INTRODUCTION: A limited number of preliminary open-label (n = 3) and placebo-controlled clinical trials (n = 5) have suggested psilocybin and LSD as potential rapid antidepressants. In this context, there is a growing need to verify and document their safety and tolerability as therapeutic agents, discuss the challenges associated with their administration, and develop safety protocols for their use as next-generation therapeutic agents. AREAS COVERED: We have analyzed all randomized, double-blind, and controlled trials that assessed the antidepressant effects of psilocybin and LSD in clinical populations to date, taking special attention to adverse events (AEs) related to their use. Prevalence, significance, and mechanisms of action related to AEs were systematically extracted, analyzed, and discussed. EXPERT OPINION: There were no serious AEs related to psilocybin and LSD administration. Most AEs were expected, manageable, and transient. Nevertheless, safety and tolerability concerns regarding some effects, such as dissociation, paranoia, and confusion, remain. Thus, randomized controlled trials with bigger samples are warranted to confirm their therapeutic effects and further investigate their safety and tolerability.
Antidepressive Agents , Lysergic Acid Diethylamide , Psilocybin , Antidepressive Agents/adverse effects , Humans , Lysergic Acid Diethylamide/adverse effects , Psilocybin/adverse effects , Randomized Controlled Trials as Topic
INTRODUCTION: Ayahuasca is a psychedelic brew originally used by Amazonian indigenous groups and in religious rituals. Pre-clinical and observational studies have demonstrated its possible potential as an antidepressant, and open- and placebo-controlled clinical trials corroborated these results. For it to become an approved treatment for depression, its safety and tolerability need to be assessed and documented. AREAS COVERED: We have gathered data regarding the occurrence of adverse events (AEs) in all reported randomized, placebo-controlled trials with healthy and clinical populations involving ayahuasca administration (n = 108 ayahuasca administrations). We systematically categorized these results, recorded their prevalence, and discussed the possible mechanisms related to their emergence. EXPERT OPINION: There were no reports of serious AEs, indicating a relative safety of ayahuasca administration in controlled settings. Most common AEs included nausea, vomiting, headaches, and transient increases in cardiovascular measurements. Ayahuasca research is still in its infancy, especially concerning the absence of large and robust clinical trials to verify its antidepressant effects. Dose standardization, legal prohibition of the possession of its alkaloids and how traditional communities will be compensated if ayahuasca becomes an approved medicine are the biggest obstacles to overcome for its future use in the therapeutic context.
Antidepressive Agents , Banisteriopsis , Antidepressive Agents/adverse effects , Banisteriopsis/adverse effects , Humans , Randomized Controlled Trials as Topic
Rationale: Previous studies with the serotonergic hallucinogens LSD and psilocybin showed that these drugs induced changes in personality traits, such as increases in Openness. However, results are inconsistent, and the effects of ayahuasca on personality were never investigated in a controlled trial. Objectives: To assess the effects of ayahuasca on personality in two randomized, placebo-controlled trials in healthy volunteers. Methods: Data from two parallel-group, randomized, placebo-controlled trials in healthy volunteers were included. In the first trial, 15 volunteers ingested ayahuasca or placebo, while in the second trial 15 volunteers received placebo+ayahuasca or cannabidiol (CBD)+ayahuasca. Personality was assessed with the NEO-Five Factor Inventory (NEO-FFI) at baseline and 21 days post-treatment. Results: There were significant differences between groups in baseline Openness scores, but not on day 21. A significant increase in Openness scores was observed in the placebo + ayahuasca group in study 2. No other within-group differences were observed for any other domain. Conclusions: Ayahuasca produced inconsistent effects on personality since it induced significant increase in Openness 21 days post-drug intake only in one of the trials. The absence of significant differences in the other ayahuasca groups could be due to small sample sizes and baseline differences among groups. The effects of ayahuasca and other serotonergic hallucinogens on personality should be further investigated in clinical samples.
