Zhu Xi, Zhang Chen, Hellerstein David, Feusner Jamie D, Wheaton Michael G, Gomez Gloria J, Schneier Franklin
Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
Anxiety Disorders Clinic, New York State Psychiatric Institute, New York, NY, USA.
Psychedelics (N Y). 2025;1(1):25-31. doi: 10.61373/pp024r.0028. Epub 2024 Sep 24.
Body dysmorphic disorder (BDD) is a severe psychiatric condition characterized by preoccupation with perceived flaws in one's appearance, which the individual views as defective or ugly. Psilocybin, a serotonin 2A receptor agonist with psychedelic properties, has emerged as a potential therapeutic agent for depression and other psychiatric disorders. This study aimed to identify subacute neural changes predicting symptomatic response to psilocybin treatment in adults with BDD. Eight adults with moderate-to-severe nondelusional BDD were administered a single oral 25 mg dose of psilocybin, accompanied by psychological support, and underwent resting state functional magnetic resonance imaging assessments 1 day before and 1 day after the dosing. Both a region of interest (ROI)-to-ROI analysis and multivariate pattern analysis (MVPA) were used to identify changes in resting state functional connectivity (rsFC) at day 1 after dosing that predicted treatment response at week 1, measured by change in Yale-Brown Obsessive Compulsive Disorder Scale Modified for BDD (BDDYBOCS) score. All participants completed the dosing and follow-up assessments over 12 weeks. BDD-YBOCS scores decreased at week 1 and week 12 after dosing (<0.001 for both). MVPA revealed a significant increase in rsFC within the Executive Control Network (ECN) at day 1. Increased rsFC within the ECN (dlPFC - Superior Parietal Lobule [FPL]), between the ECN and Default Mode Network (dlPFC - Precuneus), and between the ECN and the Salience Network (dlPFC - insula) were predictive of improvement in BDD symptoms at week 1. These findings are the first report of subacute brain effects of psilocybin in patients with BDD. Given the small sample size and uncontrolled design of the study, larger controlled studies are necessary to validate these observations. Clinicaltrials.gov : NCT04656301.
身体变形障碍（BDD）是一种严重的精神疾病，其特征是过度关注自己认为的外表缺陷，个体将这些缺陷视为有缺陷或丑陋的。裸盖菇素是一种具有致幻特性的5-羟色胺2A受体激动剂，已成为治疗抑郁症和其他精神疾病的潜在治疗药物。本研究旨在确定预测成人BDD患者对裸盖菇素治疗症状反应的亚急性神经变化。8名患有中度至重度非妄想性BDD的成年人单次口服25毫克裸盖菇素，并给予心理支持，在给药前1天和给药后1天进行静息态功能磁共振成像评估。采用感兴趣区域（ROI）到ROI分析和多变量模式分析（MVPA）来识别给药后第1天静息态功能连接（rsFC）的变化，该变化预测第1周的治疗反应，通过针对BDD修改的耶鲁-布朗强迫症量表（BDD-YBOCS）评分的变化来衡量。所有参与者在12周内完成给药和随访评估。给药后第1周和第12周BDD-YBOCS评分下降（两者均<0.001）。MVPA显示第1天执行控制网络（ECN）内的rsFC显著增加。ECN内（背外侧前额叶皮质-顶上小叶[FPL]）、ECN与默认模式网络（背外侧前额叶皮质-楔前叶）之间以及ECN与突显网络（背外侧前额叶皮质-脑岛）之间rsFC的增加可预测第1周BDD症状的改善。这些发现是裸盖菇素对BDD患者亚急性脑效应的首次报告。鉴于本研究样本量小且设计无对照，需要更大规模的对照研究来验证这些观察结果。Clinicaltrials.gov：NCT04656301。
