European Psychiatry
June 1, 2022
D. Khalifa, L. Rashed, A. Shamseldeen et al.
Combining ketamine with social isolation in male albino rats produces long-lasting behavioral and neurochemical deficits that resemble schizophrenia, offering a potential model for studying the disorder's multifactorial origins. Rats given ketamine and isolated showed fewer line crossings in an open field test, fewer open arm entries in an elevated plus maze, and lower spontaneous alternation in a Y-maze compared to controls and ketamine-treated rats housed socially. The combined intervention also increased malondialdehyde (MDA) levels and decreased glutathione peroxidase (GPx) levels in the hippocampus and cortex, indicating oxidative stress. Adding aripiprazole helped model both positive and negative symptoms.
European Psychiatry
June 1, 2022
S. Pratas Penedos, M.j. Freire, I. Fonseca et al.
MDMA-assisted psychotherapy shows promise for treating refractory PTSD. Pre-clinical and imaging studies suggest mechanisms involving memory reconsolidation and fear extinction, driven by increased serotonergic activity and release of oxytocin and brain-derived neurotrophic factor, which reduce amygdala and insula activation while increasing amygdala-hippocampus connectivity. This may create a neuroplastic 'tolerance window' for emotional engagement. A phase 3 randomized, double-blind, placebo-controlled trial reported full remission in 67% of patients at 2 months, with a safety profile comparable to SSRIs and no increase in suicidality, cardiovascular events, or abuse behavior. Emerging models emphasize unmedicated sessions for preparation and integration.
European Psychiatry
June 1, 2022
H. Yaniv, V. Savlev
A 44-year-old man with longstanding major depressive disorder who had not improved after multiple medications showed clinical improvement after six months of Esketamine treatment combined with a 30-minute therapy group held after each session. He reported a positive mood, fewer thoughts of death, and better functioning at work and home. He attributed the improvement partly to the group, which provided a peer group and a place to process the treatment experience. Vignettes from the sessions illustrate these changes.
European Psychiatry
June 1, 2022
E. Frecska, A. Kazai, P. Bokor et al.
After a long pause since the 1970 Controlled Substances Act, research on psychedelic compounds for therapy has revived. Two traditional psychological approaches have emerged: psycholytic therapy, using low to moderate doses with psychoanalytic talk therapy to release emotional content, and psychedelic therapy, using high doses for an overwhelming experience followed by integration sessions. It remains unclear which is better, and they are often mixed as psychedelic-assisted psychotherapy. To provide anchor points and warn of limitations, the authors draw on anthropological observations of cultures with long-standing psychedelic use, where administration occurs in a tight community with shared cosmology (set) and ritual context (setting)—conditions difficult to replicate in Western traditions.
European Psychiatry
June 1, 2022
B. Baune, Z. Susam, V. Falcone et al.
Intranasal S-ketamine (Spravato) can be safely and effectively administered in an acute psychiatric emergency setting to treat depressive crises in patients with treatment-resistant major depressive disorder who have severe suicidal ideation. In a case series of 10 patients (70% female, mean age 49.5 years), average MADRS scores dropped from 37 pre-treatment to 18 post-treatment, and BDI scores dropped from 39 to 24. Side effects such as dissociation were short-lived.
European Psychiatry
June 1, 2022
A. Fraga, B. Mesquita, João Facucho-Oliveira et al.
A narrative review examined whether ketamine, a dissociative anesthetic, could improve the antidepressant effects of electroconvulsive therapy (ECT) for treatment-resistant depression. ECT is a standard end-line therapy but can cause memory impairment, possibly from overstimulation of glutamate receptors in the hippocampus. Ketamine blocks NMDA receptors and stimulates glutamate release, so it was proposed as an ECT adjuvant to reduce cognitive side effects and speed response. However, response and remission rates with ketamine in ECT showed no significant difference from comparator groups, and it was linked to more psychiatric and cardiovascular adverse events. The findings do not support combining ketamine and propofol as anesthetics for ECT in major depressive disorder.
