Monitoring the use of novel psychoactive substances in Australia by wastewater-based epidemiology.

Users of novel psychoactive substances (NPS) are at risk, due to limited information about the toxicity and unpredictable effects of these compounds. Wastewater-based epidemiology (WBE) has been used as a tool to provide insight into NPS use at the population level. To understand the preferences and trends of NPS use in Australia, this study involved liquid chromatography mass spectrometry analysis of wastewater collected from Australian states and territories from February 2022 to February 2023. In total, 59 different NPS were included across two complementary analytical methods and covered up to 57 wastewater catchments over the study. The NPS detected in wastewater were 25-B-NBOMe, buphedrone, 1-benzylpiperazine (BZP), 3-chloromethcathinone, N,N-dimethylpentylone (N,N-DMP), N-ethylheptedrone, N-ethylpentylone, eutylone, 4F-phenibut, 2-fluoro deschloroketamine, hydroxetamine, mephedrone, methoxetamine, methylone, mitragynine, pentylone, phenibut, para-methoxyamphetamine (PMA), alpha-pyrrolidinovalerophenone (α-PVP) and valeryl fentanyl. The detection frequency for these NPS ranged from 3 % to 100 % of the sites analysed. A noticeable decreasing trend in eutylone detection frequency and mass loads was observed whilst simultaneously N,N-DMP and pentylone increased over the study period. The emergence of some NPS in wastewater pre-dates other sources of monitoring and provides further evidence that WBE can be used as an additional early warning system for alerting potential NPS use.

COVID-19 and Adolescent Outpatient Mental Health Service Utilization.

OBJECTIVE: The COVID-19 pandemic created challenges in accessing mental health (MH) services when adolescent well-being declined. Still, little is known about how the COVID-19 pandemic affected outpatient MH service utilization for adolescents. METHODS: Retrospective data were collected from electronic medical records of adolescents aged 12-17 years at Kaiser Permanente Mid-Atlantic States, an integrated health care system from January 2019 to December 2021. MH diagnoses included anxiety, mood disorder/depression, anxiety and mood disorder/depression, attention-deficit/hyperactivity disorder, or psychosis. We used interrupted time series analysis to compare MH visits and psychopharmaceutical prescribing before and after the COVID-19 onset. Analyses were stratified by demographics and visit modality. RESULTS: The study population of 8121 adolescents with MH visits resulted in a total of 61,971 (28.1%) of the 220,271 outpatient visits associated with an MH diagnosis. During 15,771 (7.2%) adolescent outpatient visits psychotropic medications were prescribed. The increasing rate of MH visits prior to COVID-19 was unaffected by COVID-19 onset; however, in-person visits declined by 230.5 visits per week (P < .001) from 274.5 visits per week coupled with a rise in virtual modalities. Rates of MH visits during the COVID-19 pandemic differed by sex, mental health diagnosis, and racial and ethnic identity. Psychopharmaceutical prescribing during MH visits declined beyond expected values by a mean of 32.8 visits per week (P < .001) at the start of the COVID-19 pandemic. CONCLUSIONS: A sustained switch to virtual visits highlights a new paradigm in care modalities for adolescents. Psychopharmaceutical prescribing declined requiring further qualitative assessments to improve the quality of access for adolescent MH.

[Depression: Low-threshold Cardinal Measures as a Complement or Alternative to Pharmacological or Psychotherapeutic Interventions]. / Depression: Niedrigschwellige Kardinalmaßnahmen als Basis jeder Behandlung.

The third edition of the German National Clinical Practice Guideline for Depression emphasizes the significance of cardinal measures much more strongly than before. Low-threshold cardinal measures are an indispensable component of every depression treatment, regardless of severity and setting. They are suitable as a standalone treatment for mild and moderate depression. If inadequate improvement is observed, additional therapies should be supplemented. They should be implemented immediately after diagnosis to enhance the success rate.Regarding cardinal measures, among other things, comprehensive patient education in understandable language is essential. Patients with depressive disorders require guidance on structuring their day and building healthy activities. Patients with depression-related sleep disturbances benefit from sleep hygiene rules. Wake therapy constitutes an excellent and low-risk treatment method with immediate effect, which is a standard component of adequate depression treatment. Patients with a seasonal pattern of depression should be advised on light therapy. All patients should be encouraged to engage in regular physical activity with moderate intensity.

