European Psychiatry
April 1, 2021
Jackelyne Gabrielle Jesus de Miranda, Mario Barbosa, I. Figueiredo et al.
Classic psychedelics such as LSD, mescaline, and psilocybin have been used in sacramental contexts since ancient times and were studied in psychiatry in the 1950s–1960s before research halted due to countercultural associations. Modern research has renewed interest in these substances for treating cancer-related distress and addiction. This review of articles from 2010–2020 finds that psychedelics, as 5HT2AR agonists, can occasion mystical experiences—characterized by a strong sense of unity—that may produce abrupt, sustained changes in behavior and perception. Research on psychedelics for substance use disorders is at an early stage, but results show promise with no clinically significant adverse events when high-risk individuals are excluded. Psilocybin for specific addictions may become available in the near future if safety and efficacy continue to be demonstrated.
European Psychiatry
April 1, 2021
B. Van der Kolk
A randomized, double-blind, Phase 3 trial tested three sessions of flexible-dose MDMA or placebo as an adjunct to psychotherapy in 100 participants with severe PTSD. The primary outcome was change in PTSD symptoms and functional impairment at 18 weeks. MDMA was well tolerated, with some treatment-emergent adverse events more frequent in the MDMA group, and three serious adverse events of suicidal ideation or behavior occurred. The authors will present effect sizes and responder analyses. If MDMA-assisted psychotherapy significantly reduces PTSD symptoms and functional impairment, the results could support marketing authorization applications worldwide.
European Psychiatry
April 1, 2021
Pushpendra Kumar Jain, Varchasvi Mudgal, Ujwal Sardesai et al.
Dissociative identity disorder (DID) is rare despite its popularity in the public imagination. A 30-year-old woman from a low socioeconomic background presented with episodic altered behavior. Evaluation confirmed DID, and treatment combined psychotherapy facilitated by hypnosis, escitalopram (up to 20 mg daily), and a short course of clonazepam. The patient improved, with decreased Dissociative Experiences Scale scores. The authors suggest that unconscious conflicts, such as the Elektra complex in Freudian theory, may underlie DID. They urge clinicians, especially in countries like India where trance and possession syndromes are common, to consider DID as a differential diagnosis.
European Psychiatry
April 1, 2017
L. Bartova, A. Weidenauer, M. Dold et al.
A severely depressed and chronically suicidal patient who had not responded to many antidepressant treatments, including electroconvulsive therapy (ECT) and ketamine alone, was given a combination of ECT (up to 150% bilateral stimulation) 2–3 times per week and intravenous racemic ketamine (up to 75 mg per infusion) on ECT-free days. Robust anti-suicidal and antidepressant effects appeared during the first week. After 9 ECT treatments and 7 ketamine infusions, the patient achieved a stable state and was discharged. A maintenance plan of monthly ECT with two ketamine infusions (up to 100 mg) around each ECT prevented relapse. The alternating regimen proved safe and long-term effective in this case.
European Psychiatry
March 1, 2016
M. Mithoefer
MDMA-assisted psychotherapy shows promise for treating PTSD in people who have not responded to established treatments. In a double-blind trial, PTSD resolved in 83% of those receiving MDMA plus psychotherapy versus 25% of those receiving placebo plus psychotherapy. Improvement was maintained for at least 74% of subjects at long-term follow-up averaging 45 months later. A later unpublished trial found large reductions in PTSD symptoms for both high and medium doses of MDMA. Phase III trials are needed to confirm safety and efficacy.
European Psychiatry
March 1, 2016
Á. Palma Conesa, L. Galindo Guarín, M. Grifell Guàrdia et al.
From 2009 to 2014, a Spanish harm reduction service analyzed over 17,000 drug samples and found the new psychoactive tryptamines 4-HO-DiPT and 4-AcO-DiPT in 16 samples each, and DiPT in only 4. Nine samples contained both 4-HO-DiPT and 4-AcO-DiPT. Deliveries of 4-HO-DiPT increased over the study period (4 samples in 2014), while those of 4-AcO-DiPT and DiPT decreased (1 sample each in 2014). This trend suggests a progressive replacement of 4-AcO-DiPT and DiPT by 4-HO-DiPT for recreational use. Clinical concern arises from the growing use and lack of scientific evidence on humans, with effects predicted only from users' subjective experiences.
