Kim Arum, Halton Barley, Shah Akash, Seecof Olivia M, Ross Stephen
New York University Perlmutter Cancer Center, New York, NY, USA; Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA; Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY, USA.
Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
Ann Palliat Med. 2024 Nov;13(6):1490-1501. doi: 10.21037/apm-24-35. Epub 2024 Aug 16.
Existential distress is commonly experienced by patients diagnosed with a life-threatening illness. This condition has been shown to adversely impact quality of life and is correlated with increased suicidal ideation and requests for hastened death. While palliative care teams are experienced in treating depression and anxiety, existential distress is a distinct clinical condition for which traditional medications and psychotherapy approaches demonstrate limited efficacy or duration of effect. Psychedelic drugs, including psilocybin and lysergic acid diethylamide (LSD), in conjunction with psychotherapy have been shown to produce rapid and sustained reductions in existential and psychiatric distress and may be a promising treatment for patients facing existential distress in palliative care settings. In this narrative review article, we describe the history of psychedelic medicine including early studies and the modern wave of research over the past 20 years, which includes high quality clinical trial data. This review outlines specific considerations for therapeutic application of psilocybin including pharmacokinetics, patient selection, dosing, protocol designs, and safeguards to reduce potential adverse effects to help guide future psychedelic practitioners. With growing public interest and evolving state level policy reforms allowing access to psychedelic treatments, it is critical for palliative care providers to gain familiarity with the current state of science and the potential of psilocybin assisted psychotherapy in the treatment of existential distress.
被诊断患有危及生命疾病的患者普遍会经历存在性痛苦。这种情况已被证明会对生活质量产生不利影响，并与自杀意念增加和加速死亡的请求相关。虽然姑息治疗团队在治疗抑郁症和焦虑症方面经验丰富，但存在性痛苦是一种独特的临床状况，传统药物和心理治疗方法对其疗效有限或效果持续时间较短。迷幻药物，包括裸盖菇素和麦角酸二乙酰胺（LSD），结合心理治疗已被证明能迅速且持续地减轻存在性和精神痛苦，可能是姑息治疗环境中面临存在性痛苦患者的一种有前景的治疗方法。在这篇叙述性综述文章中，我们描述了迷幻医学的历史，包括早期研究以及过去20年的现代研究浪潮，其中包括高质量的临床试验数据。这篇综述概述了裸盖菇素治疗应用的具体注意事项，包括药代动力学、患者选择、给药剂量、方案设计以及减少潜在不良反应的保障措施，以帮助指导未来的迷幻药物从业者。随着公众兴趣的增加以及州一级政策改革不断发展，允许使用迷幻药物治疗，姑息治疗提供者熟悉当前的科学状况以及裸盖菇素辅助心理治疗在治疗存在性痛苦方面的潜力至关重要。
