Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Effects of Psilocybin on Anxiety and Psychosocial Distress in Cancer Patients
Brief Summary: The primary objective of this double-blind, placebo-controlled pilot study is to assess the efficacy of psilocybin administration (4-phosphoryloxy-N,N-dimethyltryptamine), a serotonergic psychoactive agent, on psychosocial distress, with the specific primary outcome variable being anxiety associated with cancer. Secondary outcome measures will look at the effect of psilocybin on symptoms of pain perception, depression, existential/psychospiritual distress, attitudes towards disease progression and death, quality of life, and spiritual/mystical states of consciousness. In addition, a secondary objective of the study is to determine the feasibility of administering psilocybin to this patient population, with regards to the following issues: safety, patient recruitment, consent for treatment, and retention. The duration of the proposed investigation will be long enough to administer the drug one time to each of thirty-two patients and to conduct follow-up assessments. This study is separate but similar to a recently completed study at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, run by a psychiatrist, Dr. Charles Grob. Although the outcomes measures would be similar to those used as in the Grob study, the proposed dose of psilocybin is higher at 0.3mg/kg and the total subjects for the study would be 32 instead of 12. The study utilizes a cross-over design at 7 weeks and includes prospective follow-up of 6 months duration. This study has been approved by the Bellevue Psychiatry Research Committee, the NYU Oncology PRMC Committee, the Food and Drug Administration (FDA) through the issuance of an IND (77,138), the New York University School of Medicine Institutional Review Board (NYU IRB), the Health and Hospitals Corporation (HHC)-New York University (NYU) Clinical Translational Science Institute (CTSI), the NYU Bluestone Center for Clinical Research, and the Drug Enforcement Agency (DEA) through the issuance of a schedule I license.

It is hypothesized that a one time experience with psilocybin will occasion dramatic shifts in consciousness and awareness that will lead to short-term (ie hours to days) and long-term (up to 6 months in this study, following the administration of the second dosing, either psilocybin or placebo) improvement in anxiety, depression, and pain associated with advanced cancer. The exact mechanism of action is unclear but based on studies done in the 60's using serotonergic hallucinogens in patients with advanced cancer, improvements in anxiety levels, mood and pain were reported. However, a treatment model developed by the famous British psychiatrist Humphrey Osmond, offers one possibility. In this model, serotonergic hallucinogens' therapeutic mechanism lies in their ability to allow the individual to access novel dimensions of consciousness and their efficacy or lack thereof relies on whether a transcendent and mystical state of awareness is attained. Another possible mechanism relates to what Dobkin de Rios and Grob have described as 'managed altered states of consciousness,' where the power of suggestibility, occurring in a safe setting, allows one to transcend a particular state of consciousness (i.e. anxiety and depression associated with advanced illness) as a means to facilitate emotional discharge and to manage irreconcilable conflict.


Options:
A: Arm Label: Methylphenidate add on to Mirtazapine; Type: EXPERIMENTAL; Interventions: Drug: Methylphenidate | Arm Label: Placebo add on to Mirtazapine; Type: PLACEBO_COMPARATOR; Interventions: Drug: Placebo | Intervention Type: DRUG; Name: Methylphenidate; Assigned to Arm(s): Methylphenidate add on to Mirtazapine | Intervention Type: DRUG; Name: Placebo; Assigned to Arm(s): Placebo add on to Mirtazapine
B: Arm Label: Psilocybin; Type: EXPERIMENTAL; Interventions: Drug: Psilocybin, Drug: Niacin | Arm Label: Niacin; Type: ACTIVE_COMPARATOR; Interventions: Drug: Psilocybin, Drug: Niacin | Intervention Type: DRUG; Name: Psilocybin; Assigned to Arm(s): Niacin, Psilocybin | Intervention Type: DRUG; Name: Niacin; Assigned to Arm(s): Niacin, Psilocybin
C: Arm Label: Arm I (management of therapy complications); Type: EXPERIMENTAL; Interventions: Drug: venlafaxine, Other: questionnaire administration, Other: quality-of-life assessment | Arm Label: Arm II (placebo); Type: PLACEBO_COMPARATOR; Interventions: Drug: placebo, Other: questionnaire administration, Other: quality-of-life assessment | Intervention Type: DRUG; Name: venlafaxine; Assigned to Arm(s): Arm I (management of therapy complications) | Intervention Type: DRUG; Name: placebo; Assigned to Arm(s): Arm II (placebo) | Intervention Type: OTHER; Name: questionnaire administration; Assigned to Arm(s): Arm I (management of therapy complications), Arm II (placebo) | Intervention Type: OTHER; Name: quality-of-life assessment; Assigned to Arm(s): Arm I (management of therapy complications), Arm II (placebo)
D: Arm Label: Low Dose First, High Dose Second; Type: EXPERIMENTAL; Interventions: Drug: psilocybin | Arm Label: High Dose First, Low Dose Second; Type: EXPERIMENTAL; Interventions: Drug: psilocybin | Intervention Type: DRUG; Name: psilocybin; Assigned to Arm(s): High Dose First, Low Dose Second, Low Dose First, High Dose Second

Answer: B