Introducción: En este artículo se analizan los datos del equipo técnico (psicólogo, trabajador social y educador) del juzgado de menores de Toledo (España) desde el año 2001 a 2012. Metodología: Estudio descriptivo de la serie anual de una muestra de 3.333 menores infractores y de sus características psicosociales, educativas y delictivas. Resultados: En los últimos años de la serie se tiende a infracciones de mayor gravedad cometidas por chicos de mayor edad. Conclusiones: La delincuencia de menores en esta provincia desde el año 2001 se mantuvo constante hasta el año 2009, en el que se observa un destacado repunte para volver a bajar durante los años 2011 y 2012. Sin embargo, en los últimos años de la serie (a partir de 2008) se constata un aumento de la gravedad de los hechos, al ser significativamente más numerosos los delitos que las faltas. También se ha detectado que probablemente el sistema infradiagnostica a los menores infractores, tanto en problemas de salud mental como en consumo de alcohol y otras drogas. Por lo tanto, estos menores no se beneficiarían adecuadamente de las medidas impuestas por el sistema de justicia juvenil
Introduction: This paper presents an analysis of the data of the technical team (psychologist, social worker and educator) of the juvenile court of Toledo (Spain) from 2001 to 2012. Methodology: Descriptive study of the annual series of a sample of 3,333 juvenile offenders and their psychosocial, educational and criminal characteristics. Results: In the latter years of the series there tends to be infractions of greater gravity committed by older boys. Conclusions: Juvenile delinquency in the province of Toledo remained constant from 2001 until 2009, when a sharp increase was observed, which lowered again during the years 2011 and 2012. However, in the latter years of the series (starting 2008) an increase in the gravity of the acts is noted, with the number of crimes increasing more significantly than the misdemeanours. The team has also detected that perhaps institutions underestimate the diagnosis of the juvenile misdemeanours, even in mental health issues, such as abuse of alcohol and other substances. Therefore, these minors may not achieve the benefits of the justice youth system
Humans , Male , Female , Adolescent , Juvenile Delinquency/statistics & numerical data , Psychosocial Impact , Crime/classification , Crime/statistics & numerical data , Spain/epidemiology , Socioeconomic Factors
INTRODUCTION: Structural and functional abnormalities of the cerebral circuits involved in affect regulation are associated with the display of violent behaviors. The prefrontal cortex hypofunction linked to the subcortical structural hyperactivity is related to impulsive aggression. AIM: To review the current state of the neuropsychological studies concerning the possible dysfunctions in individuals who show violent and antisocial behaviors, considering the contributions for prevention and treatment. DEVELOPMENT: There is more and more evidence in favour of a neuroanatomical substrate which may represent a vulnerability factor in the expression of aggressive and antisocial behaviors. Recent studies with neuroimaging techniques show the crucial role of the prefrontal cortex and the limbic system, which are cerebral circuits in charge of affect regulation and the origins of impulsive aggressive behaviors. The importance of the functional balance of these regions is highlighted, as well as the role of impulsivity and abnormal affect control in the display of these behaviors. In addition, a view of differential underlying mechanisms of impulsive and premeditated aggression is supported. CONCLUSIONS: The study of the possible neuroanatomical and functional substrates of the impulsive aggressive behaviors, linked to the study of the psychosocial factors may be relevant from neuropsychological perspective. This comprehensive view may contribute to a better understanding of antisocial behavior.
