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

Introduction: Black Americans are significantly underrepresented in psychedelic trials despite significant mental health disparities. Growing research suggests that psychedelic-assisted therapy (PAT) is an effective treatment for post-traumatic stress disorder and depression. It is important to understand perceptions of PAT among populations with unmet mental health needs.

Methods: We conducted four focus groups to understand perceptions of psychedelic therapy within a low-income, Black, urban population.

Methods: Three main themes were identified using an inductive thematic analysis approach: (1) informed hesitation mixed with increasing openness; (2) trust, autonomy, and choice; and (3) practical solutions to increase accessibility.

Conclusions: Participants described many concerns related to legacies of racism in healthcare, research, drug prescription, and criminalization. Healthcare systems must invest in trust building with Black Americans to adequately meet healthcare needs. Participants emphasized ways of building trust through supporting autonomy and choice, investing in community building and agency, and suggestions to address barriers (e.g., providing childcare, providing transportation). These findings support calls to center the needs of Black American people given the lack of culturally salient therapeutic paradigms specifically for Black Americans utilized within PAT, improve access and address barriers to healthcare for Black Americans, and increase the quality of care available.

Objective: Prior research has found an association between psychedelic use and reduced stigma attached to mental illness. However, whether psychedelics alleviate stigma-related distress remains unclear. Since stigma impacts different groups uniquely, any moderating effect of psychedelics on stigma-related distress is likely to vary across subpopulations. This study addresses two main questions: (1) Do psychedelics moderate the relationship between stigma and distress? and (2) does this relationship vary by gender and race/ethnicity? By exploring these questions, this research seeks to contribute to our understanding of psychedelic use and its impact on mental health across diverse populations.

Methods: Data from the National Survey of Drug Use (2008-2019) were analyzed, with a weighted sample of 458,372. The main analysis used regression models in Stata 18 to examine the associations between lifetime psychedelic use (LPU) (psilocybin, lysergic acid diethylamide [LSD], N,N-dimethyltryptamine, peyote/mescaline, ayahuasca, and 3,4-Methylenedioxymethamphetamine), stigma attached to seeking mental health care, and psychological distress. This analysis examines whether the association between stigma and distress differs by gender, race/ethnicity, and psychedelic use (i.e., White men, White women, Black men, Black women, Asian men, Asian women, Hispanic men, and Hispanic women).

Results: Results indicate that men report lower perceived stigma than women, while women report higher distress. White, Black, and Hispanic women report the highest stigma levels. Regression analysis suggests that among the total population, stigma is statistically associated with higher distress, and interaction terms indicate that MDMA, psilocybin, LSD, and LPU are linked to variations in this relationship. Regression models stratified by gender and race/ethnicity suggest that while LPU, LSD, and DMT were statistically associated with differences in the relationship between stigma and distress for White men, these associations appeared weaker for other groups.

Conclusion: Psychedelic use is associated with lower reported distress from internalized stigma, though the directionality and mechanisms underlying this association remain unclear. Further research should be conducted to investigate how psychedelics can be integrated into comprehensive health treatment programs outside of psychedelics-assisted therapy. However, it is worth noting that individuals from gender and racial/ethnic minority groups may not experience the same level of benefits, suggesting other strategies may be necessary to address the stigma experienced by different groups.

Background: Psychedelics such as psilocybin, lysergic acid diethylamide, and 3,4-methylenedioxymethamphetamine are increasingly recognized for their potential therapeutic benefits in treating complex and chronic mental health conditions. Growing public interest in psychedelics may drive increased consumption outside of medically supervised clinical trials. Correspondingly, legality issues and potential risks of unregulated use underscore the need for structured aftercare support, including psychedelic integration groups, to reduce harm potential.

Methods: This study utilized a cross-sectional, observational, online, anonymous survey with 65 participants who used psychedelics and attended psychedelic integration groups. Participants provided qualitative data on their experiences via open-ended questions. Employing a deliberate analytic strategy, responses were subsequently analyzed using thematic analysis to identify key patterns and themes.

Results: Three primary themes and associated subthemes emerged from the data: (1) reasons for attending psychedelic integration groups, (2) utility of psychedelic integration groups, and (3) adverse factors influencing participants' experience of the group.

Discussion: The study underscores the therapeutic potential of psychedelic integration groups in providing essential community support and facilitating the processing of psychedelic experiences. However, it also highlights significant challenges, such as managing group dynamics and ensuring facilitators are adequately trained. These findings suggest that while integration groups can mitigate some risks associated with psychedelic use, research is needed to optimize their structure and effectiveness. Specifically, future studies should explore the development of standardized protocols and facilitator training programs to enhance the safety and efficacy of these groups. This research is crucial to inform policy and practice, ensuring that individuals seeking integration support and aftercare following psychedelic use have access to well-designed and delivered interventions.

