Psychedelic medicine (New Rochelle, N.Y.)最新文献

Background: Psilocybin is a natural alkaloid with therapeutic potential in the treatment of different mental disorders. Bibliometric information on its use is still scattered in the literature.

Objective: To investigate the temporal and bibliometric patterns of publications and the specificity of psilocybin in the treatment of mental disorders.

Method: Performed a bibliometric analysis using VOSviewer software. Documents from the period 1963 to 2023 were retrieved from the Scopus database. The search string comprised terms related to psilocybin and mental disorders. An exponential regression was performed to investigate the number of publications over time. The specificity was evaluated based on a manual analysis of the clinical trials' findings carried out with individuals diagnosed with mental disorders.

Results: We identified 853 eligible publications. An exponential regression analysis revealed an increase in the number of publications over time, with significant growth between 2016 and 2023 (52%). Publications cover countries on five continents, but are predominantly from nations with a high Human Development Index, such as the United States and the United Kingdom. Depression was the most prominent term in keyword analysis. Meta-analyses have indicated the efficacy of psilocybin in the treatment of different mental disorders (depression, anxiety, and substance use disorders).

Conclusion: The global academic panorama shows the growing recognition of psilocybin as a promising alternative in psychiatric treatment, highlighting the need for randomized clinical trials to ensure its safe and effective use.

The topic of psychological support and psychotherapy in the context of clinical investigations of psychedelic drugs is an often debated, yet predominantly unresolved issue in the field. Psychological support, as a concept, is poorly defined and there appears to be little agreement in the field regarding its essential components, boundaries and limits. While researchers have turned their attention to the role of placebo conditions and expectancy effects within the context of psychedelic clinical trials, the nature and role of psychological support remains difficult to define and capture. The objective of this perspective article is to provide a concrete description of the specific components, boundaries and limits of psychological support in comparison to psychotherapy based on the microskills framework established by Ivey et al. (2021). We propose that greater attention be placed on the specific communication units and behaviors that are considered psychological support or psychotherapy in the context of psychedelic clinical trials. Clinical trial protocols and treatment manuals should clearly define the psychosocial interventions and behaviors that fall within and outside of the scope of the trial to eliminate interventions that are not within the mandate of the specific trial or exceed the regulatory scope of practice of the session monitor(s).

Background: The underlying mechanism(s) of action of psychedelic-assisted therapy (PAT) to reduce distress, depression, and/or anxiety symptoms in life-threatening illness are poorly understood. It has been postulated that addressing death anxiety, and components of spiritual and existential distress, may be mediating factors.

Method: This systematic review describes the current evidence base regarding the impact of PAT on attitudes toward life, death, and spirituality. MEDLINE, Embase, PsychINFO, and PubMed databases were systematically searched for original clinical research articles on PAT for distress, depression, and/or anxiety symptoms in life-threatening illness, with outcome measures related to attitudes toward life, death, and spirituality. The risk of bias was assessed using Joanna Briggs Institute critical appraisal checklists. A descriptive analysis was conducted.

Results: A total of 14 articles met the inclusion criteria. Improvements in distress, depression, and/or anxiety symptoms were associated with reduced demoralization, reduced hopelessness, improvements in spirituality, greater death acceptance, a greater sense of optimism toward life, and a greater sense of meaningful existence. Mixed results were found in other attitudes toward life and death.

Conclusions: This review identifies several mechanisms by which PAT may improve distress, depression, and/or anxiety symptoms in patients with life-threatening illness, via effects on a range of attitudes toward life, death, and spirituality. Results need to be considered with caution, given the paucity and quality of available data. This review also identifies gaps in the current evidence base for consideration in future research.

Introduction: Ketamine is an evidenced-based treatment for depression, and it has shown promise in addressing many other mental health conditions related to work-related stress or burnout, such as anxiety and post-traumatic stress disorder. Ketamine-assisted psychotherapy (KAP) is part of an emerging model of psychedelic medicine that employs psychoactive agents to support the psychotherapeutic process. Frontline health care workers and first responders encountered excessive levels of job stress, especially during the COVID-19 pandemic. This article reports on a 6-week community-based group-KAP program to address symptoms of trauma, anxiety, and depression in a sample of first responders and frontline health care workers.