Aggression , Brain , Impulsive Behavior , Aggression/physiology , Aggression/psychology , Brain/anatomy & histology , Brain/pathology , Brain/physiopathology , Child , Emotions/physiology , Humans , Impulsive Behavior/pathology , Impulsive Behavior/physiopathology , Impulsive Behavior/psychology , Neuropsychology
Introducción. La alteración estructural y funcional de los circuitos cerebrales implicados en la modulación emocional está asociada a la aparición de conductas violentas. La hipofunción del córtex prefrontal, unida a la hiperactividad de las estructuras subcorticales, se vincula a la agresión de corte impulsivo. Objetivo. Revisar el estado actual de las investigaciones de neuroimagen sobre las posibles alteraciones en sujetos que presentan conductas violentas y antisociales, considerando las implicaciones para su prevención y tratamiento. Desarrollo. Cada vez existe mayor evidencia a favor de un correlato neuroanátomico que representaría un factor de vulnerabilidad en el desencadenamiento de conductas agresivas y antisociales. Recientes estudios empleando técnicas de neuroimagen muestran el papel crucial del córtex prefrontal y del sistema límbico, que son circuitos cerebrales encargados de la regulación emocional y de la génesis de comportamientos agresivos de carácter impulsivo. Se pone de manifiesto la importancia en el equilibrio funcional relativo de estas regiones y el papel de la impulsividad y el deficitario control emocional en la aparición de estas conductas. Asimismo, se aboga por la diferenciación entre agresión impulsiva y agresión premeditada, y la posible existencia de mecanismos subyacentes diferentes. Conclusiones. Desde la perspectiva de la neuropsicología es relevante el estudio de los posibles correlatos neuroanatómicos y funcionales de las conductas agresivas de carácter impulsivo, que, junto con la investigación de factores psicosociales, pueda aportar una visión integral que favorezca la comprensión de la conducta antisocial (AU)
Introduction. Structural and functional abnormalities of the cerebral circuits involved in affect regulation are associated with the display of violent behaviors. The prefrontal cortex hypofunction linked to the subcortical structural hyperactivity is related to impulsive aggression. Aim. To review the current state of the neuropsychological studies concerning the possible dysfunctions in individuals who show violent and antisocial behaviors, considering the contributions for prevention and treatment. Development. There is more and more evidence in favour of a neuroanatomical substrate which may represent a vulnerability factor in the expression of aggressive and antisocial behaviors. Recent studies with neuroimaging techniques show the crucial role of the prefrontal cortex and the limbic system, which are cerebral circuits in charge of affect regulation and the origins of impulsive aggressive behaviors. The importance of the functional balance of these regions is highlighted, as well as the role of impulsivity and abnormal affect control in the display of these behaviors. In addition, a view of differential underlying mechanisms of impulsive and premeditated aggression is supported. Conclusions. The study of the possible neuroanatomical and functional substrates of the impulsive aggressive behaviors, linked to the study of the psychosocial factors may be relevant from neuropsychological perspective. This comprehensive view may contribute to a better understanding of antisocial behavior (AU)
Humans , Impulsive Behavior/psychology , Aggression/psychology , Antisocial Personality Disorder/psychology , Neuropsychological Tests , Emotions
INTRODUCTION AND OBJECTIVE: This study analyses the neuropsychological profile of a sample of cocaine addicts and compares it with a control group from the same social environment. Also, it explores the predictive power of some neuropsychological tests on treatment outcome six months after the exploration. PARTICIPANTS AND METHOD: We administered a neuropsychological battery to 30 patients with a diagnosis of cocaine abuse or cocaine dependence, and to 30 control participants with no history of drug abuse from the same social environment. RESULTS: Verbal learning (p<0.001), immediate visual memory (p<0.05), attentional resources management (p<0.05), phonologic fluency (p<0.01), abstraction (p<0.001), complex problem-solving (p<0.05) and mental flexibility (p<0.05) are the functions most affected by cocaine use. DISCUSSION AND CONCLUSIONS: The alterations found in the addict participants were small and non-pathognomonic, though the deficits can be correlated with impact on quality of life and on everyday occupational performance. The neuropsychological exploration showed a certain predictive capacity of abstinence after 6 months (the addict participants with better verbal mnesic performance and greater mental flexibility at the beginning of the treatment seem to benefit more from this). Finally, the results suggest that addicts live in a cognitively poor social environment. It is suggested that drug use increases previous deficits, probably of an educational or environmental origin, that are common to their immediate social context.