European Psychiatry
January 1, 2010
Evelyn Doering-Silveira, Enrique Lopez, Charles S. Grob et al.
Adolescents who consume ayahuasca in a religious ritual setting perform well on neuropsychological tests, but not as well as non-using peers on complex tasks that require more cognitive functions. The study compared 40 ayahuasca-using adolescents with 40 matched controls. Both groups performed well overall, but controls outperformed users on the more demanding tests. The authors suggest ayahuasca may have subtle effects on cognition observable only during highly demanding tasks, while noting that other variables could have influenced the results.
European Psychiatry
May 1, 2002
Farāmarz Sohrābi
A 31-year-old male military veteran with moderate alcohol use disorder received sequential treatment with ibogaine hydrochloride (1550 mg, 17.9 mg/kg) followed by vaporized 5-MeO-DMT (bufotoxin source 50 mg, estimated 5-MeO-DMT content 5–7 mg) at an inpatient clinic in Mexico. SPECT neuroimaging before and 3 days after the program showed increased brain perfusion in bilateral caudate nuclei, left putamen, right insula, and temporal, occipital, and cerebellar regions. The patient reported improved mood, cessation of alcohol use, and reduced cravings at 5 days, sustained at 1 month, with a partial return to mild alcohol use at 2 months. The findings suggest short-term therapeutic outcomes and warrant further investigation.
European Psychiatry
April 1, 2025
L. Cazorla, S. Alaux, C. Mabilais et al.
In a pilot study of LSD-assisted psychotherapy for patients with resistant anxiety or depression, six of ten planned participants completed the protocol. Salivary oxytocin was measured before and after LSD intake; those analyses are pending. Self-perceived intensity of drug effects peaked at 180 minutes and showed a significant relationship with the intensity of mystical experience reported on the MEQ-30. Depression and anxiety symptom scores will be analyzed after treatment. The authors conclude that preliminary data show a clear effect of perceived treatment intensity and its link to mystical experience, and that including oxytocin data will be valuable.
European Psychiatry
April 1, 2025
E. Rognli
A register-based study using Norwegian national patient data from 2010 to 2015 found that people initially diagnosed with substance-induced psychosis face a six-year cumulative risk of later developing schizophrenia of 27.6%. The risk was highest for those whose initial diagnosis was cannabis-induced psychosis, at 36%. These high transition rates raise questions about whether the initial diagnosis was correct or whether the psychosis was an early sign of a primary psychotic disorder masked by cannabis use. The authors argue that the diagnostic label 'cannabis-induced psychosis' overemphasizes substance use and overlooks other factors such as genetic vulnerability.
European Psychiatry
April 1, 2024
V. Tsang
A ketamine-assisted psychotherapy program in British Columbia, Canada, was both less expensive and more effective than standard group psychotherapy for depression. Over five treatment cycles, the program saved an average of $14,481 per person and produced 0.94 additional quality-adjusted life years (QALYs) compared to the standard care of one provider treating three patients. The analysis used a Markov model with data from 62 program participants and published values for a control group. Incorporating such a program into provincial care could improve health outcomes and reduce government health spending.
European Psychiatry
October 23, 2023
A. U. Parnas
Auditory verbal hallucinations (AVH) in schizophrenia are not clear-cut perceptual errors but are often preceded by subtle anomalies of subjective experience, such as feeling different or thought interference. In a qualitative study of 20 readmitted patients with paranoid schizophrenia, many could not tell whether voices were internal or external and doubted whether they were voices or just thoughts. The label 'voices' was typically acquired in psychiatric settings. AVH alone do not indicate mental disturbance unless part of a deeper change in consciousness. There is continuity between thinking and hallucinating; AVH occur in the patient's intimate sphere, not in shared social space. Psychiatrists' insistence on framing AVH as perceptions may obscure their true nature.
