Butler Matthew, Seynaeve Mathieu, Nicholson Timothy R, Pick Susannah, Kanaan Richard A, Lees Andrew, Young Allan H, Rucker James
The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Ther Adv Psychopharmacol. 2020 May 11;10:2045125320912125. doi: 10.1177/2045125320912125. eCollection 2020.
Functional neurological disorder (FND), formerly known as conversion disorder, causes a high burden of disability and distress, and is amongst the most commonly encountered conditions in neurology clinics and neuropsychiatric services, yet the therapeutic evidence base is somewhat limited. There has been recent interest in the therapeutic potential of psychedelics such as psilocybin and lysergic acid diethylamide (LSD), and in recent studies psychedelics have shown promise in treating a range of neuropsychiatric conditions. Modification of neural circuits associated with self-representation is thought to underlie some of this effect, and as some contemporary theories of FND focus on aberrant somatic self-representation, psychedelics may therefore represent an unexplored treatment option for FND. We systematically reviewed studies involving the use of psychedelics in FND. Nine studies published between 1954 and 1967, with a total of 26 patients, were identified. Due to restriction of licencing of psychedelic drugs since this period, no modern studies were identified. In most cases, patients received a course of psychotherapy with variable adjunctive administration of psychedelics (in a combination known as 'psycholytic therapy'), with protocols varying between studies. Of those treated, 69% ( = 18) were found to have made at least some recovery on heterogeneous and subjective clinician-rated criteria. Adverse events were mostly mild and transient; however, at least one patient terminated the study due to distressing effects. All included studies were of low quality, often lacking control groups and valid outcome measures. Although no conclusions on efficacy may be drawn from these data, further research may help to determine whether psychedelics offer a feasible, safe and effective treatment for FND.
功能性神经障碍（FND），以前称为转换障碍，会导致严重的残疾和痛苦负担，是神经科诊所和神经精神科服务中最常见的病症之一，但其治疗证据基础在一定程度上较为有限。最近，人们对裸盖菇素和麦角酸二乙胺（LSD）等迷幻药的治疗潜力产生了兴趣，并且在最近的研究中，迷幻药已显示出治疗一系列神经精神疾病的前景。与自我表征相关的神经回路的改变被认为是这种效应的部分基础，并且由于一些当代FND理论关注异常的躯体自我表征，因此迷幻药可能代表了一种尚未被探索的FND治疗选择。我们系统地回顾了涉及在FND中使用迷幻药的研究。共确定了1954年至1967年间发表的9项研究，涉及26名患者。由于自该时期以来迷幻药的许可限制，未找到现代研究。在大多数情况下，患者接受了一个心理治疗疗程，并辅以不同的迷幻药给药方式（以一种称为“精神分解疗法”的组合形式），各研究的方案有所不同。在接受治疗的患者中，根据临床医生评定的异质性和主观标准，发现69%（n = 18）至少有一定程度的康复。不良事件大多轻微且短暂；然而，至少有一名患者因不良影响而终止了研究。所有纳入的研究质量都很低，通常缺乏对照组和有效的结局指标。尽管从这些数据中无法得出关于疗效的结论，但进一步的研究可能有助于确定迷幻药是否为FND提供一种可行、安全且有效的治疗方法。
