This article proposes 10 points considered essential on the ethics associated with the practice of psychotherapy assisted by psychedelics (PAP) : 1) respect of the legal framework (LStup) of the use of psychotropic drugs ; 2) adequately manage psychedelics (storage, production and safety) ; 3) announce adverse effects to the competent authority ; 4) guarantee a psychotherapeutic follow-up ; 5) guarantee the safety of the patients during the treatment ; 6) establish indications on the basis of scientific evidence ; 7) do not confuse personal recreational use and strict medical use ; 8) avoid proselytizing or bad medical practices ; 9) do not to consider the personal consumption of psychedelics as a competency in care and 10) ensure that access to care is equitable and reasonable.
Cet article propose 10 points jugés essentiels au sujet de la déontologie associée à la pratique de la psychothérapie assistée par psychédéliques (PAP) : 1) Respecter le cadre légal (LStup) de l'utilisation des psychotropes ; 2) gérer les psychédéliques de manière adéquate (stockage, production et sécurité) ; 3) annoncer les effets indésirables à la pharmacovigilance ; 4) garantir un suivi psychothérapeutique ; 5) garantir la sécurité des patients lors du traitement ; 6) poser les indications sur la base des évidences scientifiques ; 7) ne pas confondre l'usage récréatif personnel et un usage médical strict ; 8) éviter le prosélytisme ou les mauvaises pratiques médicales ; 9) ne pas considérer la consommation personnelle de psychédéliques comme faisant office de compétence en matière de soins et 10) veiller à rendre l'accès aux soins équitables et raisonnables.
Drug-Related Side Effects and Adverse Reactions , Hallucinogens , Humans , Hallucinogens/adverse effects , Psychotherapy , Group Processes
Psilocybin is increasingly studied for its antidepressant effect, but its optimal dosage for depression remains unclear. We conducted a systematic review and a dose-response meta-analysis to find the optimal dosage of psilocybin to reduce depression scores. Following our protocol (CRD 42022220190) multiple electronic databases were searched from their inception until February 2023, to identify double-blind randomized placebo-controlled (RCTs) fixed-dose trials evaluating the use of psilocybin for adult patients with primary or secondary depression. A one-stage dose-response meta-analysis with restricted cubic splines was used. Cochrane risk of bias was used to assess risk of bias. Our analysis included seven studies with a total of 489 participants. Among these, four studies focused on primary depression (N = 366), including one study with patients suffering from treatment-resistant depression. The remaining three studies examined secondary depression (N = 123). The determined 95% effective doses per day (ED95) were 8.92, 24.68, and 36.08 mg/70 kg for patients with secondary depression, primary depression, and both subgroups, respectively. We observed significant dose-response associations for all curves, each plateauing at different levels, except for the bell-shaped curve observed in the case of secondary depression. Additionally, we found significant dose-response associations for various side effects, including physical discomfort, blood pressure increase, nausea/vomiting, headache/migraine, and the risk of prolonged psychosis. In conclusion, we discovered specific ED95 values for different populations, indicating higher ED95 values for treatment-resistant depression, primary depression, and secondary depression groups. Further RCTs are necessary for each population to determine the optimal dosage, allowing for maximum efficacy while minimizing side effects.
Depression , Psychotic Disorders , Adult , Humans , Depression/drug therapy , Psilocybin/adverse effects , Antidepressive Agents/therapeutic use , Psychotic Disorders/drug therapy , Randomized Controlled Trials as Topic
BACKGROUND: Despite the growth of psychedelic research, psychedelic-assisted group psychotherapy (PAGP) has received little attention in comparison to individual psychedelic-assisted psychotherapy models. METHODS: In this article, we aim to discuss the therapeutic potential of PAGP, as well as outline existing models and the challenges of this approach. Using Irvin Yalom's 11 therapeutic factors of group therapy as a basic framework, we analyse current literature from clinical studies and neurobiological research relative to the topic of PAGP. RESULTS: We argue that combining psychedelic substances and group psychotherapy may prove beneficial for increasing group connectedness and interpersonal learning, potentially enhancing prosocial behaviour with direct opportunities to practice newly acquired knowledge about previously maladaptive behavioural patterns. Challenges regarding this approach include a more rigid therapy structure and potential loss of openness from patients, which may be ameliorated by adequate therapeutic training. CONCLUSION: We hope for this article to support clinical research on PAGP by presenting a therapeutic framework and outlining its mechanisms and challenges.