Cocaine-Related Disorders/psychology , Cocaine-Related Disorders/therapy , Cognition , Memory , Social Environment , Adult , Female , Humans , Male , Neuropsychological Tests , Prognosis , Treatment Outcome
OBJECTIVE: Several studies have shown evidence of executive function impairment associated with substance abuse. This suggests the potential usefulness of a baseline assessment measure to screen for dysexecutive impairments in individuals beginning treatment. The Dysexecutive Questionnaire (DEX) is a test widely used to estimate executive dysfunction. The main objective of this work is to study the psychometric properties of the Spanish version of the Dysexecutive Questionnaire (DEX-Sp). A complementary goal is to study its potential utility for initial screening in addicted individuals seeking treatment. METHOD: A sample of 131 non-clinical and 127 clinical individuals meeting the DSM-IV-TR substance abuse or dependence criteria were recruited. RESULTS: Internal consistency of the questionnaire was assessed (Cronbach's Alfa=0.91), as well as other reliability indicators. Exploratory and confirmatory factor analysis offers four- and five-factor solutions. Also tested were the dimensionality and structural model and its convergent and discriminant validity with other instruments. Differences between clinical and non-clinical individuals and total scores were also analyzed. CONCLUSIONS: The data suggest that the Spanish version of the DEX is a useful measure for assessing general symptoms of dysexecutive syndrome, and a valid, reliable and adequate screening test for estimating cognitive impairment associated with substance abuse.
Frontal Lobe/physiopathology , Substance-Related Disorders/physiopathology , Surveys and Questionnaires , Adult , Female , Humans , Language , Male , Psychometrics , Substance-Related Disorders/diagnosis
Introducción y objetivo. El presente estudio analiza el perfil neuropsicológico de una muestra de adictos a la cocaína y lo compara con el de un grupo control extraído de su entorno social cercano. A su vez, pretende explorar la capacidad predictiva de algunas pruebas neuropsicológicas sobre los resultados del tratamiento a los seis meses de la exploración. Sujetos y método. Se administra una batería neuropsicológica a 30 pacientes con abuso o dependencia a la cocaína y otros 30 participantes de su ambiente social próximo. Resultados. Se observa cómo el aprendizaje verbal (p<0,001) y la memoria visual inmediata (p<0,05), la gestión de los recursos atencionales (p<0,05), la fluidez fonológica (p<0,01), la abstracción (p<0,001), la resolución de problemas complejos (p<0,05) y la flexibilidad cognitiva (p<0,05) son las funciones más afectadas por el consumo de cocaína. Discusión y conclusiones. Las alteraciones halladas en el rendimiento de los adictos son sutiles y no patognomónicas, si bien se pueden correlacionar los déficits con el impacto en la calidad de vida y el desempeño ocupacional cotidiano. La exploración neuropsicológica ha mostrado una cierta capacidad predictiva del estado de la abstinencia a los 6 meses (los adictos con mejor rendimiento amnésico verbal y mayor flexibilidad cognitiva en el momento de iniciar el tratamiento parecen beneficiarse mejor de éste). Por último, los resultados reflejan que los adictos se desenvuelven en un ambiente cognitivamente empobrecido. Se sugiere que el consumo de la sustancia acrecienta déficits previos, probablemente de origen educacional o ambiental, que son comunes a su entorno social próximo (AU)
Introduction and objective. This study analyses the neuropsychological profile of a sample of cocaine addicts and compares it with a control group from the same social environment. Also, it explores the predictive power of some neuropsychological tests on treatment outcome six months after the exploration. Participants and method. We administered a neuropsychological battery to 30 patients with a diagnosis of cocaine abuse or cocaine dependence, and to 30 control participants with no history of drug abuse from the same social environment. Results. Verbal learning (p<0.001), immediate visual memory (p<0.05), attentional resources management (p<0.05), phonologicfluency (p<0.01), abstraction (p<0.001), complex problem-solving (p<0.05) and mental flexibility (p<0.05) are the functions most affected by cocaine use. Discussion and conclusions. The alterations found in the addict participants were small and non-pathognomonic, though the deficits can be correlated with impact on quality of life and on everyday occupational performance. The neuropsychological exploration showed a certain predictive capacity of abstinence after 6 months (the addict participants with better verbal amnesic performance and greater mental flexibility at the beginning of the treatment seem to benefit more from this). Finally, the results suggest that addicts live in a cognitively poor social environment. It is suggested that drug use increases previous deficits, probably of an educational or environmental origin, that are common to their immediate social context (AU)
