame: 6 weeks
Hamilton Anxiety Rating Scale (HAM-A)
Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0-56, where \<17 indi- cates mild severity, 18-24 mild to moderate severity and 25-30 moderate to severe.
Time frame: 6 weeks
Clinician-Administered PTSD Scale for DSM-5
Total severity score on the CAPS-5 represents the sum of the individual severity scores (0-4) for each of the 20 PTSD symptoms (CAPS-5 items 1-20 that have TR definite or probable). Total scores range from 0-80, with higher scores indicating more severe PTSD symptoms.
Time frame: 6 weeks
Brief Symptom Inventory (BSI)
Scores on a 5-point scale ranging from 0 (not at all) to 4 (extremely). Higher scores indicate higher severity.
Time frame: 6 weeks
Difficulties in Emotion Regulation Scale (DERS)
Responses ranging from 1 to 5, 36 items total. Higher scores indicate worse outcomes.
Time frame: From enrollment to the end of treatment at 6 weeks
Southampton Mindfulness Questionnaire (SMQ)
12 items are rated on a seven-point Likert scale, and the scores range from 0 to 72. Higher scores indicate better mindfulness outcomes.
Time frame: From enrollment to the end of treatment at 6 weeks
Brief Experiential Avoidance Questionnaire (BEAQ)
Scores range from 15 to 90, with higher scores indicating worse outcomes (greater experiential avoidance).
Time frame: From enrollment to the end of treatment at 6 weeks
Self-Compassion Scale-Short Form (SCS-SF)
Score range from 1 to 5, with higher scores indicating better outcomes (higher self-compassion).
Time frame: From enrollment to the end of treatment at 6 weeks
Quality of Life Enjoyment & Satisfaction Questionnaire - Short Form (Q-LES-Q-SF)
Scores range from 14 to 70, with higher scores indicating better outcomes.
Time frame: From enrollment to the end of treatment at 6 weeks
Inventory for Depression and Anxiety Symptoms (IDAS-II)
18 subscales each ranging from 1 to 90, higher scores indicating worse outcomes.
Time frame: From enrollment to the end of treatment at 6 weeks
Ten-Item Personality Inventory (TIPI)
The total personality score ranges from 10-70, with higher scores indicating more endorsement of the respective personality type.
Time frame: From enrollment to the end of treatment at 6 weeks
Stanford Expectations of Treatment Scale (SETS)
Scores range from 0 to 18, with higher scores indicating greater expectancy.
Time frame: From enrollment to the end of treatment at 6 weeks
Mystical Experience Questionnaire (MEQ)
Total score ranges from 0 to 150, with higher score indicating greater endorsement of mystical-type experience.
Time frame: From enrollment to the end of treatment at 6 weeks
Psychological Insight Questionnaire (PIQ)
Scores range from 0 to 5, with higher scores indicating more insight.
Time frame: From enrollment to the end of treatment at 6 weeks
Challenging Experience Questionnaire (CEQ)
Scores range from 0-4 per sub scale, with higher scores indicating more challenging experience.
Time frame: From enrollment to the end of treatment at 6 weeks
Ego Dissolution Inventory (EDI)
Scores range from 0 to 100, with higher scores indicating more ego dissolution.
Time frame: From enrollment to the end of treatment at 6 weeks
Emotional Breakthrough Inventory (EBI)
Scores range from 0 to 100, with higher scores indicating more ego dissolution.
Time frame: From enrollment to the end of treatment at 6 weeks
Theoretical Orientation Profile Scale-Revised (TOPS-R)
Scores range from 0 to 10, with higher scores indicating more endorsement of respective orientation.
Time frame: From enrollment to the end of treatment at 6 weeks
Working Alliance Inventory-Short Revised (WAI-SR)
Scores range from 15-60, with higher scores indicating higher alliance.
Time frame: From enrollment to the end of treatment at 6 weeks
Alcohol Use Disorders Identification Test (AUDIT)
Scores range 0 to 40, with higher scores indicating worse outcomes.
Time frame: From enrollment to the end of treatment at 6 weeks
Drug Use Disorders Identification Test (DUDIT)
Scores range 0 to 40, with higher scores indicating worse outcomes.
Time frame: From enrollment to the end of treatment at 6 weeks
Fagerstrom Test for Nicotine Dependence (FTND)
Scores range 0 to 10, with higher scores indicating worse outcomes.
Time frame: From enrollment to the end of treatment at 6 weeks
Persisting Effects Questionnaire (PEQ)
Scores range varies depending on the sets of questions, with 143 total, with higher scores indicating more positive effect outcomes.
Time frame: From enrollment to the end of treatment at 6 weeks
Psychedelic Integration Scale (PIS)
Scores range from 1 to 5, with higher scores indicating better integration outcomes.
Time frame: From enrollment to the end of treatment at 6 weeks
Dimensional Obsessive-Compulsive Scale (DOCS)
Scores range 0 to 80, with higher scores indicating worse outcomes.
Time frame: From enrollment to the end of treatment at 6 weeks
Obsessive Beliefs Questionnaire-44 (OBQ-44)
Scores range from 44 to 308, with higher scores indicating worse outcomes.
Time frame: From enrollment to the end of treatment at 6 weeks
Beck Anxiety Inventory (BAI)
Scores range 0 to 63, with higher scores indicating worse outcomes.
Time frame: From enrollment to the end of treatment at 6 weeks
Beck Depression Inventory (BDI-II)
Scores range 0 to 63, with higher scores indicating worse outcomes.
Time frame: From enrollment to the end of treatment at 6 weeks
PTSD Checklist for DSM-5 (PCL)
Scores range 0 to 80, with higher scores indicating worse outcomes.
Time frame: From enrollment to the end of treatment at 6 weeks
Posttraumatic Maladaptive Beliefs (PMB)
Scores range 15 to 105, with higher scores indicating worse outcomes.
Time frame: From enrollment to the end of treatment at 6 weeks
daily diary
questions about daily events, stressors, mood, mind wandering, and rumination.
Time frame: 7 consecutive days at night at the start of participation, daily between dosing and the 4- week follow-up,
The Internal-External Locus of Control Short Scale-4 (IE-4)
Locus of control is defined as a generalized expectation of internal or external control of reinforcement
Time frame: From enrollment to the end of treatment at 6 weeks
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