European Psychiatry
April 1, 2021
Pushpendra Kumar Jain, Varchasvi Mudgal, Ujwal Sardesai et al.
Dissociative identity disorder (DID) is rare despite its popularity in the public imagination. A 30-year-old woman from a low socioeconomic background presented with episodic altered behavior. Evaluation confirmed DID, and treatment combined psychotherapy facilitated by hypnosis, escitalopram (up to 20 mg daily), and a short course of clonazepam. The patient improved, with decreased Dissociative Experiences Scale scores. The authors suggest that unconscious conflicts, such as the Elektra complex in Freudian theory, may underlie DID. They urge clinicians, especially in countries like India where trance and possession syndromes are common, to consider DID as a differential diagnosis.
European Psychiatry
April 1, 2021
Jackelyne Gabrielle Jesus de Miranda, Mario Barbosa, I. Figueiredo et al.
Classic psychedelics such as LSD, mescaline, and psilocybin have been used in sacramental contexts since ancient times and were studied in psychiatry in the 1950s–1960s before research halted due to countercultural associations. Modern research has renewed interest in these substances for treating cancer-related distress and addiction. This review of articles from 2010–2020 finds that psychedelics, as 5HT2AR agonists, can occasion mystical experiences—characterized by a strong sense of unity—that may produce abrupt, sustained changes in behavior and perception. Research on psychedelics for substance use disorders is at an early stage, but results show promise with no clinically significant adverse events when high-risk individuals are excluded. Psilocybin for specific addictions may become available in the near future if safety and efficacy continue to be demonstrated.
European Psychiatry
April 1, 2021
B. Van der Kolk
A randomized, double-blind, Phase 3 trial tested three sessions of flexible-dose MDMA or placebo as an adjunct to psychotherapy in 100 participants with severe PTSD. The primary outcome was change in PTSD symptoms and functional impairment at 18 weeks. MDMA was well tolerated, with some treatment-emergent adverse events more frequent in the MDMA group, and three serious adverse events of suicidal ideation or behavior occurred. The authors will present effect sizes and responder analyses. If MDMA-assisted psychotherapy significantly reduces PTSD symptoms and functional impairment, the results could support marketing authorization applications worldwide.
European Psychiatry
April 1, 2017
L. Bartova, A. Weidenauer, M. Dold et al.
A severely depressed and chronically suicidal patient who had not responded to many antidepressant treatments, including electroconvulsive therapy (ECT) and ketamine alone, was given a combination of ECT (up to 150% bilateral stimulation) 2–3 times per week and intravenous racemic ketamine (up to 75 mg per infusion) on ECT-free days. Robust anti-suicidal and antidepressant effects appeared during the first week. After 9 ECT treatments and 7 ketamine infusions, the patient achieved a stable state and was discharged. A maintenance plan of monthly ECT with two ketamine infusions (up to 100 mg) around each ECT prevented relapse. The alternating regimen proved safe and long-term effective in this case.
European Psychiatry
March 1, 2016
M. Mithoefer
MDMA-assisted psychotherapy shows promise for treating PTSD in people who have not responded to established treatments. In a double-blind trial, PTSD resolved in 83% of those receiving MDMA plus psychotherapy versus 25% of those receiving placebo plus psychotherapy. Improvement was maintained for at least 74% of subjects at long-term follow-up averaging 45 months later. A later unpublished trial found large reductions in PTSD symptoms for both high and medium doses of MDMA. Phase III trials are needed to confirm safety and efficacy.
European Psychiatry
March 1, 2016
Á. Palma Conesa, L. Galindo Guarín, M. Grifell Guàrdia et al.