European Psychiatry
October 23, 2023
M. Bogenschutz
The field of psychedelic medicine has advanced rapidly in the last 2-3 years, with a notable increase in the number and size of controlled clinical trials, more sophisticated conceptual models for understanding therapeutic effects, and progress toward treatment models that could enable access to safe and effective psychedelic therapies if regulatory approval is granted. Despite these advances, the field remains in its infancy, and much more work is needed to determine the contributions of psychedelics to healthcare and neuroscience.
European Psychiatry
June 1, 2022
J. Bramness
Cannabis use, particularly high-potency products with increased THC content, is linked to a rise in cannabis-induced psychosis and schizophrenia. In Scandinavian countries, the incidence of cannabis-induced psychosis and the population-attributable fraction of cannabis for schizophrenia have increased alongside treatment seeking for cannabis use disorders. Up to one third of people with cannabis-induced psychosis later receive a schizophrenia diagnosis, strengthening evidence for a causal relationship. The authors argue that cannabis-induced psychosis should be reclassified from the substance-use chapter (F1) to the psychotic-disorders chapter (F2) of the ICD-10, as no other psychotic diagnosis specifies a precipitating factor.
European Psychiatry
April 1, 2021
M. Trigo
A review of recent literature on psychedelic drugs such as LSD for depression finds that data from clinical research show LSD relieves distress concerning death, particularly in terminally ill cancer patients, and helps treat addictions including alcoholism and nicotine. There is more limited data on classic hallucinogens for depression and anxiety disorders. The studies completed to date are not sufficient to establish clinically relevant effects, though outcomes are encouraging and larger, well-designed, placebo-controlled trials are underway or being planned.
European Psychiatry
April 1, 2017
A. Oda
Cannabis psychosis and methamphetamine psychosis differ in their core symptoms: methamphetamine psychosis typically involves auditory hallucinations and paranoia that resolve quickly with treatment, whereas cannabis psychosis is characterized by megalomania and a pseudo-enlightenment experience of supernatural existence, leading users to cling to an unrealistic sense of omnipotence and repeat abuse. Because cannabis grows wild and is legal in some countries, users often lack guilt and instead enjoy contact with supernatural power, resulting in social withdrawal and contributing to social problems. The authors argue psychiatrists should recognize these risks and the difficulty of rehabilitating cannabis users.
European Psychiatry
March 1, 2016
I. Hamilton, P. Galdas, H. Essex
Male cannabis users outnumber female users by 2:1, and a similar ratio appears for hospital admissions with schizophrenia or psychosis. However, the ratio increases to 4:1 for admissions with cannabis psychosis, indicating marked gender differences. The research used British Crime Survey data, Hospital Episode Statistics, and prior epidemiological studies. Attending to gender is important for understanding and providing gender-sensitive services.
European Psychiatry
January 1, 2009
I.B. Crome
This contribution reviews UK research on substance misuse and mental illness over the past 20 years. Early work focused on alcohol and alcoholic hallucinosis, concluding that few cases developed into schizophrenia. More recent large epidemiological and clinical studies examine the relationship between cannabis use and later psychosis. The presentation cautions against asserting cannabis is necessarily causal, highlighting clinical and policy implications of misinterpreting evidence. It proposes revisiting alcohol-related psychotic illness with more sophisticated methods and suggests investigating other drugs associated with psychotic illness to find a common mechanism linking substance use and psychosis.
European Psychiatry
January 1, 2009
M. Arendt
Among 535 people treated in Denmark for cannabis-induced psychosis and followed for at least three years, 44.5% later received a diagnosis of schizophrenia-spectrum disorders. New psychotic episodes of any type occurred in 77.2%, and 47.1% were diagnosed with schizophrenia-spectrum disorders more than a year after the initial cannabis-induced psychosis. Both those with cannabis-induced psychosis and those with schizophrenia had similarly elevated rates of schizophrenia and other psychiatric disorders in their first-degree relatives. Cannabis-induced psychosis may be an early sign of schizophrenia rather than a separate condition.