Special considerations for evaluating psilocybin-facilitated psychotherapy in vulnerable populations

Ortiz, Cynthia E; Dourron, Haley Maria; Sweat, Noah W; Garcia-Romeu, Albert; MacCarthy, Sarah; Anderson, B.; Hendricks, Peter S.

doi:10.1016/j.neuropharm.2022.109127

Cited by 13 publications

(4 citation statements)

References 49 publications

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“…The percentage of participants who reported lifetime classic psychedelic use (22%) was similar to the prevalence of lifetime classic psychedelic use (23%) in another study using Prolific Academic for study recruitment, 25 but it was still higher than the prevalence in the United States (14%) in previous research using the National Survey on Drug Use and Health (NSDUH). 2 This may be because the current sample was of higher socioeconomic status than the NSDUH sample 26 and also because the previous research using the NSDUH likely underestimates ayahuasca and DMT use. 25 Second, the questionnaire did not include items related to set and setting of the most insightful classic psychedelic experience, which could have been used to identify context-dependent variables related to psychological insight, health behavior, and physical health.…”

Section: Discussionmentioning

confidence: 91%

Classic psychedelics, health behavior, and physical health

Simonsson

Hendricks

Chambers

et al. 2022

Therapeutic Advances in Psychopharmacology

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Background: Preliminary evidence suggests that classic psychedelics may be effective in the treatment of some psychiatric disorders, yet little remains known about their effects on health behavior and physical health. Objectives: The purpose of this study was to investigate associations of lifetime classic psychedelic use and psychological insight during one’s most insightful classic psychedelic experience with health behavior and physical health. Methods: Using data representative of the US population with regard to sex, age, and ethnicity ( N = 2822), this study examined associations of lifetime classic psychedelic use and psychological insight with health behavior and physical health. Results: Lifetime classic psychedelic use was associated with more healthy tobacco-related and diet-related behavior ( β = 0.05 and 0.09, respectively). Among lifetime classic psychedelic users ( n = 613), greater Psychological Insight Questionnaire (PIQ) total scale, PIQ Avoidance and Maladaptive Patterns (AMP) subscale, and PIQ Goals and Adaptive Patterns (GAP) subscale scores were each associated with higher odds of more healthy exercise-related behavior [adjusted odds ratios (aOR) (95% confidence interval, CI = 1.38 (1.13–1.68), 1.38 (1.13–1.68), and 1.32 (1.10–1.60), respectively] and higher odds of having a healthy body mass index (BMI) [aOR (95% CI) = 1.32 (1.07–1.63), 1.36 (1.10–1.69), and 1.23 (1.01–1.50), respectively], and greater GAP subscale scores were associated with more healthy diet-related behavior ( β = 0.10). All PIQ scales were positively associated with some health behavior improvements (overall, diet, exercise) attributed to respondents’ most insightful classic psychedelic experience ( β = 0.42, 0.18, and 0.17; β = 0.40, 0.19, and 0.17; and β = 0.40, 0.15, and 0.15, respectively), but only PIQ total scale and AMP subscale scores were positively associated with alcohol-related health behavior improvements ( β = 0.13 and 0.16, respectively). Conclusion: Although these results cannot demonstrate causality, they suggest that psychological insight during a classic psychedelic experience may lead to positive health behavior change and better physical health in some domains, in particular in those related to weight management.

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Section: Discussionmentioning

confidence: 91%

Classic psychedelics, health behavior, and physical health

Simonsson

Hendricks

Chambers

et al. 2022

Therapeutic Advances in Psychopharmacology

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“…Our sample was predominantly white, young and educated, and although this appears to partly reflect the common demographic profile of psychedelic users ( Yockey et al, 2020 ), GDS may also disproportionately reach these populations ( Barratt et al, 2017 ). Low representation of ethnic minorities and socioeconomically disadvantaged individuals is a significant problem in psychedelic research, especially considering these populations are greatly affected by the mental conditions that any future psychedelic therapy would be used to treat ( Ortiz et al, 2022 ; Rea and Wallace, 2021 ; Williams et al, 2021 ); and recent evidence does suggest the psychedelic user population is becoming increasingly ethnically diverse ( Davis et al, 2022 ). Furthermore, those reached by the survey advertising and who choose to volunteer may have specific interests and knowledge about the topics of the survey ( Eysenbach and Wyatt, 2002 ); and for instance be better educated about optimal practices of psychedelic use, contributing to more favourable outcomes.…”