From 2009 to 2014, a Spanish harm reduction service analyzed over 17,000 drug samples and found the new psychoactive tryptamines 4-HO-DiPT and 4-AcO-DiPT in 16 samples each, and DiPT in only 4. Nine samples contained both 4-HO-DiPT and 4-AcO-DiPT. Deliveries of 4-HO-DiPT increased over the study period (4 samples in 2014), while those of 4-AcO-DiPT and DiPT decreased (1 sample each in 2014). This trend suggests a progressive replacement of 4-AcO-DiPT and DiPT by 4-HO-DiPT for recreational use. Clinical concern arises from the growing use and lack of scientific evidence on humans, with effects predicted only from users' subjective experiences.
European Psychiatry
January 1, 2010
Evelyn Doering-Silveira, Enrique Lopez, Charles S. Grob et al.
Adolescents who consume ayahuasca in a religious ritual setting perform well on neuropsychological tests, but not as well as non-using peers on complex tasks that require more cognitive functions. The study compared 40 ayahuasca-using adolescents with 40 matched controls. Both groups performed well overall, but controls outperformed users on the more demanding tests. The authors suggest ayahuasca may have subtle effects on cognition observable only during highly demanding tasks, while noting that other variables could have influenced the results.
European Psychiatry
May 1, 2002
Farāmarz Sohrābi
A 31-year-old male military veteran with moderate alcohol use disorder received sequential treatment with ibogaine hydrochloride (1550 mg, 17.9 mg/kg) followed by vaporized 5-MeO-DMT (bufotoxin source 50 mg, estimated 5-MeO-DMT content 5–7 mg) at an inpatient clinic in Mexico. SPECT neuroimaging before and 3 days after the program showed increased brain perfusion in bilateral caudate nuclei, left putamen, right insula, and temporal, occipital, and cerebellar regions. The patient reported improved mood, cessation of alcohol use, and reduced cravings at 5 days, sustained at 1 month, with a partial return to mild alcohol use at 2 months. The findings suggest short-term therapeutic outcomes and warrant further investigation.
European Psychiatry
April 1, 2025
E. Rognli
A register-based study using Norwegian national patient data from 2010 to 2015 found that people initially diagnosed with substance-induced psychosis face a six-year cumulative risk of later developing schizophrenia of 27.6%. The risk was highest for those whose initial diagnosis was cannabis-induced psychosis, at 36%. These high transition rates raise questions about whether the initial diagnosis was correct or whether the psychosis was an early sign of a primary psychotic disorder masked by cannabis use. The authors argue that the diagnostic label 'cannabis-induced psychosis' overemphasizes substance use and overlooks other factors such as genetic vulnerability.
European Psychiatry
April 1, 2025
L. Cazorla, S. Alaux, C. Mabilais et al.
In a pilot study of LSD-assisted psychotherapy for patients with resistant anxiety or depression, six of ten planned participants completed the protocol. Salivary oxytocin was measured before and after LSD intake; those analyses are pending. Self-perceived intensity of drug effects peaked at 180 minutes and showed a significant relationship with the intensity of mystical experience reported on the MEQ-30. Depression and anxiety symptom scores will be analyzed after treatment. The authors conclude that preliminary data show a clear effect of perceived treatment intensity and its link to mystical experience, and that including oxytocin data will be valuable.
European Psychiatry
August 27, 2024
M. Gomes, A. Fernandes, P. Veloso et al.
Philosophy of mind examines consciousness, the mind-body problem, personal identity, and free will versus determinism. These philosophical concepts offer psychiatrists a framework for understanding psychiatric disorders and improving patient-centered care. The "hard problem" of consciousness—why physical brain processes produce subjective experience—helps psychiatrists appreciate diverse conscious experiences and empathize with patients. The mind-body problem highlights challenges in reconciling mental phenomena with neurobiology, and integrating dualism, materialism, and emergentism supports holistic mental health care. Philosophical views on personal identity deepen understanding of disorders like dissociative identity disorder and psychosis. Debates on free will and determinism inform ethical issues such as involuntary hospitalization and balancing autonomy with paternalism.
