Sholevar Roxanne, Kromka William, Beaussant Yvan
Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
J Palliat Med. 2025 Jul;28(7):967-981. doi: 10.1089/jpm.2024.0346. Epub 2025 Jan 22.
Psychiatric and existential distress are common and difficult-to-treat symptoms that are frequently encountered in the palliative care setting; current treatment options are limited in efficacy and tolerability. Psychedelic-assisted therapies (PAT) have gained public and scientific interest in their potential to induce rapid and effective reductions in psychiatric and existential distress in patients with serious medical illness, but remain available only in the research setting. Ketamine as a pharmacologic agent has a large body of evidence in the treatment of refractory depression. To review the evidence that exists for use of ketamine or ketamine-assisted psychotherapy (KAP) for psychiatric and existential distress in patients with serious medical illness, aiming to identify therapeutic signals and gaps in research. A literature search identified publications of (1) ketamine or KAP, (2) psychiatric or existential distress, and (3) palliative care or patients with serious medical illness. Identified reports were carefully reviewed with attention to population and treatment-related factors, which were described in a narrative and aggregate format. Nine studies and 12 case reports were identified that reported positive results and a good safety profile. There was significant variation in patient population, setting, route of administration, dosing schedule, and concurrent treatments. Most reports were of ketamine as a pharmacologic agent for symptoms of psychiatric distress. Evidence suggests that ketamine may induce rapid and transient improvements in psychiatric symptoms in patients with serious medical illness. A large gap in research exists for KAP and symptoms of existential distress. There is a signal that suggests ketamine could be used in a psychedelic therapy model with potential benefits over classical psychedelics.
精神和存在性困扰是姑息治疗环境中常见且难以治疗的症状；目前的治疗选择在疗效和耐受性方面有限。迷幻辅助疗法（PAT）因其有可能迅速有效地减轻重症患者的精神和存在性困扰而引起了公众和科学界的关注，但目前仅在研究环境中可用。氯胺酮作为一种药物，在治疗难治性抑郁症方面有大量证据。为了回顾氯胺酮或氯胺酮辅助心理治疗（KAP）用于重症患者精神和存在性困扰的现有证据，旨在识别治疗信号和研究差距。一项文献检索确定了关于（1）氯胺酮或KAP、（2）精神或存在性困扰、（3）姑息治疗或重症患者的出版物。对确定的报告进行了仔细审查，关注人群和与治疗相关的因素，并以叙述和汇总的形式进行了描述。确定了9项研究和12份病例报告，这些报告均报告了积极结果和良好的安全性。患者人群、治疗环境、给药途径、给药方案和联合治疗存在显著差异。大多数报告是关于氯胺酮作为治疗精神困扰症状的药物。证据表明，氯胺酮可能会使重症患者的精神症状迅速得到短暂改善。KAP和存在性困扰症状的研究存在很大差距。有迹象表明，氯胺酮可用于迷幻治疗模式，可能比传统迷幻药更具优势。