Methods: Recruitment was self-directed based on a sense of work-related stress. All participants completed a 6-week ketamine-assisted psychotherapy group intervention with three to six participants per group. The group characteristics and repeated measures comparisons were analyzed via descriptive statistics, pre- and post-intervention measure comparisons and regression modeling.

Results: Sixteen patients received KAP in small groups with "pre" and "post" treatment evaluation of anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), and trauma (Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). Symptoms of trauma, anxiety, and depression were significantly reduced (p < 0.002) from "pre" to "post" test.

Conclusion: These results suggest that the community-based group-KAP program described here may be a useful treatment for work-related stress, though further formal evaluation is required. Future directions, limitations, and interpretations are discussed.

Introductions: Mystical experiences are powerful experiences that may have therapeutic value. Ketamine, a dissociative anesthetic, has shown potential to induce mystical experiences. However, little research has explored this phenomenon, particularly in treatment-resistant depression.

Methods: We analyzed clinical data from 60 veterans with treatment-resistant depression receiving a total of 189 ketamine treatments. Veterans either received intranasal esketamine or racemic parenteral ketamine (intravenous or intramuscular). The Revised Mystical Experience Questionnaire (MEQ-30) was administered following ketamine treatments to assess the occurrence of mystical experience. A linear mixed model was used to examine the association between MEQ-30 scores and several treatment-related variables including gender, age, treatment number, dose, comorbid post-traumatic stress disorder, and pretreatment depression rating scores (PHQ-9).

Results: Complete mystical experience was reported in 17.02% of esketamine treatments and 18.19% of racemic ketamine treatments. In the esketamine group, a greater number of treatment sessions was associated with higher MEQ-30 scores (p = 0.05). In the racemic ketamine group, higher doses were associated with higher MEQ-30 scores (p = 0.002).

Discussion: These findings suggest that ketamine can occasion mystical experiences in veterans with treatment-resistant depression. Future studies should further explore the mystical-type effects of ketamine as a potential contributor to its therapeutic effect in treatment-resistant depression.

Background and aims: Gender-themed lysergic acid diethylamide (LSD) experiences have been documented anecdotally but not yet studied systematically. This study aimed to explore such experiences using data from Reddit to better understand their nature and potential therapeutic implications.

Methods: In this retrospective observational study, posts and comments on the "r/LSD" subreddit reporting gender-themed LSD experiences were analyzed. Posts containing terms related to gender identity, including "gender," "transgender," and "trans," were reviewed and coded using inductive and deductive thematic approaches.

Results: Of 94 unique anecdotes, 47.9% of authors identified as non-cisgender at time of LSD use, with most describing experiences that enhanced gender-identity related self-acceptance (80%); 17.0% of authors were gender questioning at the time of LSD use, and most (93.8%) reported clarifying effects of LSD. Fifteen authors (16.0%) reported potential effects of LSD on gender transitioning or plans to transition. A notable minority of the 24 authors identifying as cisgender at time of LSD use (41.7%) explored non-cisgender identities during their LSD experiences, while 29.2% reported their LSD experience introduced a non-cisgender identity for the first time that persisted post-LSD. Challenging experiences were reported by 17.0% of authors, and 11.1% of non-cisgender authors reported LSD experiences that decreased gender identity-related self-acceptance.

Conclusions: Our findings suggest LSD may support the exploration and acceptance of gender identity in certain individuals, highlighting a potential role in treating gender dysphoria. They also raise important questions about the need for addressing possible LSD-induced gender identity changes during the informed consent process of clinical trials. Given the fragmentary nature of social media data and challenges in analyzing it, these findings should be confirmed with surveys and prospective observational studies.

Background: In recent years, there has been a resurgence in research exploring the therapeutic potential of psychedelics for treating mental health disorders, coinciding with increasing psychedelic use and changing legal landscapes in the United States and globally. Despite these shifts, there remains a notable gap in understanding related to the safety of psychedelic use during critical stages of the female reproductive cycle, including menstruation, pregnancy, postpartum, breastfeeding, and menopause.

Methods: This narrative mini-review provides a brief summary of recently published articles in this evolving therapeutic landscape and discusses critical public health implications for addressing psychedelic use for women's reproductive health.

