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There has recently been a renewal of human research with classical hallucinogens (psychedelics). This paper first briefly discusses the unique history of human hallucinogen research, and then reviews the risks of hallucinogen administration and safeguards for minimizing these risks. Although hallucinogens are relatively safe physiologically and are...

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... To satisfy this urgent need with effective tools, a cautious and rigorous research process is necessary, particularly in light of the serious adverse events that, although rare, have been reported in the literature (Johnson, Richards, & Griffiths, 2008). In this manuscript, certain methodological aspects of the ongoing psychedelic research requiring improvement will be described. ...
... This approach of preferably selecting psychedelic-experienced participants for the trials is understandable in light of the risk of the appearance of psychotic and bipolar breaks, or the inducement of acute anxiety states commonly termed "bad trips" (Johnson et al., 2008;Dos Santos, Bouso, & Hallak, 2017). If subjects with previous experience did not face serious adverse events, it can be expected that they will tolerate the drug and the profound experience associated. ...
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While the field of psychedelic research is continuously expanding and offers new hope for achieving successful treatments for physical and mental disorders, certain methodological aspects require improvement. Some of the flaws are shared with clinical trials for other kinds of drugs and others are specific to the field. Given that psychedelic research is an emerging field, it is important to address these problems in a timely manner. In this manuscript, we present the main methodological issues in psychedelic research, ranging from the most manageable (e.g., non-representative samples) to the most complex (e.g., limitations of the biomedical model). In addition, given its relevance, we dedicate a section of the manuscript to a discussion of ethical concerns around psychedelic research.
... 1,2 For some people with mental illness, the hallucinogenic experience could increase the risk of psychosis, often making them ineligible to participate in psychedelic research. 3 In healthy individuals, there is also the risk of a disturbing adverse psychological event, or "bad trip." 4 Nonetheless, according to some theorists, there are good reasons to provide patients hallucinogenic psychedelics even if nonhallucinogenic options are available. ...
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This article examines five arguments on the use of non-hallucinogenic psychedelics in psychiatry. The authors argue that researchers and physicians should continue to use hallucinogenic psychedelics because current data support their therapeutic effect. If equally safe and efficacious non-hallucinogenic psychedelics were developed, these should also be an option offered to appropriate patients.
... The way that subjective effects are framed-i.e., as potential therapeutic mechanisms vs. adverse events-might affect how patients and providers weigh risks and benefits as part of the shared decision-making process. The treatment frame may also influence how ketamine is delivered, experienced, and perhaps even the degree to which it is efficacious, as has been the case for classic hallucinogens, for which exist guidelines acknowledging the impact of contextual variables on psychological and physical safety (Johnson et al., 2008). Preliminary data on the unique benefits of ketamine when combined with psychotherapy (Dore et al., 2019;Mathai et al., 2022) further suggest the value of a more nuanced therapeutic context than is currently routine. ...
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Background: Given increasing community-based and off-label use of ketamine for psychiatric indications, we examined current informed consent processes from a convenience sample of outpatient ketamine clinics to identify areas of congruence with current evidence and opportunities for growth. Methods: Using a rubric developed from existing practice guidelines, we conducted an exploratory analysis of informed consent documents (IC-Docs) from 23 American clinics offering ketamine as a psychiatric treatment. Domains assessed included clinical content, procedures, and syntax. Results: Participating clinics (23/288) varied widely in their constitution, training, and services provided. We found that IC-Docs addressed a majority of consent elements, though did so variably on an item-level. Areas for improvement included communication around long-term adverse effects, treatment alternatives, medical/psychiatric evaluation prior to treatment, medical/psychological support during treatment, adjunctive psychological interventions, and subjective/dissociative-type effects. All forms were limited by poor readability. Limitations: Our study was limited by convenience sampling along with possible underestimation of verbal consent processes. Conclusions: As ketamine continues to emerge as a psychiatric intervention, both patients and providers will benefit from a deliberate consent process informed by scientific, ethical, and pragmatic factors toward the goal of shared decision-making regarding treatment.
... Clinical psychedelic studies are conducted in carefully controlled environments where few adverse events have been reported [2]. There is considerable literature providing guidelines for safety in clinical settings [11], including advice for professional psychedelic therapists [12,13]. However, there is scant research about reducing harm for recreational users. ...