THE CURIOUS CASE OF 'PSYCHO-OPHTHALMOLOGY': A NARRATIVE REVIEW OF OPHTHALMOLOGICAL ASPECTS OF PSYCHIATRIC DISORDERS.

Consultation Liaison Psychiatry (CLP) deals with the interface shared between psychiatry and various other disciplines of medicine. The interface shared by psychiatry and ophthalmology is among the lesser discussed ones in the field of CLP, despite the fact that it holds clinical relevance in the evaluation, management and outcomes of both psychiatric and ophthalmological disorders. This narrative review focusses on the ophthalmological aspects of psychiatric disorders, with respect to their manifestations, assessment, and management. Psychiatric disorders, including schizophrenia, affective disorders, 'functional' disorders, and substance use disorders, have numerous ophthalmic manifestations, which can have clinical implications for the patients. Even the psychotropic drugs given for psychiatric disorders can lead to side effects affecting the eye, but these are among the lesser-discussed side effects. Some psychiatric disorders can be investigated using various ophthalmic functions, the assessments ranging from simple physical examination to the use of instruments like a fundoscope, which can be useful for a psychiatrist in their routine practice. Lastly, eye functions can also be used in the treatment of psychiatric conditions, as is seen in eye movement desensitization and reprocessing. This review reiterates the fact that more attention needs to be given to the field of 'psycho-ophthalmology', which holds great promise in the coming days.

Effective isolation of cannabidiol and cannabidiolic acid free of psychotropic phytocannabinoids from hemp extract by fast centrifugal partition chromatography.

Cannabidiol (CBD), together with its precursor cannabidiolic acid (CBDA), is the major phytocannabinoid occurring in most hemp cultivars. To ensure the safe use of these compounds, their effective isolation from hemp extract is required, with special emphasis on the elimination of ∆9-tetrahydrocannabinol (∆9-THC) and ∆9-tetrahydrocannabinolic acid (∆9-THCA-A). In this study, we demonstrate the applicability of fast centrifugal partition chromatography (FCPC) as a challenging format of counter-current preparative chromatography for the isolation of CBD and CBDA free of psychotropic compounds that may occur in Cannabis sativa L. plant extracts. Thirty-eight solvent mixtures were tested to identify a suitable two-phase system for this purpose. Based on the measured partition coefficients (KD) and separation factors (α), the two-phase system consisting of n-heptane:ethyl acetate:ethanol:water (1.5:0.5:1.5:0.5; v:v:v:v) was selected as an optimal solvent mixture. Employing UHPLC-HRMS/MS for target analysis of collected fractions, the elution profiles of 17 most common phytocannabinoids were determined. Under experimental conditions, the purity of isolated CBD and CBDA was 98.9 and 95.1% (w/w), respectively. Neither of ∆9-THC nor of ∆9-THCA-A were present; only trace amounts of other biologically active compounds contained in hemp extract were detected by screening against in-house spectral library using UHPLC-HRMS.

Parental Attitude Towards the Prescription of Psychotropic Medications for Mental Disorders in Children in a Tertiary Care University Hospital in Oman.

Objectives: This study aimed to investigate parental attitude towards psychotropic drugs' use for children's mental disorders. Methods: This cross-sectional study was conducted from December 2020 to March 2021 at the Department of Behavioural Medicine, Sultan Qaboos University Hospital, Muscat, Oman. A questionnaire was used to determine parents' opinions and attitudes about use of psychotropic medications on their children and, in a small proportion, other caregivers if the child attended with them. Risk factors associated with parents who preferred to consult a folk healer (FH) for children with mental disorders were identified by the logistic regression model. Results: A total of 299 parents participating in the study (response rate: 95.2%). Most (n = 244, 81.6%) agreed to give their child psychotropic medications if necessary, but 25.4% (n = 76) would consult an FH before a psychiatrist. Married parents were 14.5 times (P = 0.011) more likely than separated or divorced parents to consult an FH. Caregivers with a monthly income below 500 OMR and between 500 and 1,000 OMR were 2.5 (P = 0.016) and 3.2 times (P <0.001), respectively, more likely than those with more than 1,000 OMR to consult an FH. Parents who disagreed with giving their children psychotropic medications were 3.8 times (P <0.001) more likely to consult an FH than parents who agreed to give them if necessary. Conclusion: Most parents agreed to give their children psychotropic medications if necessary. However, a proportion of parents and caregivers preferred to consult an FH before accessing mental health services.

