University Center of Psychiatry, University Medical Center Groningen, Postbus 30.001, 9700 RB, Groningen, The Netherlands.
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
CNS Drugs. 2020 Sep;34(9):925-946. doi: 10.1007/s40263-020-00748-y.
Interest in the use of psychedelic substances for the treatment of mental disorders is increasing. Processes that may affect therapeutic change are not yet fully understood. Qualitative research methods are increasingly used to examine patient accounts; however, currently, no systematic review exists that synthesizes these findings in relation to the use of psychedelics for the treatment of mental disorders.
To provide an overview of salient themes in patient experiences of psychedelic treatments for mental disorders, presenting both common and diverging elements in patients' accounts, and elucidating how these affect the treatment process.
We systematically searched the PubMed, MEDLINE, PsycINFO, and Embase databases for English-language qualitative literature without time limitations. Inclusion criteria were qualitative research design; peer-reviewed studies; based on verbalized patient utterances; and a level of abstraction or analysis of the results. Thematic synthesis was used to analyze and synthesize results across studies. A critical appraisal of study quality and methodological rigor was conducted using the Critical Appraisal Skills Programme (CASP).
Fifteen research articles, comprising 178 patient experiences, were included. Studies exhibited a broad heterogeneity in terms of substance, mental disorder, treatment context, and qualitative methodology. Substances included psilocybin, lysergic acid diethylamide (LSD), ibogaine, ayahuasca, ketamine and 3,4-methylenedioxymethamphetamine (MDMA). Disorders included anxiety, depression, eating disorders, post-traumatic stress disorder, and substance use disorders. While the included compounds were heterogeneous in pharmacology and treatment contexts, patients reported largely comparable experiences across disorders, which included phenomenological analogous effects, perspectives on the intervention, therapeutic processes and treatment outcomes. Comparable therapeutic processes included insights, altered self-perception, increased connectedness, transcendental experiences, and an expanded emotional spectrum, which patients reported contributed to clinically and personally relevant responses.
This review demonstrates how qualitative research of psychedelic treatments can contribute to distinguishing specific features of specific substances, and carry otherwise undiscovered implications for the treatment of specific psychiatric disorders.
人们对使用迷幻药物治疗精神障碍的兴趣日益增加。然而，目前对于影响治疗效果的机制尚不完全清楚。定性研究方法越来越多地用于检查患者的叙述；但是，目前尚无系统评价综合这些发现与使用迷幻药物治疗精神障碍的关系。
综述精神障碍患者使用迷幻药物治疗的体验中显著的主题，呈现患者叙述中常见和不同的元素，并阐明这些因素如何影响治疗过程。
我们系统地检索了PubMed、MEDLINE、PsycINFO 和 Embase 数据库，未设置时间限制，纳入英语定性文献。纳入标准为：定性研究设计；同行评议研究；基于患者言语表达；以及结果的抽象或分析水平。使用主题综合分析方法对研究进行分析和综合。使用批判性评估技能计划（CASP）对研究质量和方法学严谨性进行批判性评估。
纳入了 15 篇研究文章，共 178 名患者的体验。研究在药物、精神障碍、治疗环境和定性方法学方面表现出广泛的异质性。所涉及的药物包括裸盖菇素、麦角酸二乙酰胺（LSD）、伊博格碱、死藤水、氯胺酮和 3,4-亚甲基二氧甲基苯丙胺（MDMA）。涉及的障碍包括焦虑、抑郁、饮食障碍、创伤后应激障碍和物质使用障碍。虽然所涉及的化合物在药理学和治疗环境方面存在差异，但患者在不同障碍中报告了相似的体验，包括现象学类似的影响、对干预的看法、治疗过程和治疗结果。相似的治疗过程包括见解、自我认知改变、联系增加、超越体验和情感范围扩大，患者报告这些过程有助于产生临床和个人相关的反应。
本综述表明，迷幻药物治疗的定性研究如何有助于区分特定药物的特定特征，并对特定精神障碍的治疗产生否则未被发现的影响。