Hallucinogens , Psychotherapy, Group , Humans , Hallucinogens/pharmacology , Hallucinogens/therapeutic use , Psychotherapy
BACKGROUND: Problematic interpersonal patterns, as defined by the core conflictual relationship theme (CCRT) method, are part of the clinical presentation of clients with borderline personality disorder (BPD). So far, we do not know whether the pervasiveness of interpersonal patterns changes and if this change explains therapy outcome. METHODS: In a secondary analysis of a randomized controlled trial on a brief version of psychiatric treatment for BPD, a treatment with a psychodynamic focus, the present study included N = 39 clients. One early session and one late session of the treatment were transcribed and analyzed using the CCRT method. RESULTS: It appeared that pervasiveness of the predominant CCRT decreased over the course of the brief treatment; this effect was robust across treatment conditions. Change in pervasiveness in any CCRT component explained a small portion of variance of the decrease in borderline symptoms observed at the end of treatment. DISCUSSION: Lessening of pervasiveness of problematic in-session interpersonal patterns may be hypothesized as potential mechanism of effective treatment for BPD which should be tested in controlled designs.
Borderline Personality Disorder , Borderline Personality Disorder/psychology , Humans , Psychotherapy/methods , Treatment Outcome
The practice of microdosing, which consists of ingesting a hallucinogen at 5-10% of a dose that would induce a psychedelic effect, has recently been the subject of growing interest by the media. The craze for microdosing has been relayed by the supposed effects of increased performance and creativity reported by professionals, especially in Silicon Valley. Despite this strong public interest, the evidence supporting this practice remains preliminary. Available studies are mostly based on single doses, leaving open the question of a possible stronger effect with regular doses. LSD's main effect is on the serotonin system, in particular on 5-HT2A receptors, a receptor involved in neurobiological processes underlying learning.
La pratique du microdosage, qui consiste à ingérer un hallucinogène à 5-10 % d'une dose qui induirait un effet psychédélique, a récemment fait l'objet d'un intérêt croissant par les médias. L'engouement constaté pour le microdosage a été relayé par des effets d'augmentation de performance et de créativité rapportés par les milieux professionnels, notamment de la Silicon Valley. Malgré ce vif intérêt public, les évidences soutenant cette pratique restent préliminaires. Les études disponibles sont pour la plupart basées sur des prises uniques, laissant ouverte la question d'un effet éventuel plus marqué avec la prise de doses régulières. Le LSD exerce ses principaux effets sur le système sérotoninergique, en particulier sur les récepteurs 5-HT2A, impliqués dans des processus neurobiologiques sous-tendant l'apprentissage.
Hallucinogens , Lysergic Acid Diethylamide , Creativity , Humans
The development of research, clinical practice and prevention in addiction medicine is, compared to other disciplines, more influenced by socio-political factors. Research on psychedelics has thus long been hampered by prohibitive policy but has recently been revived thanks to the relaxation of these political positions. The extensive prescription of baclofen for alcohol addiction is mainly the consequence of popular support and has so far not been clearly supported by specific research. The aim of the new Gambling Act was to harmonize the regulatory provisions for lotteries and betting on the one hand and casino gambling on the other, while at the same time opening up the market for online gambling.
Le développement de la recherche, de la pratique clinique et de la prévention en addictologie est davantage influencé par les circonstances sociopolitiques que dans de nombreuses autres disciplines. La recherche sur les psychédéliques a ainsi longtemps été entravée par une politique prohibitive mais a été relancée récemment grâce à l'assouplissement de ces positions politiques. La prescription importante du baclofène pour traiter l'addiction à l'alcool est principalement la conséquence d'un soutien populaire et n'est jusqu'à présent pas clairement appuyée par la recherche spécifique. Le but de la nouvelle loi sur les jeux d'argent était d'harmoniser les dispositifs de régulation concernant les loteries et paris d'une part et les jeux de casinos d'autre part, tout en ouvrant le marché des jeux en ligne.
Addiction Medicine/trends , Gambling , Gambling/economics , Gambling/prevention & control , Humans , Politics