Efectividad de la hipnosis en cantidad y calidad del sueño en pacientes con depresión post-COVID / Effectiveness of hypnotherapy on sleep quality and quantity in patients with post-COVID depression

Introducción: Se conocen diversos tratamientos para tratar y curar la depresión. Entre los más utilizados se encuentran la psicoterapia y la medicación. La hipnosis clínica utiliza un discurso basado en la sugestión y en los reflejos condicionados del sueño, para lograr la estabilidad en la desregulación del ciclo sueño / vigilia, lo cual es un factor esencial en el tratamiento de las personas deprimidas por la COVID-19. Objetivo: Comparar la evolución en la calidad y cantidad de sueño en pacientes con depresión post-COVID que fueron tratados con medicación e hipnosis. Métodos: Se realizó un estudio explicativo-comparativo, y un diseño cuasi-experimental. La muestra fue de 40 pacientes que fueron ingresados en el Hospital Universitario Clínico Quirúrgico «Cmdte. Manuel Fajardo Rivero», de Santa Clara, entre enero y marzo de 2021, con COVID-19. En un grupo de pacientes se empleó el inventario de depresión de Beck y un cuestionario para evaluar la cantidad y calidad del sueño antes y después de la intervención con medicación; en el otro grupo se empleó la hipnosis. Se utilizó la estadística descriptiva. Resultados: En ambos grupos la terapia empleada fue efectiva, redujo los niveles de depresión y eliminó las alteraciones del sueño. Conclusiones: Ambas formas de tratamiento se pueden emplear para tratar la depresión y los desórdenes propios del sueño. El método sugestivo de despertar de sueño hipnótico a sueño natural fue tan efectivo como los psicofármacos empleados.

Introduction: various treatments are known to treat and cure depression. Psychotherapy and medication are among the most used. Clinical hypnosis uses a discourse based on suggestions and conditioned sleep reflexes to achieve stability in sleep-wake cycle dysregulation, which is an essential factor in the treatment of people depressed by COVID-19. Objective: to compare the evolution in sleep quality and quantity in patients with post-COVID depression who were treated with medication and hypnotherapy. Methods: an explanatory comparative study with a quasi-experimental design was carried out. The sample consisted of 40 patients who were admitted due to COVID-19 at "Cmdte. Manuel Fajardo Rivero" Clinical and Surgical University Hospital from Santa Clara between January and March 2021. Beck Depression Inventory and a questionnaire were used in a group of patients to assess the sleep quality and quantity before and after the intervention with medication; hypnosis was used in the other group. Descriptive statistics was also used. Results: the used therapy was effective in both groups, reduced levels of depression and eliminated sleep disturbances. Conclusions: both forms of treatment can be used to treat depression and sleep disorders. The suggestive method of awakening from hypnotic sleep to natural sleep was as effective as the psychoactive drugs used.

Substance Use Disorders and Role of Complementary and Integrative Medicine/Functional Medicine.

Substance use disorders are a growing concern for all ages, including adolescents. Even though there is an increase in recreational substance use and a wider variety of drugs is available to this young population, treatment options remain scarce. Most medications have limited evidence in this population. Few specialists treat individuals struggling with addiction along with mental health disorders. As the evidence grows, these treatments are usually included in complementary and integrative medicine. This article discusses available evidence for many complementary and integrative treatment approaches while briefly describing existing psychotherapeutic and psychotropic medications.

Reduction in caffeine withdrawal after open-label decaffeinated coffee.