Results: Studies have uncovered notable sex differences in users' subjective and physiological experiences of psychedelics. Interactions between psychedelics' mechanisms of action and female hormones suggest opportunities for addressing symptoms of menstruation, sexual dysfunction, chronic pelvic pain, menopause, and postpartum depression (PPD). Women in indigenous communities have traditionally used psychedelics as important components of healing rituals. Yet, potential risks associated with psychedelic use during the reproductive years, specifically during gestation and breastfeeding, underscore the importance of caution and informed decision-making.

Conclusion: While there is therapeutic potential for psychedelics in women's reproductive health issues, comprehensive research pertaining to women is lacking. While rigorous scientific inquiry into the safety, efficacy, and mechanisms of action of psychedelics in women's health is paramount, public health messaging should dispel myths and promote risk reduction strategies. Collaboration with indigenous communities and vulnerable populations can enrich understanding and ensure culturally sensitive approaches. Through enhanced research and collaboration, psychedelics can be explored to potentially address unmet needs and enhance women's well-being across diverse reproductive contexts. Existing guidance fails to focus on recommendations for women, highlighting the need for harm reduction strategies.

Background: Prior research examining the associations between psychedelic use and general psychotic symptoms has yielded mixed findings. However, no studies have investigated the relationships between psychedelic use and specific psychotic symptoms, and whether these relationships might differ among those with liability to psychosis, namely those with a history of psychotic or bipolar disorders.

Methods: Using cross-sectional survey data from a purposive sample (n = 548), we first regressed estimated lifetime psychedelic use occasions and personal and family history of psychotic or bipolar disorders on the Magical Ideation Scale, Referential Thinking Scale, Self-Evaluation of Negative Symptoms, and Continuum of Auditory Hallucinations-State Assessment, unadjusted and adjusted for a range of covariates. We then tested the interactions of estimated lifetime psychedelic use occasions with personal and family history of psychotic or bipolar disorders on these same measures, unadjusted and adjusted for the same set of covariates.

Results: In unadjusted models, the estimated number of lifetime psychedelic use occasions was robustly associated with less referential thinking, whereas personal and family histories of psychotic and bipolar disorders were each associated with moderately or slightly greater scores on all measures. Covariate-adjusted regression models revealed that the estimated number of lifetime psychedelic use occasions was not associated with any of the measured psychotic symptoms. A personal history of psychotic disorders was associated with moderately greater magical ideation, referential thinking, and auditory hallucinations, whereas a family history of psychotic disorders was associated with slightly greater negative symptoms. Neither personal nor family history of bipolar disorder was associated with any psychotic symptoms. Finally, estimated lifetime psychedelic use occasions interacted only with a personal history of psychotic disorders on one measure, such that auditory hallucinations were less severe as psychedelic use occasions increased among those with a personal history of psychotic disorder; there was no relationship between psychedelic use and auditory hallucinations among those without a personal history of psychotic disorder.

Conclusion: Naturalistic psychedelic use may not be associated with psychotic symptoms, even among those with a personal or family history of psychotic or bipolar disorders. Further work probing the risk-benefit profile for people typically excluded from clinical trials involving psychedelics is needed.

With several classical psychedelics being designated as breakthrough therapies and the recent review of a New Drug Application for 3,4-Methylenedioxymethamphetamine in the treatment of posttraumatic stress disorder, the likelihood of psychedelic medication becoming approved for clinical use in the United States is high. Psychedelic-assisted therapy (PAT) may have a high demand in rural America, where residents experience higher burdens of morbidity and premature mortality, due to unique social disparities not shared by urban residents. In these rural settings, barriers to accessing PAT include geographic, economic, and cultural factors as well as the preexisting shortage of health care providers. Disparate access to PAT for rural residents in the United States could exacerbate existing rural-urban inequities. Thus far, the potential challenges of implementing PAT in rural communities have not been extensively discussed in the medical literature. In this perspective, we explore notable implementation barriers in the rural setting and propose potential solutions, including the incorporation of PAT into rural health care training programs, leveraging tools for remote care such as teletherapy for PAT preparation and integration sessions, and implementing new models of care and economic incentives to enable rural PAT providers and rural generalists to deliver PAT. Providing PAT in rural areas will require creative approaches to surmount significant obstacles: the potential solutions discussed here may help ensure rural populations are not left behind if psychedelic medicine is reincorporated into clinical practice in the United States.