Humans , Male , Female , Cocaine-Related Disorders/psychology , Cocaine-Related Disorders/therapy , Neuropsychology , Social Environment , Cognition Disorders/diagnosis , Attention , Memory , Cocaine/adverse effects , Neuropsychological Tests , Quality of Life
Objetivo: Diversos estudios han evidenciado el deterioro de las funciones ejecutivas asociado al abuso de sustancias. Este hecho sugiere la conveniencia de contar con algún instrumento de cribado que sirva para establecer una línea base sobre los déficits que presentan los sujetos que inician tratamiento. El Cuestionario Disejecutivo (DEX) es un test ampliamente utilizado para estimar disfunción ejecutiva. El principal objetivo del presente trabajo se centra en estudiar las propiedades de la versión española del Cuestionario Disejecutivo (DEX-Sp). Complementariamente se pretende estudiar su potencial utilidad como instrumento de cribado en adictos en tratamiento. Método: 131 sujetos de población no clínica y 127 adictos (con criterios DSM-IVTR para abuso o dependencia). Resultados: Se estudia la consistencia interna (¬ de Cronbach = 0,91) entre otros indicadores de fiabilidad. El análisis factorial exploratorio y confirmatorio ofrece soluciones de 4 y 5 factores. Se estudió la dimensionalidad y el modelo estructural de base, así como la validez convergente y discriminante. Se estudiaron las diferencias apreciadas entre adictos y población no clínica. Conclusiones: Los datos sugieren que la versión española del DEX es un instrumento útil para evaluar síntomas disejecutivos generales, con la suficiente fiabilidad y validez para explorar deterioro cognitivo asociado al abuso desustancias (AU)
Objective: Several studies have shown evidence of executive function impairment associated with substance abuse. This suggests the potential usefulness of a baseline assessment measure to screen for dysexecutive impairments in individuals beginning treatment. The Dysexecutive Questionnaire (DEX) is a test widely used to estimate executive dysfunction. The main objective of this work is to study the psychometric properties of the Spanish version of the Dysexecutive Questionnaire (DEX-Sp). A complementary goal is to study its potential utility for initial screening in addicted individuals seeking treatment. Method: A sample of 131 non-clinical and 127 clinical individuals meeting the DSM-IV-TR substance abuse or dependence criteria were recruited. Results: Internal consistency of the questionnaire was assessed (Cronbachs ¬ =0.91), as well as other reliability indicators. Exploratory and confirmatory factor analysis offers four- and five-factor solutions. Also tested were the dimensionality and structural model and its convergent and discriminant validity with other instruments. Differences between clinical and non-clinical individuals and total scores were also analyzed. Conclusions: The data suggest that the Spanish version of the DEX is a useful measure for assessing general symptoms of dysexecutive syndrome, and a valid, reliable and adequate screening test for estimating cognitive impairment associated with substance abuse (AU)
Humans , Male , Female , Frontal Lobe/physiopathology , Syndrome , Substance-Related Disorders , Neurobehavioral Manifestations , Surveys and Questionnaires , Factor Analysis, Statistical , Psychometrics , Mass Screening
Cardiovascular Diseases/chemically induced , Chemical and Drug Induced Liver Injury , Cognition/drug effects , Memory/drug effects , N-Methyl-3,4-methylenedioxyamphetamine/adverse effects , Clinical Trials as Topic , Combined Modality Therapy , Humans , N-Methyl-3,4-methylenedioxyamphetamine/therapeutic use , Psychotherapy , Stress Disorders, Post-Traumatic/therapy
Hallucinogens/therapeutic use , N-Methyl-3,4-methylenedioxyamphetamine/therapeutic use , Rape/psychology , Stress Disorders, Post-Traumatic/drug therapy , Stress Disorders, Post-Traumatic/etiology , Adult , Clinical Trials as Topic , Combined Modality Therapy , Female , Hallucinogens/administration & dosage , Humans , N-Methyl-3,4-methylenedioxyamphetamine/administration & dosage , Psychotherapy/methods , Stress Disorders, Post-Traumatic/therapy
No disponible
Adult , Aged , Male , Female , Humans , Stress Disorders, Post-Traumatic , N-Methyl-3,4-methylenedioxyamphetamine , Myositis, Inclusion Body , Rape , Psychotherapy , Combined Modality Therapy , Hallucinogens , Sjogren's Syndrome