BACKGROUND: Withdrawal from addictive drugs can be reduced by administering placebo deceptively, but in the clinic it is unethical to deceive the patient. Open-label placebo effects have been observed across a range of psychophysiological phenomena, and may also apply to drug withdrawal. METHOD: 24-hour abstinent heavy coffee drinkers (N = 61) rated their caffeine withdrawal symptoms before being allocated to one of three groups. The Deceptive group was given decaffeinated coffee (decaf) and told it was caffeinated, the Open-Label group given decaf and told it was decaf and the Control group given water and told it was water. After 45 min, caffeine withdrawal was measured again. All participants rated their expectancies of withdrawal reduction from caffeinated coffee, decaf and water prior to being randomised and the end of the study. RESULTS: There was a significant 9.5-point reduction in caffeine withdrawal in the Open-Label group (95% confidence interval (CI): 4.7, 14.3; p = 0.002), which was 8.6 points less than the Deceptive group (95%CI: 0.4, 16.8; p = 0.014) but 8.9 points greater than the Control group (95%CI: 0.6, 17.2; p = 0.012). Pre-randomisation, participants expected caffeinated coffee to reduce their withdrawal symptoms the most, followed by water and decaf, Pre-randomisation expectancy of withdrawal was only associated with amount of withdrawal reduction in the Deceptive group. CONCLUSION: It appears as if open-label placebo caffeine (i.e. decaf) can reduce caffeine withdrawal symptoms, even when people do not hold a conscious expectancy it will do so. There may be ways to integrate open-label placebo procedures into clinical interventions for drug dependence without violating informed consent.

Medicine use in people with intellectual disabilities: a Finnish nationwide register study.

BACKGROUND: People with intellectual disability (ID) are a vulnerable group in our society; many of them depend on other people for assistance in their everyday lives. Compared with the general population, people with ID have poorer general health and, therefore, need more healthcare services and use more medicines. The aim of this study is to define the population of all Finnish people with ID using administrative data and to compare their medicine use and expenditure on medicines to those of the age-matched and sex-matched controls. METHODS: People with ID and their age-matched and sex-matched controls (1:1) were extracted from nationwide healthcare and social allowance registers. Administrative register data on all prescription medicine purchases in 2019 were used to determine the prevalence of medicine use in both groups on a general level and by medicine categories. The differences in the prevalence of medicine use between the two groups were analysed using the logistic regression model. In addition, we studied the total expenditure on reimbursable medicine purchases covered by the National Health Insurance between people with ID and control group. RESULTS: The subpopulation of people with ID consisted 37 196 individuals, of whom 82.7% purchased prescription medicines in 2019. The corresponding share of individuals purchasing prescription medicines in the control group was 70.3%. The differences in the prevalence of medicine use between the two populations were highest in the younger age groups (0-6, 7-12 and 13-17). In the study population, 28.1% (OR = 12.28; 95% CI: 11.54-13.07) of the people used antipsychotics, making it the most used medicine category in people with ID. In the control group, 3.3% of people used antipsychotics. Compared with the control group, the use of antiepileptics, drugs for constipation, mineral supplements and anxiolytics was four to seven times higher among people with ID. Furthermore, the median expenditure on medicine use among people with ID was four times higher than in the control group. CONCLUSIONS: Compared with the control group, people with ID used more medicines, especially psychotropics, and their expenditure on medicine use was higher.

Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts.

INTRODUCTION: Generalized anxiety disorder (GAD) is common and disabling. Different versions of cognitive behavioral therapy (CBT) have been tested, but no treatment works for everyone. Therefore, researchers have attempted approaches to enhance CBT. AREAS COVERED: The current narrative review examines meta-analyses and individual trials of CBT-based treatments for GAD. We focus on CBT and its cognitive and behavioral components as well as efforts to enhance CBT and its dissemination and generalizability. Enhancement efforts included interpersonal and emotional processing therapy, mindfulness-based CBT, emotion regulation therapy, intolerance of uncertainty therapy, the unified protocol, metacognitive therapy, motivational interviewing, and contrast avoidance targeted treatment. Emerging strategies to enhance dissemination have focused on technologically based treatments. Attempts at generalizability have included examination of efficacy within diverse racial and ethnic groups. EXPERT OPINION: We conclude that CBT is efficacious, and a number of enhancement efforts have shown some promise in improving upon CBT in single trials. However, more research is needed, particularly efforts to determine which enhancements work best for which individuals and what are the mechanisms of change. Furthermore, few technological interventions have been compared to active treatments. Finally, much more attention needs to be paid to ethnic and racial diversity in randomized controlled trials.

