The understanding of responses to traumatic events has been greatly influenced by the introduction of the diagnosis of post-traumatic stress disorder (PTSD). In this paper we review the initial versions of the diagnostic criteria for this condition and the associated epidemiological findings, including sociocultural differences. We consider evidence for post-traumatic reactions occurring in...
Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in understanding and categorizing mental disorder, both...
Self-referential processing is a core feature of human experience and includes a variety of mental faculties that support conception of the self, including internal representations that associate salient information to one's identity. It is well understood that self-referential processing is important for the onset, maintenance, prevention and treatment of psychiatric conditions, including...
Over the past few years, research and public interest in psychedelic agents – such as psilocybin and 3,4-methylenedioxymethamphetamine (MDMA) – for mental health purposes has skyrocketed. The therapeutic approach to the use of these agents involves three components: preparation, drug administration, and integration. This bundled treatment has been termed psychedelic-assisted therapy (PAT). The...
Interest in the use of serotonergic agonists such as psilocybin in treatment-resistant depression (TRD) has grown more quickly than the evidence on which to base a final opinion, as emphasized by McIntyre et al1 in their review. Psilocybin, once metabolized to psilocin, activates 5-HT2A receptors, enhancing GABA function in local circuits in the cortex and increasing connectivity between...
Psychosis is the most ineffable experience of mental disorder. We provide here the first co-written bottom-up review of the lived experience of psychosis, whereby experts by experience primarily selected the subjective themes, that were subsequently enriched by phenomenologically-informed perspectives. First-person accounts within and outside the medical field were screened and discussed in...
The significance for psychiatry of a patient's subjective or "lived" experience seems obvious even on casual reflection, especially in cases of severe mental illness. It is likely that curiosity and concern about what a patient is experiencing is a prerequisite for building trust or a therapeutic alliance, particularly when the experiences seem highly unsettling and unusual. Few would deny that...
A psychedelic drug is one that “produces thought, mood and perceptual changes otherwise rarely experienced except in dreams, contemplative and religious exaltation, flashes of vivid involuntary memory, and acute psychosis”1. It does so “without causing physical addiction, craving, major physiological disturbances, delirium, disorientation or amnesia”1. The “classic psychedelics” include...
The self is an elusive concept. We have an intuitive sense as to what it refers to, but it defies simple definition. There is some consensus that the self can be broadly separated into what W. James referred to as the "I" and the "me" – the self that experiences, and the self that extends outwards in space and in time, allowing it to be perceived as an object1. This includes the self as...
Serotonin is a key neuromodulator known to be involved in brain development, perception, cognition, and mood. However, unlike as with dopamine for example, a compelling unified theory of brain serotonin function has not yet been established. This is likely due to the exceptional complexity of the serotonin system, with its 14+ receptors, over twice the number identified for any of the other...
tial impact of psychedelic drugs on psychiatry to that of the microscope on biology and, while this analogy may strike some as laughable, let us reflect for a moment that human research with psychedelics has been effectively moribund since the restrictive drug policy reforms of the 1960s-70s, and has only recently been revived. Classic serotonergic psychedelics – such as LSD, psilocybin and...
Epidemiological evidence demonstrates that cannabis use is associated with an increased risk of psychotic outcomes, and confirms a dose-response relationship between the level of use and the risk of later psychosis. High-potency cannabis and synthetic cannabinoids carry the greatest risk. Experimental administration of tetrahydrocannabinol, the active ingredient of cannabis, induces transient...
Relapse and recurrence are common and debilitating aspects of major depressive disorder. Furthermore, the risk of developing a chronic course of illness increases with each successive episode and, even among patients who achieve clinical remission, residual depressive symptoms are commonly reported. Maintenance antidepressant monotherapy is effective as long as it is continued, yet in practice...
Novel psychoactive substances include synthetic cannabinoids, cathinone derivatives, psychedelic phenethylamines, novel stimulants, synthetic opioids, tryptamine derivatives, phencyclidine-like dissociatives, piperazines, GABA-A/B receptor agonists, a range of prescribedmedications, psychoactive plants/herbs, and a large series of performance and image enhancing drugs. Users are typically...
Major depressive disorder and bipolar depression are among the most prevalent and disabling mental disorders worldwide. Real-world effectiveness trials in major depressive disorder have underscored that most pharmacological options target monoamines, which are involved in a minority (15-20%) of synaptic contacts in the mammalian brain. Most synapses (∼50%) use the amino acid glutamate as their...
There is considerable overlap between phenomenological and neurocognitive perspectives on delusions. In this paper, we first review major phenomenological accounts of delusions, beginning with Jaspers' ideas regarding incomprehensibility, delusional mood, and disturbed "cogito" (basic, minimal, or core self-experience) in what he termed "delusion proper" in schizophrenia. Then we discuss later...
Sass and Byrom 1 do a fine job in explaining the phenomenological approach to delusions, linking themes in phenomenological psychopathology to work on predictive coding, and emphasizing the heterogeneity of delusional experience. Delusions, they maintain, presuppose more enveloping changes in a person's sense of self, body, and world. In this commentary, I will address a theme that is not so...
In this study, we asked people from two samples (a clinical one, consisting of patients with schizophrenia, and a non-clinical one, including university students) to complete the Revised Hallucination Scale (RHS) as a self-questionnaire. When the participants responded positively to an item, they were encouraged to provide further detailed descriptions (i.e., examples of their own experiences)...
Despite the avalanche of empirical data on prodromal/"at risk" conditions, the essential aspects of the vulnerability to the schizophrenia spectrum remain largely unaddressed. We report here the results of the Copenhagen Schizophrenia Prodromal Study, a prospective, observational study of first admission patients in putative state of beginning psychosis (N=151) with a follow-up length of 60...
WE BRIEFLY REVIEW THE EVIDENCE THAT CANNABIS USE IN ADOLESCENCE AND YOUNG ADULTHOOD IS A CONTRIBUTORY CAUSE OF SCHIZOPHRENIFORM PSYCHOSES, BY SUMMARISING LONGITUDINAL STUDIES THAT: a) have examined relationships between cannabis use and the risk of psychosis or psychotic symptoms; and b) have controlled for potential confounders, such as other forms of drug use and personal characteristics that...