Journal of Clinical Psychopharmacology最新文献

Background: The use of second-generation antipsychotics (SGAs) for managing challenging behaviors in youth with autism spectrum disorder (ASD) is increasing, but studies on antipsychotic-induced weight gain in this population remain limited. Overweight/obesity [body mass index (BMI) ≥85th percentile] could increase health complications and health care costs. This study examines clinical factors associated with overweight/obesity in youth with ASD.

Methods: Electronic medical records of youth (ages 5 to 17 years) with ASD, seen at a university-affiliated Autism Center from 2018 to 2022, were analyzed.

Results: There were 97 youths with ASD prescribed SGAs and 261 who were not. The rate of overweight/obesity (BMI≥85th percentile) did not differ by SGA use. Youth prescribed SGAs were more likely to have public insurance (63.9% vs. 45.2%, P=0.002) and a comorbid disruptive behavior disorder (DBD) diagnosis (69.1% vs. 24.1%, P<0.001). Youth with overweight/obesity were more likely to have public insurance (61.6% vs. 42.5%, P<0.001) and a DBD diagnosis (46.6% vs. 29.2%, P<0.001). Youth with SGAs and stimulants were less likely to be overweight or obese than youth with SGAs without stimulant co-treatment.

Conclusions: Mean BMI percentile and the rate of overweight/obesity did not differ by SGA use. Public insurance and DBD diagnosis have positive relationships with overweight/obesity, whereas stimulant co-treatment with SGA had a negative relationship. It is important to carefully consider the risks and benefits of SGA use, especially in under-resourced youth and those with disruptive behaviors.

Purpose/background: The therapeutic effects of psilocybin treatment are thought to be influenced by the subjective dose-dependent psychedelic experience, as well as the individual participant's mindset and the treatment environment. However, the relative contribution of an individual's pretreatment clinical characteristics and their subjective psychedelic experience remains unclear. We examined the relationship between pretreatment participant factors and the acute effects of COMP360 psilocybin.

Methods/procedures: Participants (N=233) with treatment-resistant depression received a single dose of 25, 10, or 1 mg of COMP360 psilocybin (a synthesized, pharmaceutical-grade, proprietary formulation of psilocybin, developed by the sponsor, Compass Pathfinder Ltd., a subsidiary of Compass Pathways plc: ClinicalTrials.gov, NCT03775200). The psychedelic experience was assessed by the Five-Dimensional Altered States of Consciousness questionnaire (5D-ASC) and Emotional Breakthrough Inventory (EBI). We used hierarchical regression to measure the relative contribution of pretreatment clinical characteristics (along the cognitive-affective, somatic, and functional impairment domains) in addition to the drug dose to the subjective psychedelic experience.

Findings/results: Dose was the strongest and most consistent predictor of the psychedelic experience. Some pretreatment characteristics contributed weakly to subjective experiences. Positive affect, lower generalized anxiety symptoms, higher executive functioning, and greater personality disorder symptoms had significant effects on different aspects of the subjective psychedelic experience.

Implications/conclusions: These findings challenge the assumption that pretreatment characteristics are major determinants of the acute psychedelic experience. While some traits may modestly modulate aspects of the experience, dose remains the largest driver.

Background: With a rapid rise in clinical trials investigating psychogenic substances, the field faces considerable concerns regarding transparency and conflicts of interest. This study aims to systematically characterize ongoing NIH-registered clinical trials investigating psychogenic substances for psychiatric disorders as of late 2024, including research protocols, institutional settings, and funding sources.

Procedures: This cross-sectional analysis evaluated ongoing trials from ClinicalTrials.gov that studied psychogenic substances-defined as compounds significantly affecting perception, cognition, or emotion-for psychiatric conditions. Data collected included substance class, targeted diagnoses, trial phase, geographic location, study design (eg, blinding), recruitment status, and funding sources.

Findings: A total of 181 trials met the inclusion criteria, with the majority in phase 2 (n=93; 51.4%) or phase 1 (n=33; 18.2%). The most frequently studied substances were psilocybin (n=64; 35.4%) and ketamine (n=61; 33.7%). Trials were notably concentrated within a small number of leading academic institutions. Most trials (n=148; 81.2%) listed their funding source as "other," of which 127 (86.4%) were sponsored by universities or university-affiliated institutions. Blinding was not reported in 38.7% (n=70) of trials. The primary conditions studied were major depressive disorder (n=94; 51.9%), posttraumatic stress disorder (n=38; 21.0%), and alcohol use disorder (n=21; 11.6%).

Implications: Ongoing clinical trials of psychogenic substances for psychiatric disorders are largely concentrated at select institutions and primarily focus on psilocybin and ketamine. The majority lack clear disclosure of funding sources, highlighting a need for enhanced transparency to build trust and facilitate the ethical advancement of this rapidly evolving area of psychiatric research.