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Background Alongside a recent revival in the use of psychedelics in clinical settings, there have been increases in the prevalence of recreational use, with many using psychedelics to deal with difficult emotions or to improve well-being. While clinical research is conducted in carefully controlled settings, this is not necessarily the case for recreational use. In this mixed methods online survey study, we aimed to develop an understanding of frequently used psychedelic harm reduction practices in recreational settings and how their use relates to the psychedelic experience. We also aimed to characterise users’ first and most recent psychedelic trips to understand how harm reduction changes with experience. Methods Participants ( n = 163) recounted their first and most recent psychedelic experience by providing details about the harm reduction practices they employed and completing the Challenging Experience Questionnaire (CEQ) and Emotional Breakthrough Inventory (EBI). We also asked open-ended questions for a more in-depth qualitative understanding of their views on psychedelic harm reduction. Results Using ANOVA, we observe greater use of harm reduction practices for participants’ most recent versus first psychedelic experience and that use of these practices is positively associated with EBI scores and negatively associated with CEQ scores (particularly for the first experience). Participants engaged in a wide range of harm reduction practices and we provide details of those which are most commonly used and those which are deemed most important by experienced users. Our qualitative analysis indicated that participants were largely positive about psychedelics and many recounted profound positive experiences. While specifics of the drug they were taking was important for aspects of harm reduction, participants largely focused on the importance of ensuring a good “set and setting” for enhancing positive effects. Conclusions Our research helps us understand how engagement in harm reduction may increase with experience. Our mixed methods data shed light on the perceived importance of different harm reduction practices and examine their association with the psychedelic experience itself. Together, our research has important implications for the development of psychedelic harm reduction advice and provides opportunities for future research to explore the importance of these different practices in more detail.
... As diretrizes de segurança para pesquisa de alucinógenos humanos de 2008 recomendam a exclusão de voluntários com histórico pessoal ou familiar de transtornos psicóticos ou outros transtornos psiquiátricos graves [7]. Eles também recomendam a presença de pelo menos dois monitores de estudo, ou seja, dois psicoterapeutas extensivamente treinados, durante uma sessão psicodélica. ...
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Portuguese translation of Turkia, Mika: Self-treatment of psychosis and complex post-traumatic stress disorder with LSD and DMT—A retrospective case study. Psychiatry Research Case Reports 2022;1(2):100029, https://doi.org/10.1016/j.psycr.2022.100029
... Ihmisillä tehtävän psykedeelitutkimuksen turvallisuutta koskevat linjaukset vuodelta 2008 suosittavat sellaisten henkilöiden poissulkemista, joilla tai joiden suvussa on esiintynyt psykoottisuutta tai muita vakavia psykiatrisia sairauksia [7]. Linjaukset suosittavat myös, että hoitotilanteessa olisi oltava läsnä ainakin kaksi valvojaa, ts. ...
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Finnish translation of Turkia, Mika: Self-treatment of psychosis and complex post-traumatic stress disorder with LSD and DMT—A retrospective case study. Psychiatry Research Case Reports 2022;1(2):100029, https://doi.org/10.1016/j.psycr.2022.100029
... However, they can increase pulse rate and blood pressure, thus contraindicating their use by individuals with cardiovascular disease. In addition, prescription and over-the-counter drugs that modulate serotonin-as well as lithium and haloperidol-may potentiate their effects (Johnson et al., 2008). However, despite their limited physiological adverse effects, psychedelics may produce anxiety, paranoia, confusion, and psychotic-like reactions (Griffiths et al., 2006;Johnson et al., 2008). ...
... In addition, prescription and over-the-counter drugs that modulate serotonin-as well as lithium and haloperidol-may potentiate their effects (Johnson et al., 2008). However, despite their limited physiological adverse effects, psychedelics may produce anxiety, paranoia, confusion, and psychotic-like reactions (Griffiths et al., 2006;Johnson et al., 2008). Such experiences can be not only incredibly harrowing, but also potentially dangerous. ...
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Recent studies implicate the use of psychedelic substances in the treatment of psychiatric conditions. However, this literature also suggests that the psychedelics may have utility in the promotion of positive adult development. Accordingly, this paper outlines a study exploring this premise. An online sample (n = 684) of psychedelic users and non-users (age range: 18–24 to 75–84; median = 25–34) was recruited. Conditional process analysis was used to assess whether the relationship between psychedelic use and two facets of adult development, adjustment and growth, would be mediated by openness to experience, awe-proneness, and mystical experiences, and whether these relationships would be moderated by drug-use reflection/integration. Results show that the direct relationship between psychedelic use and growth was moderated by drug-use reflection/integration. In addition, the indirect relationship between psychedelic use and adjustment was mediated through awe-proneness, while the indirect relationships between psychedelic use and growth were mediated via awe-proneness and openness to experience; drug-use reflection/integration moderated these mediated relationships. In addition, drug-use reflection/integration directly predicted openness, awe-proneness, and growth. These findings suggest that, when used with self-expansive intentions and actively reflected upon and integrated post use, psychedelics may augment positive adult development.
... Under the influence of both classic and atypical psychedelics psychological complications and adverse effects may occur. Acute symptoms like disorientation, panic, fear and overwhelming distress-often referred to as bad trip-may arise, especially in a difficult setting (Johnson et al., 2008;Baylen and Rosenberg, 2006;Perry et al., 2007). In a study investigating negative experiences under psilocybin in 1993 recreational users, 39% rated it among the top five most challenging experiences of his/her life and 11% put self or others at risk of physical harm. ...
