Abrams Stephanie Karzon, Rabinovitch Brenden Samuel, Zafar Rayyan, Aziz Aly Shah, Cherup Nicholas Paul, McMillan David W, Nielson Jessica L, Lewis Evan Cole
Numinus Toronto, Toronto, Ontario, Canada.
Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, Ontario, Canada.
Neurotrauma Rep. 2023 Aug 22;4(1):543-550. doi: 10.1089/neur.2023.0022. eCollection 2023.
Psychedelic-assisted therapy (PAT) may treat various mental health conditions. Despite its promising therapeutic signal across mental health outcomes, less attention is paid on its potential to provide therapeutic benefits across complex medical situations within rehabilitation medicine. Persons with spinal cord injury (SCI) have a high prevalence of treatment-resistant mental health comorbidities that compound the extent of their physical disability. Reports from online discussion forums suggest that those living with SCI are using psychedelics, though the motivation for their use is unknown. These anecdotal reports describe a consistent phenomenon of neuromuscular and autonomic hypersensitivity to classical serotonergic psychedelics, such as psilocybin and lysergic acid diethylamide (LSD). Persons describe intense muscle spasms, sweating, and tremors, with an eventual return to baseline and no reports of worsening of their baseline neurological deficits. The discomfort experienced interferes with the subjective beneficial effects self-reported. This phenomenon has not been described previously in the academic literature. We aim to provide a descriptive review and explanatory theoretical framework hypothesizing this phenomenon as a peripherally dominant serotonin syndrome-like clinical picture-that should be considered as such when persons with SCI are exposed to classical psychedelics. Raising awareness of this syndrome may help our mechanistic understanding of serotonergic psychedelics and stimulate development of treatment protocols permitting persons with SCI to safely tolerate their adverse effects. As PAT transitions from research trials into accepted clinical and decriminalized use, efforts must be made from a harm reduction perspective to understand these adverse events, while also serving as an informed consent process aid if such therapeutic approaches are to be considered for use in persons living with SCI.
迷幻剂辅助疗法（PAT）可能治疗多种心理健康状况。尽管其在心理健康结果方面显示出有前景的治疗信号，但在康复医学中，对于其在复杂医疗情况下提供治疗益处的潜力关注较少。脊髓损伤（SCI）患者中，难治性心理健康合并症的患病率很高，这加剧了他们身体残疾的程度。在线讨论论坛的报告表明，脊髓损伤患者正在使用迷幻剂，但其使用动机尚不清楚。这些轶事报告描述了一种一致的现象，即对经典的血清素能迷幻剂，如裸盖菇素和麦角酸二乙酰胺（LSD），存在神经肌肉和自主神经超敏反应。患者描述有强烈的肌肉痉挛、出汗和震颤，最终恢复到基线水平，且没有报告其基线神经功能缺损恶化。所经历的不适干扰了自我报告的主观有益效果。这一现象此前在学术文献中尚未被描述。我们旨在提供一篇描述性综述和解释性理论框架，将这一现象假设为一种以周围为主的血清素综合征样临床表现——当脊髓损伤患者接触经典迷幻剂时应如此看待。提高对这种综合征的认识可能有助于我们对血清素能迷幻剂的机制理解，并刺激治疗方案的开发，使脊髓损伤患者能够安全地耐受其不良反应。随着迷幻剂辅助疗法从研究试验过渡到被接受的临床应用和非刑事化使用，必须从减少伤害的角度努力了解这些不良事件，同时如果考虑将这种治疗方法用于脊髓损伤患者，也可作为知情同意过程的辅助。
