Amanda E. Downey

Psychedelic-assisted psychotherapy is generating substantial clinical interest, yet despite growing economic scrutiny, a practical question has received surprisingly little attention: how do specific delivery decisions drive cost? Labor costs—typically the dominant cost component of psychedelic therapy delivery—depend on a tangle of interacting design choices: the number, length, and staffing of treatment sessions (including provider qualifications, group versus individual format, and medical backup requirements), and local hourly wage rates. Together, these factors can produce order-of-magnitude differences in per-patient cost that resist easy estimation and are rarely modeled explicitly, making rational planning difficult. As psychedelic-assisted psychotherapy moves from clinical trials and state-licensed programs toward anticipated Food and Drug Administration (FDA) approval, each stage bringing distinct staffing, regulatory, and reimbursement conditions, the need for flexible cost modeling is clear. To make these trade-offs visible and tractable, we developed TripTally (https://danieldickison.github.io/pat-calculator/), an open-access web calculator that, unlike existing economic analyses of fixed scenarios, allows any researcher, clinician, or policymaker to estimate labor costs using staffing configurations and wage rates specific to their own context.

Purpose of Review: There is growing evidence that psychedelics and associated treatment modalities may offer therapeutic benefits across a range of psychiatric conditions. Anorexia nervosa (AN), a serious and often treatment-resistant illness associated with significant morbidity and mortality, is one such condition for which psilocybin-assisted therapy (PAT) may hold promise. Recent Findings: To date, research on PAT for AN has focused primarily on adults, despite the fact that AN frequently begins in adolescence, and early age of onset portends poorer prognosis, including more severe AN, more lifetime psychiatric comorbidity, and greater life difficulties. Summary: Given these risks, an exploration of the theoretical potential of PAT for adolescent populations is warranted. Important considerations include biological implications, developmental stage, and consent. Adaptations to the current models of psilocybin-assisted therapy in studies of adults are proposed, and emerging models that address the unique challenges of these patients are discussed.

Objective: The aim of this study was to develop and assess the effectiveness of an online independent learning module for educating preclinical medical students about eating disorders. Methods: The curriculum was designed using Kern’s six-step framework. The 60-min eating disorders module incorporated case-based learning, narrative medicine, and real-time feedback to enhance engagement and critical thinking. Surveys were used to assess medical student attitudes, knowledge, and comfort with eating disorder diagnosis and treatment at pre-training and post-training. Paired t-tests and descriptive statistics were used for analysis. Results: Among 130 preclinical medical students, significant improvements were observed from pre to post-training in diagnostic knowledge ( p < 0.05). Students also reported significantly improved comfort with eating disorder screening and differential diagnosis ( p < 0.001), as well as significantly improved attitudes about the importance of medical and psychological support for people with eating disorders ( p = .008). Conclusions: Findings provide preliminary evidence of the effectiveness of a brief self-paced independent learning module in improving medical students’ knowledge, comfort, and attitudes in the initial identification and management of eating disorders. Future research can build on these initial findings to examine longer-term knowledge sustainment and additional interventions that may influence the application of knowledge or skills in real-world practice.

Objective: Elevated physical activity is a feature of anorexia nervosa (AN), often associated with poorer clinical outcomes. Less is known about how physical activity energy expenditure (PAEE) prior to hospital admission relates to illness severity at presentation. Method: Secondary data analysis of the Study of Refeeding to Optimize Inpatient Gains, a randomized controlled trial comparing inpatient refeeding approaches in AN and atypical AN. Upon admission, patients self‐reported: physical activity (past 7 days), Eating Disorder Examination–Questionnaire (EDE‐Q), anxiety (GAD‐7), depression (PHQ‐A), distress tolerance (DTS), and menstrual status. Medical instability (heart rate and systolic blood pressure, orthostasis, electrolyte abnormalities) was assessed. PAEE was calculated by multiplying the activity‐specific Metabolic Equivalent of Task (MET, kcal/kg/h) by the number of hours per activity; weekly METs for all activities were summed and averaged to obtain mean METs/day, then multiplied by admission body weight (kg) to obtain PAEE (kcal/d). Regressions assessed the association of PAEE and admission variables. Results: Physical activity data were available for 91 of 116 patients (56% with AN, 95% female), with M (SD) age = 16.6 (2.5) years and %median Body Mass Index = 84.6 (11.4). Across 37 recorded activities, PAEE was 354 (319) kcal/day. Higher PAEE was associated with older age, longer duration of weight loss, higher eating restraint (EDE‐Q; β = 0.17, p = 0.04), and anxiety (GAD‐7; β = 0.57, p = 0.04), but not with markers of medical instability. Discussion: Patients with high PAEE may need additional psychological support for anxiety and eating disorder cognitions during hospital admission. Further research is needed to understand how pre‐admission PAEE relates to long‐term recovery. Public Significance Statement: Patients with anorexia nervosa (AN) and atypical AN often report increased physical activity (PA). The extent to which energy expended in PA impacts indices of illness severity in the acute phase of illness is less well understood, especially among those who are subsequently hospitalized. Findings suggest patients expending greater energy in PA prior to admission may benefit from additional support to manage higher anxiety and eating restraint while in hospital. Trial Registration: ClinicalTrials.gov identifier: NCT02488109