Introduction: Psychedelic substances have been used for centuries in various cultural and religious contexts, and more recently, in clinical research and therapy. There is a surge of interest in psychedelics, and psychedelic-assisted psychotherapy is becoming increasingly accessible. However, most individuals using psychedelics do so outside of therapeutic contexts. It is important to understand the adverse experiences that may occur with psychedelic use, as well as adverse events that may happen even in therapeutic contexts.

Materials and methods: We conducted an anonymous online survey of individuals who self-reported past psychedelic use. We asked about the frequency of experiencing 12 different adverse experiences when using psychedelics, and if they or someone they know was the victim of inappropriate sexual contact by a psychedelic sitter, guide, or practitioner. Participants could also describe other adverse experiences.

Results: Among 1,221 participants, most reported having adverse experiences such as being frightened (74.3%), sadness (58.6%), feeling their body shake or tremble (54.3%), and loneliness (51.6%) during their psychedelic experiences. About half of participants reported having some other adverse experience, and one in ten participants had adverse physical reactions. About one-third of participants knew someone who was arrested for possession or use of psychedelics; 8% reported that they or someone they know was the victim of inappropriate sexual contact by a psychedelic sitter, guide, or practitioner; and one-quarter of participants knew someone who experienced a severe adverse event other than inappropriate sexual contact or arrest.

Conclusion: Despite beneficial effects, psychedelic experiences can also be challenging, distressing, or even harmful. Adverse events can increase the risks of psychological harm, legal problems, stigma, and public health issues. Therefore, it is essential to prevent, identify, manage, and treat adverse events during psychedelic experiences to ensure the safety and well-being of the participants and the facilitators, and create opportunities for "integration" even with unguided sessions.

Background: Psilocybin can produce long-term changes in personality, personal values, and behavior. Although psilocybin-assisted therapy (PAT) is being actively studied for various psychiatric conditions, its effects on personal values in patients with alcohol use disorder (AUD) remain unexplored. This study examined the effects of PAT on personal values in patients with AUD and assessed relationships between value changes, acute psilocybin experiences, and drinking outcomes.

Methods: In a phase II clinical trial (NCT02061293), 93 participants with AUD received 12 weeks of treatment, including manualized psychotherapy and two 8-h drug administration sessions with either psilocybin (n = 48) or active placebo (n = 45). Personal values were assessed before and after treatment using the Schwartz Value Survey (SVS), which includes 4 domain scores (Openness to Change, Self-Enhancement, Conservation, Self-Transcendence) and 10 subscales. The acute psychedelic experience was measured using the 30-item Mystical Experience Questionnaire (MEQ) and the 5-Dimensional Altered States of Consciousness Scale (5D-ASC). Treatment effects were assessed using univariate ANCOVAs, with baseline SVS values as covariates. Time effects within each group were evaluated using paired t-tests. Pearson correlations examined the relationship between value changes and acute effects, and also value changes and drinking outcomes.

Results: Significant treatment effects were detected for the Conservation domain and its subscales "security" and "tradition." No other domains or subscales showed significant treatment effects. Within the psilocybin group, time effects were significant only for conservation, and its subscales "tradition," and "security". No significant time effects were detected in the placebo group. In the psilocybin group, the MEQ subscale Ineffability was significantly associated with increases in Conservation, "security," and "tradition" (r = 0.31-0.34). 5D-ASC subscale Vigilance Reduction was associated with Conservation (r = 0.31), but not its subscales. 5D-ASC subscale Dread of Ego Dissolution during the psilocybin sessions correlated with increases in "tradition" (r = 0.31). None of the value changes were significantly associated with drinking outcomes.

Conclusion: PAT may alter value structure in patients with AUD patients by increasing Conservation. Although some associations were found between acute psychedelic effects and changes in Conservation, these value changes were not related to drinking outcomes.

Research has demonstrated both risks and benefits to using psychedelics as a therapeutic intervention for a variety of mental health conditions. In recent years, the public discourse around psychedelic treatments has been largely positive and focused on benefits more than risks. We believe the field would benefit from more balanced attention to the risks as well as benefits of psychedelics within the scientific community and broader public. Coverage of psychedelic science has swung between a pendulum of extremes, from fearmongering in past decades to effusive optimism today. Public discourse about the risks and benefits of psychedelics can and should instead be grounded in the growing evidence from clinical trials as well as participant reports. While most adverse events related to pyschedelics are mild, some have been severe and serious, and public education about the existence and nature of those risks is necessary. We predict that as more studies are conducted and eligibility criteria are relaxed to improve access, the incidence and severity of adverse events will increase. While no medical intervention is risk-free, it will be increasingly important to quantify and effectively communicate the risk/benefit profile of psychedelics.