New Insight Concerning Therapeutic Drug Monitoring-The Importance of the Concept of Psychonephrology.

Recently, the concept of psychonephrology was developed and has been recognized as a field of study that focuses on nephrology and mental health fields, such as psychiatry and psychosomatic medicine. Indeed, patients with chronic kidney disease frequently suffer from mental problems as the disease stage progresses. Most psychotropic drugs are hepatically metabolized, but some are unmetabolized and eliminated renally. However, renal disease may affect the pharmacokinetics of many psychotropic drugs, as the decreased renal function not only delays the urinary excretion of the drug and its metabolites but also alters various pharmacokinetic factors, such as protein-binding, enterohepatic circulation, and activity of drug-metabolizing enzymes. Therefore, when prescribing drug therapy for patients with both renal disease and mental issues, we should consider reducing the dosage of psychotropic drugs that are eliminated mainly via the kidney and also carefully monitor the blood drug concentrations of other drugs with a high extrarenal clearance, such as those that are largely metabolized in the liver. Furthermore, we should carefully consider the dialyzability of each psychotropic drug, as the dialyzability impacts the drug clearance in patients with end-stage renal failure undergoing dialysis. Therapeutic drug monitoring (TDM) may be a useful tool for adjusting the dosage of psychotropic drugs appropriately in patients with renal disease. We herein review the pharmacokinetic considerations for psychotropic drugs in patients with renal disease as well as those undergoing dialysis and offer new insight concerning TDM in the field of psychonephrology.

Impact of standardizing care for agitation in dementia using an integrated care pathway on an inpatient geriatric psychiatry unit.

OBJECTIVES: This study examined the effectiveness of an integrated care pathway (ICP), including a medication algorithm, to treat agitation associated with dementia. DESIGN: Analyses of data (both prospective and retrospective) collected during routine clinical care. SETTING: Geriatric Psychiatry Inpatient Unit. PARTICIPANTS: Patients with agitation associated with dementia (n = 28) who were treated as part of the implementation of the ICP and those who received treatment-as-usual (TAU) (n = 28) on the same inpatient unit before the implementation of the ICP. Two control groups of patients without dementia treated on the same unit contemporaneously to the TAU (n = 17) and ICP groups (n = 36) were included to account for any secular trends. INTERVENTION: ICP. MEASUREMENTS: Cohen Mansfield Agitation Inventory (CMAI), Neuropsychiatric Inventory Questionnaire (NPIQ), and assessment of motor symptoms were completed during the ICP implementation. Chart review was used to obtain length of inpatient stay and rates of psychotropic polypharmacy. RESULTS: Patients in the ICP group experienced a reduction in their scores on the CMAI and NPIQ and no changes in motor symptoms. Compared to the TAU group, the ICP group had a higher chance of an earlier discharge from hospital, a lower rate of psychotropic polypharmacy, and a lower chance of having a fall during hospital stay. In contrast, these outcomes did not differ between the two control groups. CONCLUSIONS: These preliminary results suggest that an ICP can be used effectively to treat agitation associated with dementia in inpatients. A larger randomized study is needed to confirm these results.

Functional brain connectomes reflect acute and chronic cannabis use.

Resting state fMRI has been employed to identify alterations in functional connectivity within or between brain regions following acute and chronic exposure to Δ9-tetrahydrocannabinol (THC), the psychoactive component in cannabis. Most studies focused a priori on a limited number of local brain areas or circuits, without considering the impact of cannabis on whole-brain network organization. The present study attempted to identify changes in the whole-brain human functional connectome as assessed with ultra-high field (7T) resting state scans of cannabis users (N = 26) during placebo and following vaporization of cannabis. Two distinct data-driven methodologies, i.e. network-based statistics (NBS) and connICA, were used to identify changes in functional connectomes associated with acute cannabis intoxication and history of cannabis use. Both methodologies revealed a broad state of hyperconnectivity within the entire range of major brain networks in chronic cannabis users compared to occasional cannabis users, which might be reflective of an adaptive network reorganization following prolonged cannabis exposure. The connICA methodology also extracted a distinct spatial connectivity pattern of hypoconnectivity involving the dorsal attention, limbic, subcortical and cerebellum networks and of hyperconnectivity between the default mode and ventral attention network, that was associated with the feeling of subjective high during THC intoxication. Whole-brain network approaches identified spatial patterns in functional brain connectomes that distinguished acute from chronic cannabis use, and offer an important utility for probing the interplay between short and long-term alterations in functional brain dynamics when progressing from occasional to chronic use of cannabis.

