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精神科中使用迷幻剂的伦理和实践考虑。

Ethical and Practical Considerations for the Use of Psychedelics in Psychiatry.

机构信息

Private practice, Bethesda (Barber); Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Dike).

出版信息

Psychiatr Serv. 2023 Aug 1;74(8):838-846. doi: 10.1176/appi.ps.20220525. Epub 2023 Mar 29.

Abstract

In recent years, psychedelic-assisted psychotherapies have reentered the realm of rigorous scientific inquiry, garnering much attention from both the psychiatric community and the broader public. Headlines on major media platforms frequently tout the psychedelic future of psychiatry, and patients increasingly ask about the prospect of using psychedelics during their sessions. Despite this enthusiasm, psychedelics remain in an investigational stage, and more research and regulatory work are required before psychedelics can be deemed appropriate for general clinical use. In this climate, psychiatrists are increasingly curious about the prospects of psychedelic treatments. This review's goal was to help psychiatrists better understand the complexities of the burgeoning field of psychedelic-assisted psychotherapy. The discussion encompasses issues surrounding psychedelics in their current investigational stage and issues for psychiatrists to consider should psychedelics become available for broad clinical use. This review discusses research equipoise in the context of the current enthusiasm for psychedelics, informed consent, patient vulnerability, equity and access, differences between clinical and nonclinical psychedelic uses, and psychedelic self-enhancement. As psychedelics move closer toward regulatory approval beyond research settings, it is vital that these promising treatments be used ethically. The unique features of psychedelic therapies, including the altered states of consciousness they produce and the vulnerability that such states entail for patients, require careful consideration to minimize potential ethical pitfalls. This review seeks to ensure that psychiatrists are equipped to use psychedelic psychotherapy both ethically and effectively.

摘要

近年来,迷幻药辅助心理治疗重新进入了严格的科学研究领域,引起了精神病学界和更广泛公众的极大关注。主要媒体平台上的头条新闻经常吹捧精神病学的迷幻未来,越来越多的患者询问在治疗期间使用迷幻药的前景。尽管如此,迷幻药仍处于研究阶段,在迷幻药被认为适合广泛临床使用之前,还需要进行更多的研究和监管工作。在这种情况下,精神科医生越来越好奇迷幻药物治疗的前景。这篇综述的目的是帮助精神科医生更好地理解迷幻药辅助心理治疗这一新兴领域的复杂性。讨论包括当前研究阶段迷幻药的相关问题,以及如果迷幻药可广泛用于临床,精神科医生需要考虑的问题。这篇综述讨论了当前迷幻药热潮背景下的研究平衡、知情同意、患者脆弱性、公平性和可及性、临床和非临床迷幻药使用之间的差异,以及迷幻药自我增强。随着迷幻药在研究环境之外更接近监管批准,这些有前途的治疗方法必须在伦理上得到合理使用。迷幻疗法的独特特征,包括它们产生的意识改变状态以及这些状态对患者带来的脆弱性,需要仔细考虑,以尽量减少潜在的伦理陷阱。本综述旨在确保精神科医生能够在伦理和有效两方面使用迷幻心理治疗。

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