Background: Bipolar II disorder (BD-II) is often associated with chronic and treatment resistant major depressive episodes. Psilocybin has shown promise for its rapid-acting antidepressant effects, though its impact on bipolar depression remains unexplored. In the present subgroup analysis of an already published trial on treatment-resistant depression (TRD), we aimed to preliminarily evaluate the safety and efficacy of psilocybin in patients with BD-II.

Methods: Adults with TRD associated with BD-II, excluding those with psychosis were included. Participants underwent one or two psilocybin sessions, each with a dose of 25 mg, along with preparatory and integrative psychotherapy sessions.

Results: A total of four participants with a mean age of 37.5  ±  4.15 years were included. At baseline, the mean Montgomery-Åsberg Depression Rating Scale (MADRS) score was 32.5 (95% CI: 26.3-38.7, SD = 3.87). By week 2 post-dose, mean MADRS decreased to 20.3, and 2 weeks after dose 2, it further dropped to 19. At the end of the 6-month study, the mean MADRS score was 21.3. Young Mania Rating Scale scores remained stable at a mean of one throughout the study with no evidence of treatment emergent mania, hypomania or psychosis observed in any participants.

Conclusions: These findings suggest potential improvement in depressive symptoms with psilocybin administration in BD-II. Future studies with larger sample size are required to replicate our results and further evaluate antidepressant effects of psilocybin in bipolar depression.

Introduction: Serotonergic psychedelics, serotonin 2A receptor agonists such as psilocybin that can result in substantially altered states of consciousness, are used in recreational and research settings. The safety of psychedelic experiences in research settings is supported by controlled physical environments, presence of clinical and medical staff to address emergent issues, screening for personal and family history of potential contraindications, and psychoeducational preparation with psychological support. Research settings typically provide psychoeducation to participants verbally and in writing (e.g., informed consent), and such documents and conversations can provide safety-related information-but may also introduce a wide range of expectancies. Such expectancies might involve the specific character of the acute subjective effects of psychedelics, possible side effects, and anticipated outcomes.

Methods: To better understand the content of this psychoeducation, we gathered study materials from many psilocybin studies conducted in the past two decades in healthy and therapeutic populations. We conducted a reflexive thematic analysis to better understand these documents.

Results: While these documents varied substantially between studies, we identified themes intended to lower levels of risk and optimize therapeutic effects from psychedelic treatments. The most frequently coded themes related to (1) biological and physical safety, (2) psychological safety and well-being, (3) aspects of setting, and (4) potential for expectancies. Prioritizing biological and psychological safety was evident in the materials from all sites. Furthermore, we identify potential contributors to expectancy unrelated to safety and suggest that these extrapharmacological elements be studied systematically in future research.

Conclusions: Ideally, future research should strive to maximize safety while attempting to minimize extraneous expectancies.

Background: The resurgent interest in psychedelic-assisted therapy for conditions like depression, end-of-life anxiety, and post-traumatic stress disorder is generating highly promising results. Within this therapeutic context, music's role is multifaceted, seen as a critical environmental component and even akin to a hidden therapist. Contemporary clinical protocols often advocate for music that is lyric-free and unfamiliar, yet these guidelines are based on limited empirical evidence.

Methods: Our study, drawing on data from over 2,000 participants in the Canadian Psychedelic Survey (CPS), explores the interplay between music and 11 classical and non-classical psychedelic substances in predominantly non-clinical usage scenarios. This cross-sectional survey included 14 questions delving into patterns of psychedelic use and music preferences in naturalistic environments.

Results: Our findings reveal that a substantial majority of respondents experienced both therapeutic benefits and enjoyment from integrating music with psychedelic substances, although the extent of these benefits varied significantly across different substances.

Discussion: Contrary to clinical recommendations, only 10% and 22%, respectively, of survey respondents agreed that music for psychedelic experiences should be unfamiliar and without understandable lyrics. Furthermore, our data suggest potential unique benefits of psychedelic experiences devoid of music, particularly with the shortest and longest acting substances. These insights indicate that the prevailing guidelines for music selection in psychedelic therapies may benefit from further, nuanced research into substance-specific effect.