Immunosuppressive activity of non-psychoactive Cannabis sativa L. extract on the function of human T lymphocytes.

BACKGROUND: Cannabis sativa L. extracts (CSE) are used for treating inflammatory conditions, but little is known about their immunomodulatory effects. We investigated a novel CSE with high (14%) CBD and low (0.2%) THC concentration in comparison with pure CBD on primary human lymphocytes. METHODS: Proliferation, cell cycle distribution, apoptosis/necrosis and viability were analysed with standard methods. Genotoxicity was evaluated with the comet-assay. The effect on T lymphocyte activation was evaluated via CD25/CD69 marker expression, degranulation assays and the production of cytokines. The influence on the transcription factors was analysed using Jurkat reporter cell lines. Specific CB2 receptor antagonist SR144528 and TRPV1 receptor antagonist A78416B were used to study the involvement of CB2 or TRPV1 receptors. RESULTS: CSE inhibited the proliferation of activated T lymphocytes in a dose-dependent manner without inducing apoptosis, necrosis, or affecting cell viability and DNA integrity. The inhibitory effect was mediated via the suppression of T lymphocytes activation, particularly by the suppression of CD25 surface marker expression. Furthermore, CSE interferes with the functionality of the T lymphocytes, as indicated by inhibition of degranulation, IL-2, and IFN-γ production. AP-1-and-NFAT-reporter activation was reduced implicating an AP-1-and-NFAT-mediated mode of action. The effects were in part reversed by SR144528 and A78416B, showing that the effects were mainly mediated by CB2 and TRPV1 receptors. CONCLUSION: CSE and CBD have immunomodulatory effects and interfere with the activation and functionality of T lymphocytes. A comparison between CSE and CBD suggests that the immunosuppressive effect of CSE is mostly due to the effect of CBD.

Association Between Prenatal Cannabis Use and Psychotropic Medication Use in Pregnant Patients With Depression and Anxiety.

OBJECTIVES: This cross-sectional study examined associations between prenatal cannabis use and prescribed psychotropic medication use among pregnant patients with depression or anxiety in a large, integrated healthcare system. METHODS: Study patients had a confirmed pregnancy and a depressive or anxiety disorder defined by International Classification of Diseases codes between 2012 and 2018 at Kaiser Permanente Northern California. Patients were screened for prenatal substance use via a self-reported questionnaire and urine toxicology test as part of standard prenatal care. Generalized estimating equation models tested for associations between prenatal cannabis use and any dispensation of antidepressants, benzodiazepines, and hypnotics during gestation. Models were stratified by diagnosis (depression or anxiety) and depression symptom severity. RESULTS: This study included 35,047 pregnancies (32,278 patients; 17.6% aged <25 years, 48.1% non-Hispanic White). Adjusting for patient age, income, race/ethnicity, and depression symptom severity, the 12.6% of patients who screened positive for prenatal cannabis use demonstrated higher odds of prenatal benzodiazepine (adjusted odds ratios [aOR] = 1.40; 95% confidence interval [CI] = 1.20-1.62) and hypnotic (aOR = 1.28; 95% CI = 1.11-1.48), but not antidepressants (aOR = 1.05, 95% CI = 0.96-1.14) use. This pattern persisted when diagnostic groups were examined separately. The odds of prenatal benzodiazepine and hypnotic use associated with prenatal cannabis use were higher among pregnancies with severe depression symptom severity (31.8% of the sample). CONCLUSIONS: Among pregnant patients with depression or anxiety, prenatal cannabis use was associated with higher odds of prenatal benzodiazepine and hypnotic use. As patients may be using cannabis to address depression and anxiety, prescribers should remain vigilant for under- or untreated psychiatric symptoms among pregnant patients and provide evidence-based treatments.

