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. 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. 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.
RATIONALE:Mucus plugs occur in chronic obstructive pulmonary disease (COPD), but little is known about their size and airway location or whether these mucus plug features change as emphysema worsens. METHODS:Computed tomographic lung scans from 31 participants with COPD from the SubPopulations and InteRmediate Outcomes In COPD Study (SPIROMICS) cohort were analyzed to quantify mucus plug size and airway location and extent of emphysema. Radiologist annotations of mucus plugs were incorporated in an image processing pipeline to generate size and location information. Emphysema was quantified as the percentage of voxels less than -950 Hounsfield units. MEASUREMENTS AND MAIN RESULTS:The length distribution of 563 annotated mucus plugs varied from 2 to 50 mm. The distribution was multimodal, and an 11-mm length defined short ("stubby," ≤11 mm) and long ("stringy," >11 mm) plug phenotypes, with stubby plugs being most common (64%). Mucus plugs localized predominantly to airway generations 6 to 9, and their prevalence was highest in lower lobes. On a lobar basis, the mucus plug number decreased as emphysema percentage increased, whereas average mucus plug volume tended to increase. CONCLUSION:COPD is characterized by mucus plugs of varying size and shape, and emphysematous lung regions may be differentially susceptible to formation of these plugs. The location of mucus plugs in segmental and subsegmental airways in COPD makes them amenable to treatment with inhaled medications or bronchoscopy.
