迷幻剂与迷幻辅助心理疗法。
Psychedelics and Psychedelic-Assisted Psychotherapy.
机构信息
Department of Psychiatry, New York University School of Medicine, New York (Reiff); Department of Psychiatry and Human Behavior, Emory University School of Medicine, Atlanta (Richman, McDonald); Department of Psychiatry, Dell Medical School and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff); Department of Psychiatry and Human Behavior, Butler Hospital, Brown University, Providence, R.I. (Carpenter); Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., and Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin).
出版信息
Am J Psychiatry. 2020 May 1;177(5):391-410. doi: 10.1176/appi.ajp.2019.19010035. Epub 2020 Feb 26.
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," "-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), -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.
目的
作者提供了一份基于证据的文献综述，总结了迷幻药物在精神疾病中的临床应用。
方法
通过 Ovid 对 PubMed 和 PsycINFO 进行检索，查找 2007 年至 2019 年 7 月 1 日期间在同行评审期刊上发表的、以人类为研究对象、报告“裸盖菇素”“麦角酸二乙基酰胺”“LSD”“死藤水”“-亚甲二氧基甲基苯丙胺”和“MDMA”等药物在精神障碍中的临床应用的英文文献。共检索到 1603 篇文章，并进行筛选。标题或摘要中未包含“临床试验”“治疗”或“成像”的文章被过滤掉。剩余的 161 篇文章由两位或多位作者进行了审查。作者确定了 14 篇报告了麦角酸二乙基酰胺（LSD）、-亚甲二氧基甲基苯丙胺（MDMA）、裸盖菇素和死藤水治疗心境障碍和焦虑障碍、创伤和应激相关障碍以及物质相关和成瘾障碍以及临终关怀的精心设计的临床试验的文章。
结果
数据库最完备的是 MDMA 和裸盖菇素，这两种药物均被美国食品和药物管理局（FDA）指定为创伤后应激障碍（PTSD）和治疗抵抗性抑郁症的“突破性疗法”。LSD 和死藤水的研究为观察性研究，但现有证据表明，这些药物在特定精神障碍中可能具有治疗作用。
结论
随机临床试验支持 MDMA 治疗 PTSD 和裸盖菇素治疗抑郁症和癌症相关焦虑的疗效。支持 LSD 和死藤水在治疗精神障碍中的应用的研究尚处于初步阶段，但很有前景。总体而言，目前还没有足够的数据库来支持 FDA 批准任何迷幻化合物在精神障碍的常规临床应用，但有必要继续研究迷幻药物治疗精神障碍的疗效。
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