Therapeutic effect of an ayahuasca analogue in clinically depressed patients: a longitudinal observational study.

RATIONALE: Studies have suggested mental health improvements following the use of the psychotropic plant concoction ayahuasca in non-clinical and clinical samples. OBJECTIVES: The present observational study assessed depressive symptomatology in 20 clinically depressed patients (symptom score > 13 on the Beck's Depression Inventory) before attendance of an ayahuasca ceremony and 1 month and 1 year after. Secondary measures included ratings of altered states of consciousness and ego dissolution during the ayahuasca ceremony as well as global measures of mindfulness, satisfaction with life, depression, anxiety, and stress. RESULTS: Twenty participants completed baseline and 1-day follow-up, 19 completed measures at 1-month follow-up, and 17 completed measures at 1-year follow-up. BDI scores reduced from baseline (M = 22.7) to all post-ceremony measures (Ms 11.45, 12.89, and 8.88, for 1-day, 1-month, and 1-year follow-up, respectively). After 1 day, 12/20 participants were in remission (BDI < 13). Remission rates after 1 month and 1 year were 13/19 and 12/17, respectively. Three participants remained mildly depressed (BDI 14-19) at the 1-month and 1-year follow-up. Two participants did not respond and remained at a moderate/severe level of depression at 1-year follow-up. Reductions on the secondary mental health measures and increases in mindfulness and satisfaction with life were found up to 1 year post-ceremony. Improvements in clinical depression and mental health correlated with levels of experienced ego dissolution and oceanic boundlessness during the ceremony up to 1 month after the ceremony. Engagement in additional mental health treatments or use of another psychedelic during study participation may have contributed to improved mental health ratings at 1-year follow-up. CONCLUSION: Ayahuasca produces long-term mental health improvements in clinically depressed patients, which highlights its therapeutic potential.

Effects of the psychoactive compounds in green tea on risky decision-making.

Epigallocatechin-3-gallate (EGCG) and caffeine are the two primary compounds found in green tea. While EGCG has anxiolytic and anti-inflammatory effects, its acute effects on cognition are not well understood. Furthermore, despite widespread green tea consumption, little is known about how EGCG and caffeine co-administration impacts behavior. Here, we investigated the effects of multiple doses of either EGCG or caffeine on a rat model of risk-taking. This was assessed using the risky decision-making task (RDT), in which rats choose between a small, well-tolerated reward and a large reward with escalating risk of mild footshock. Rats were tested in RDT after acute systemic administration of EGCG, caffeine or joint EGCG and caffeine. EGCG caused a dose-dependent reduction in risk-taking without affecting reward discrimination or task engagement. Caffeine did not impact risk-taking, but elevated locomotor activity and reduced task engagement at high doses. Finally, exposure to both EGCG and caffeine had no effect on risk-taking, suggesting that low-dose caffeine is sufficient to mask the risk-aversion caused by EGCG. These data suggest EGCG as a potential therapeutic treatment for psychological disorders that induce compulsive risky decision-making.

Protestantism and psychoactive drugs: implications for nursing and health / Protestantismo y drogas psicoactivas: implicaciones para la salud y la enfermería / Protestantismo e drogas psicoativas: implicações para a saúde e enfermagem

Objectives: To identify and analyze the social representations of psychoactive drugs to the protestant religious group and their implications for nursing care. Method: The data collection was carried out in the state and city of Rio de Janeiro, through the Free Evocation of Words technique. Results: The participants were 300 subjects divided into three subgroups with 100 Protestant evangelical subjects. Of them, 74.67% were female (224 participants) and 25.33%, males (76). Final thoughts: The assistance, taking into account the factors beyond spiritual, is beneficial not only for the patient, but also for the Nursing team, because it improves the spiritual awareness and understanding of the individual as a being beyond the disease.