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This is a narrative review about the role of classic and two atypical psychedelics in the treatment of unipolar and bipolar depression. Since the 1990s, psychedelics experience a renaissance in biomedical research. The so-called classic psychedelics include lysergic acid diethylamide (LSD), psilocybin, mescaline and ayahuasca. Characteristic effects like alterations in sensory perception, as well as emotion- and self-processing are induced by stimulation of serotonin 2A receptors in cortical areas. The new paradigm of psychedelic-assisted psychotherapy suggests a therapeutic framework in which a safely conducted psychedelic experience is integrated into a continuous psychotherapeutic process. First randomized, controlled trials with psilocybin show promising efficacy, tolerability, and adherence in the treatment of unipolar depression. On the other hand, classic psychedelics seem to be associated with the induction of mania, which is an important issue to consider for the design of research and clinical protocols. So called atypical psychedelics are a heterogeneous group with overlapping subjective effects but different neurobiological mechanisms. Two examples of therapeutic value in psychiatry are 3,4-methyl enedioxy methamphetamine (MDMA) and ketamine. Since 2020 the ketamine enantiomer esketamine has been granted international approval for treatment-resistant unipolar depression, and also first evidence exists for the therapeutic efficacy of ketamine in bipolar depression. Whether psychedelics will fulfil current expectations and find their way into broader clinical use will depend on future rigorous clinical trials with larger sample sizes. A well-considered therapeutic and legal framework will be crucial for these substances to create new treatment settings and a potential paradigm shift.
... In this sense, it could be more appropriate to start traumafocused psychotherapy a bit later. In contrast, patients could be accompanied before and during the first Esketamine sessions with techniques that have been developed to improve tolerance and avoid "bad-trip" during psychotropic-assisted therapy (67). ...
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Introduction Major depressive disorder (MDD) is more likely to resist to usual treatment when it is associated with post-traumatic stress disorder (PTSD). Capitalizing on the effect of ketamine in both treatment-resistant depression (TRD) and PTSD, we conducted a study in order to assess the efficacy of intranasal (IN) Esketamine in patients having TRD with comorbid PTSD. Materials and Methods In this open-label, single arm, retrospective pilot study, 11 patients were treated with IN Esketamine (56 or 84 mg) with a longitudinal follow-up of 6 months. IN Esketamine was administered twice weekly during the first month, once weekly during the second month, and then once every 1 or 2 weeks. Patients were assessed with Montgomery-Åsberg Depression Rating Scale (MADRS), Patient Health Questionnaire 9 items, Global Assessment of Functioning (GAF), and Clinical Global Impression-Suicide Scale (CGI-SS). Results We included 9 women and 2 men (mean age 47.3 ± 11.1 years). The mean (SD) MADRS scores decreased significantly from 38.6 (6.4) at baseline to 18.2 (10.03) after 6 months of IN Esketamine; 7 patients were responders and 3 patients were in remission. The percentage of patients who were moderately to severely suicidal declined from 63.6% at baseline to 27.3% after 1 month of IN Esketamine sessions. No serious adverse reactions were observed. Conclusion This study reports the outcomes of 11 severely ill patients with comorbid TRD and PTSD after IN Esketamine treatment. Esketamine significantly improved depression symptoms, suggesting that it is likely to be a treatment of choice in this specific population.
... Use in research was paused as it was listed as a schedule I drug in 1970 because psilocybin-produced mushrooms became a recreational drug for the general public (Hofmann, 1968;Nichols, 2004;Metzner, 2005). Nowadays, as the relative safety of psilocybin has been recognized, it is widely used as a psychedelic in human studies especially in neurobiology related research (Hasler et al., 2004;Johnson et al., 2008;Carhart-Harris and Goodwin, 2017). For example, it is used as an agonist targeting serotonin-2A receptors, and this helps to understand the relationship between serotonin and both drug-induced and disorder-based psychotic states (Geyer and Vollenweider, 2008;Petri et al., 2014). ...
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Mushrooms have long been considered as delicacies as well as used as important dietary supplements and food. However, there are major concerns with poisonous mushrooms as these pose threats to public health and safety. In this paper, we provide a review focusing on poisonous mushrooms, their toxins, symptoms and utilizations. In addition, this paper establishes a poisonous mushroom list which includes 643 species from two phyla, 16 orders, 51 families and 148 genera. The toxicity of all these species was verified and 332 species were ranked as P1 signifying that these species have toxic studies and or clinical poisoning case records and 311 species were P2 meaning they had previously been recorded as poisonous in other studies. Furthermore, we discuss advances in technology including how genomic studies could be used as a breakthrough tool in the field of toxic mushrooms. With this comprehensive review, we aim to promote public awareness of poisonous mushrooms, including how to avoid mushroom poisoning, and how to better utilize poisonous mushroom resources.