Section: Discussionmentioning

confidence: 99%

Investigation of self-treatment with lysergic acid diethylamide and psilocybin mushrooms: Findings from the Global Drug Survey 2020

et al. 2023

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Background: Growing numbers of people are using psychedelics for personal psychotherapy outside clinical settings, but research on such use is scarce. Aims: This study investigated the patterns of use, self-reported outcomes and outcome predictors of psychedelic ‘self-treatment’ of mental health conditions or specific worries/concerns in life. Methods: We use data from the Global Drug Survey 2020, a large online survey on drug use collected between November 2019 and February 2020. In all, 3364 respondents reported their self-treatment experiences with lysergic acid diethylamide ( N = 1996) or psilocybin mushrooms ( N = 1368). The primary outcome of interest was the 17-item self-treatment outcome scale, items reflecting aspects of well-being, psychiatric symptoms, social-emotional skills, and health behaviours. Results: Positive changes were observed across all 17 outcome items, with the strongest benefits on items related to insight and mood. Negative effects were reported by 22.5% of respondents. High intensity of psychedelic experience, seeking advice before treatment, treating with psilocybin mushrooms and treating post-traumatic stress disorder were associated with higher scores on the self-treatment outcome scale after averaging values across all 17 items. Younger age, high intensity of experience and treating with LSD were associated with increased number of negative outcomes. Conclusions: This study brings important insights into self-treatment practices with psychedelics in a large international sample. Outcomes were generally favourable, but negative effects appeared more frequent than in clinical settings. Our findings can help inform safe practices of psychedelic use in the community, and inspire clinical research. Future research can be improved with utilisation of prospective designs and additional predictive variables.

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“…Prior to the commencement of the study, a rigorous individual assessment, specifically focusing on cognitive capabilities, is imperative. If significant impairment in cognitive capacity is identified among AD patients, researchers must ascertain the necessity of legal guardians’ involvement and ensure their legal eligibility for providing informed consent ( Lawrence et al, 2014 ; Ortiz et al, 2022 ).…”

Section: Legal and Ethical Issuesmentioning

confidence: 99%

“…The cognitive state of AD patients may influence their perception of time and processing abilities ( Honma et al, 2015 ). Therefore, the study design should contemplate the reduction of experimental duration to accommodate potential shorter attention spans and tolerance levels in patients ( Ortiz et al, 2022 ).…”

Section: Legal and Ethical Issuesmentioning

confidence: 99%

Psilocybin for the treatment of Alzheimer’s disease

Zheng,

Ma,

Yang

et al. 2024

Front. Neurosci.

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Alzheimer’s disease (AD) stands as a formidable neurodegenerative ailment and a prominent contributor to dementia. The scarcity of available therapies for AD accentuates the exigency for innovative treatment modalities. Psilocybin, a psychoactive alkaloid intrinsic to hallucinogenic mushrooms, has garnered attention within the neuropsychiatric realm due to its established safety and efficacy in treating depression. Nonetheless, its potential as a therapeutic avenue for AD remains largely uncharted. This comprehensive review endeavors to encapsulate the pharmacological effects of psilocybin while elucidating the existing evidence concerning its potential mechanisms contributing to a positive impact on AD. Specifically, the active metabolite of psilocybin, psilocin, elicits its effects through the modulation of the 5-hydroxytryptamine 2A receptor (5-HT2A receptor). This modulation causes heightened neural plasticity, diminished inflammation, and improvements in cognitive functions such as creativity, cognitive flexibility, and emotional facial recognition. Noteworthy is psilocybin’s promising role in mitigating anxiety and depression symptoms in AD patients. Acknowledging the attendant adverse reactions, we proffer strategies aimed at tempering or mitigating its hallucinogenic effects. Moreover, we broach the ethical and legal dimensions inherent in psilocybin’s exploration for AD treatment. By traversing these avenues, We propose therapeutic potential of psilocybin in the nuanced management of Alzheimer’s disease.

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Special considerations for evaluating psilocybin-facilitated psychotherapy in vulnerable populations

Cited by 13 publications

References 49 publications

Classic psychedelics, health behavior, and physical health

Classic psychedelics, health behavior, and physical health

Investigation of self-treatment with lysergic acid diethylamide and psilocybin mushrooms: Findings from the Global Drug Survey 2020

Psilocybin for the treatment of Alzheimer’s disease

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