Psychedelics and Psychedelic-Assisted Psychotherapy.

(Reprinted with permission from The American Journal of Psychiatry 2020; 177:391-410).

Psychedelics and Psychedelic-Assisted Psychotherapy.

OBJECTIVE: The authors provide an evidenced-based summary of the literature on the clinical application of psychedelic drugs in psychiatric disorders. METHODS: Searches of PubMed and PsycINFO via Ovid were conducted for articles in English, in peer-reviewed journals, reporting on "psilocybin," "lysergic acid diethylamide," "LSD," "ayahuasca," "3,4-methylenedioxymethamphetamine," and "MDMA," in human subjects, published between 2007 and July 1, 2019. A total of 1,603 articles were identified and screened. Articles that did not contain the terms "clinical trial," "therapy," or "imaging" in the title or abstract were filtered out. The 161 remaining articles were reviewed by two or more authors. The authors identified 14 articles reporting on well-designed clinical trials investigating the efficacy of lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (MDMA), psilocybin, and ayahuasca for the treatment of mood and anxiety disorders, trauma and stress-related disorders, and substance-related and addictive disorders as well as in end-of-life care. RESULTS: The most significant database exists for MDMA and psilocybin, which have been designated by the U.S. Food and Drug Administration (FDA) as "breakthrough therapies" for posttraumatic stress disorder (PTSD) and treatment-resistant depression, respectively. The research on LSD and ayahuasca is observational, but available evidence suggests that these agents may have therapeutic effects in specific psychiatric disorders. CONCLUSIONS: Randomized clinical trials support the efficacy of MDMA in the treatment of PTSD and psilocybin in the treatment of depression and cancer-related anxiety. The research to support the use of LSD and ayahuasca in the treatment of psychiatric disorders is preliminary, although promising. Overall, the database is insufficient for FDA approval of any psychedelic compound for routine clinical use in psychiatric disorders at this time, but continued research on the efficacy of psychedelics for the treatment of psychiatric disorders is warranted.

Learning to be interprofessional advocates in the public sector.

Engaging in advocacy is an ethical responsibility for behavioral health professionals, as reflected in professional competencies across disciplines and in personal accounts of wanting to affect change at various levels of patients'/clients' and communities' ecologies. However, the literature is replete with examples of barriers to routine advocacy engagement, including lack of an organized structure into which efforts can be embedded. There exists the desire among behavioral health professionals to engage in more advocacy work, yet a shared sense of not knowing how to incorporate this work into existing professional roles. One way to address these barriers is to establish more collaborative advocacy work environments within the public sector settings that employ behavioral health professionals. This article offers the first descriptive account of developing, implementing, and maintaining such a collaborative interprofessional advocacy workgroup. To that end, this case study is one example of such a group, the Atlanta Behavioral Health Advocates, based within the Emory University School of Medicine in the Department of Psychiatry and Behavioral Sciences and situated also within Grady Health System, a public health care system. This paper details our experiences forming and engaging in this group, which we believe can serve as a model for others developing similar advocacy workgroups in public sector settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

α-Pyrrolidinopentiophenone ("Flakka") Catalyzing Catatonia: A Case Report and Literature Review.

: Synthetic cathinones are a class of novel psychoactive substances. α-Pyrrolidinopentiophenone (α-PVP), or "Flakka", is one of these substances. Users often present acutely psychotic or agitated. We present the case of a 20-year-old male without prior psychiatric history who was brought to the hospital by his family because of increasingly bizarre and erratic behavior after reported ingestion of Flakka. What ensued was a prolonged course of psychosis and severe catatonia. Synthetic cathinones are thought to cause catatonia in approximately 1% of cases. Awareness of the possible presentations associated with α-PVP intoxication is increasingly important and should be further explored, as they can have important implications in setting expectations for care. Additionally, providers should have a low threshold for asking patients about bath salt ingestion.

Family as the primary caregiver: palliative care in the Golan Heights.

Palliative care is recognised by the WHO as an essential component of care for the seriously ill. Geographically isolated and historically underserved communities, particularly from ethnic minority groups, face obstacles in obtaining adequate palliative care. This case involves the care of a 26-year-old Druze man suffering from a terminal cancer in his Golan Heights village. Local physicians were able to train the patient's father in a palliative care capacity. In the effort of capacity building, the physician and palliative care team also aided the aggrieved family in the process of coping. Robust support networks, both at state and community levels, facilitated the care provided. In showcasing the role of the national and local safety net in activating and building community resources to address a dearth of palliative care services in disadvantaged regions, this case models a potentially effective community-based approach to palliative care for patients from underserved populations.