Objetivos: Identificar y analizar las representaciones sociales de las drogas psicoactivas para el grupo religioso protestante y sus implicaciones para el cuidado de enfermería. Método: La recolección de datos se realizó en el estado y ciudad de Río de Janeiro, mediante la técnica de Evocación Libre de Palabras. Resultados: Los participantes fueron 300 sujetos divididos entres subgrupos con 100 sujetos evangélicos protestantes. De ellos, el 74,67% eran mujeres (224 participantes) y el 25,33%, hombres (76). Reflexiones finales: La asistencia, teniendo en cuenta los factores más allá de lo espiritual, es beneficiosa no solo para el paciente, sino también para el equipo de Enfermería, porque mejora la conciencia espiritual y la comprensión del individuo como un ser más allá de la enfermedad.

Objetivos: Identificar e analisar as representações sociais das drogas psicoativas para o grupo religioso protestante e suas implicações para o cuidado de enfermagem. Método: A coleta de dados foi realizada no estado e município do Rio de Janeiro, por meio da técnica de Evocação Livre de Palavras. Resultados: Participaram do estudo, 300 sujeitos divididos em grupos de 100 sujeitos para cada subgrupo de evangélicos protestantes. Dos quais 74,67% eram do gênero feminino (224 participantes) e 25,33 do gênero masculino (25,33%). Considerações Finais: A assistência levando-se em conta os fatores para além do espiritual é benéfica não apenas para o paciente, mas também para a equipe de Enfermagem, pois melhora a consciência espiritual e a compreensão do indivíduo como um ser para além da doença.

Prevalence of cathinones and other new psychoactive substances in hair of parents and children of families with known or suspected parental abuse of conventional illegal drugs.

BACKGROUND: Hair analysis of parents and their children was regularly used since 2011 as a diagnostic tool in a social support project for families with known or suspected abuse of conventional illegal drugs and revealed a high incidence of cocaine, cannabinoids, amphetamines, ecstasy and heroin. In this context, the prevalence of new psychoactive substances (NPS) in these families should be important for a realistic estimate of the situation. METHODS: The extracts of 1537 hair samples from 318 children (age 1-14 years), 44 adolescents and 611 adults, which were collected and tested for conventional drugs between June 2016 and April 2021 and frozen at -20 °C, were reanalyzed by a validated LC-MS/MS method (limits of quantitation 5-24 pg/mg) for 33 cathinones, 10 phenylethylamines, 5 piperazines including the antidepressant trazodone, 2 tryptamines, 9 designer benzodiazepines, 4 synthetic opioids and 4 ketamine-like substances including phencyclidine. RESULTS: Between one and up to five from 42 of these substances were detected in 227 samples (14.8%). The most frequently detected substances were benzedrone (62x), α-pyrrolidinovalerophenone (41x), N-ethylamphetamine (29x), dimethyltryptamine (13x) and pyrovalerone (11x). The quantification was possible only for 34 results of 15 drugs and the remaining majority of the results were unambiguously identified below LLOQ. The relative frequency of conventional drugs in the 227 NPS positive samples was higher than in all 1310 NPS negative samples for cocaine (69.6% vs. 56.0%), heroin (6-acetylmorphine 8.8% vs. 4.9%), amphetamine (16.3% vs. 7.7%) and MDMA (16.3% vs. 7.0%) but was similar for THC (38.3% vs. 36.3%) and benzodiazepines (1.8% vs. 1.7%). The high prevalence of N-ethylamphetamine can be explained as a byproduct of the illicit amphetamine synthesis from benzaldehyde and nitroethane rather than as a separate drug or as a combined metabolite of amphetamine and ethanol. The isolated appearance of 3-trifluoromethylphenylpiperazine in 9 hair samples collected in January 2017 can be caused either by its use as an NPS or by its formation as a metabolite of the medical drug flibanserin. The results were compared within 17 families whose members were tested at the same time and showed positive NPS results. The detected drugs agreed between both parents only in about half of the cases whereas the drugs found in children's hair was always detected also in hair of one or both parents. CONCLUSION: The re-testing of hair extracts for NPS after long-time storage in frozen state enables an impression about the relative high prevalence in the tested population group, despite the limitation by partial degradation of the substances and the corresponding impossibility in quantitative assessments. In addition to conventional drugs, the hair test for these substances should be useful in unclear cases of child's welfare endangerment and in family law.