Background: Psychedelic-assisted therapy (PAT) is gaining recognition as a promising intervention for treatment-refractory mental health conditions in adults. While interest in its applications for adolescents is growing, critical gaps remain in understanding safe and effective delivery of PAT to this vulnerable population, including implications for caregiver/family (used interchangeably) involvement in the intervention. Caregivers play a crucial role in adolescent mental health treatment by supporting recovery and disrupting illness-maintaining patterns. They also benefit from resources to navigate the challenges of caregiving. This review synthesizes existing literature on evidence-based adolescent mental health treatments, best practices in PAT delivery, and family systems theory to propose a framework for integrating caregivers in adolescent PAT. Conclusion: Current literature in both PAT and adolescent mental health provides a compelling case for the direct involvement of caregivers in PAT for adolescent populations. In modern PAT, therapeutic setting (i.e., “set and setting”) is increasingly recognized as essential for optimizing outcomes. Similarly, the family system serves as a critical setting that may shape PAT efficacy in adolescents. This review provides recommendations and unique considerations for the incorporation of caregivers into PAT protocols for adolescents to maximize safety and efficacy of the intervention.

Introduction: Although eating disorders (EDs) affect youth from all socioeconomic backgrounds, little is known about the treatment experiences of under‐resourced youth with EDs. To address this gap, we examined patterns of outpatient and inpatient service utilization among publicly–insured youth with EDs in California and potential disparities for youth with additional marginalized identities.Method: Participants were identified from the full sample of California Medicaid/Medi‐Cal beneficiaries aged 7–18 with ≥ 1 service episode between January 1, 2014 and December 31, 2016. Claims data were extracted for youth with a full year of claims after the first known ED diagnosis (N = 3311) to analyze outpatient mental health, outpatient medical/physical, inpatient mental health, and inpatient medical/physical service use across ED diagnosis and demographic characteristics (sex, age, race/ethnicity, and preferred language).Results: Outpatient individual and family therapy service utilization was low across ED diagnoses (4–7 individual therapy sessions and ≈5 family therapy sessions annually). Conversely, hospitalization rates were high, particularly among youth with anorexia nervosa (27.8%) and bulimia nervosa (30.0%). Youth with other specified feeding or ED had high medical service utilization, with more days of outpatient medical care and greater odds of medical hospitalization than youth with all other diagnoses. Latinx youth, Black youth, and boys tended to receive fewer services after accounting for diagnosis, with disparities particularly pronounced for Latinx youth.Conclusions: Publicly–insured youth with EDs in California experience high hospitalization rates but receive limited outpatient therapy. Additional research is needed to identify possible unmet needs and factors contributing to treatment disparities among these youth.

Unlike psychopharmacologic interventions for other psychiatric conditions, few medications have emerged as helpful in improving eating disorder cognitions and evidence-based psychotherapies fail many patients. Novel treatments are urgently needed to address anorexia nervosa (AN), which is increasingly prevalent and difficult to treat. This article provides an overview of preliminary investigations into cannabidiol, psilocybin therapy, ketamine and the ketogenic diet, transcranial magnetic stimulation, and vagus nerve stimulation in individuals with AN. These pilot studies underscore the need for larger clinical trials that include more participant diversity in order to rapidly translate findings to real-world clinical practice.

Background: As the field of psychedelic therapy grows, it is vital to consider who can safely engage with psilocybin therapy. In most modern clinical trials of psilocybin therapy, individuals with a family history of bipolar disorder (BD) have been excluded from participation because of their genetic predisposition for developing BD. Review: Case studies and survey data shed light on the risks of psilocybin therapy among those with a family history of BD in the absence of data from modern clinical trials. We review existing evidence that could inform risk stratification for these individuals, including genetic proximity to the affected relative, BD type, age at onset in the relative, and participant age. Hypothesizing that the risk of developing BD may predict the risk of developing serious adverse events when engaging with psilocybin therapy, we propose a risk stratification tool to be utilized when determining the relative risks of psilocybin therapy to those with a family history of BD in the context of clinical trials. Conclusion: Balancing the need for effective treatments against the potential for serious adverse events in those undergoing psilocybin therapy with a family history of BD, we argue for caution in psychedelic clinical trials but not outright exclusion of these individuals. Our risk stratification tool allows for more nuanced inclusion and exclusion criteria.