European Psychiatry
August 27, 2024
J. K. Nowocień, N. Szejko
Transcendental cinema, as defined by Paul Schrader, shares core principles with mindfulness philosophy, allowing a film screening to function as a meditation session. Analyzing David Lynch's Twin Peaks, the authors argue that the style's formal tools—such as extended scenes and minimal cuts—force active participation, focusing attention on present emotions and experiences. This process mirrors mindfulness meditation, which has been shown to alleviate neuropsychiatric and other ailments. The cinema experience not only depicts a protagonist's self-development but also deepens viewers' self-awareness and understanding of the human psyche, potentially supporting health and therapeutic insight.
European Psychiatry
August 27, 2024
D. Perczel-Forintos, D. Sal
A mindfulness-based cognitive therapy (MBCT) program for chronic headache patients in Hungary reduced the negative impact of pain on quality of life, pain catastrophizing, and depression, with moderate to large effect sizes. Participants also showed increases in mindfulness skills such as non-reactivity and non-judgmental awareness, and in adaptive emotion regulation strategies. The results align with international evidence that MBCT can help people cope more adaptively with chronic headache.
European Psychiatry
April 1, 2024
V. Tsang
A ketamine-assisted psychotherapy program in British Columbia, Canada, was both less expensive and more effective than standard group psychotherapy for depression. Over five treatment cycles, the program saved an average of $14,481 per person and produced 0.94 additional quality-adjusted life years (QALYs) compared to the standard care of one provider treating three patients. The analysis used a Markov model with data from 62 program participants and published values for a control group. Incorporating such a program into provincial care could improve health outcomes and reduce government health spending.
European Psychiatry
April 1, 2024
K. Sattler, T. Walia, V. Tsang
A crossover trial of 32 participants undergoing ketamine-assisted group therapy for treatment-resistant mental health conditions compares two types of music—a "weightless" playlist and a "grounding" playlist—administered in counterbalanced order. The study evaluates subjective clinical efficacy via psychiatric questionnaires (PHQ-9, GAD-7, PCL-5) and objective changes in brain activity measured by EEG from a MUSE headband before and after each session. Order effects and relevant demographic and medical factors will be controlled. No prior work has examined how different music types influence patient experience with ketamine-assisted therapy in a group setting.
European Psychiatry
November 17, 2023
N. Báthori, B. Polner, P. Simor
A network analysis of 1,419 general-population adults (77% female) mapped connections among specific insomnia symptoms, dreaming features, and schizotypy dimensions. Disorganization, frequent awakenings, and nightmares were the most central nodes within their respective clusters. Frequent nightmares acted as a bridge, linking unusual perceptual experiences with frequent awakenings. The results suggest that particular sleep complaints and specific schizotypy dimensions are differentially connected, highlighting heterogeneity often masked by umbrella terms like insomnia and psychosis.
European Psychiatry
November 17, 2023
C. Alvarez Garcia, L. Nocete Navarro, A. Sanz Giancola
Posttraumatic nightmares (PTN) are a frequent symptom of posttraumatic stress disorder, with prevalence up to 96%, and are an independent risk factor for suicide. The two main current treatments are Imagery Rehearsal Therapy (IRT), a cognitive-behavioral intervention that helps patients change nightmare content, and prazosin, an alpha-adrenergic receptor antagonist. However, prazosin has not shown significant differences compared to placebo. Emerging evidence suggests nabilone, a synthetic cannabinoid, may be helpful; a Canadian clinical trial found that 72% of patients experienced complete disappearance or important reduction of PTN. More research is needed for an effective treatment.
European Psychiatry
November 17, 2023
L. Tjokrodipo, A. Sneep, P. Michielsen
The incubus phenomenon is a sleep-related disorder combining sleep paralysis with compound hallucinations, including sensed presence, fear, visual and auditory hallucinations, unusual body experiences, chest pressure, breathing difficulty, and pain. A 29-year-old man with intellectual disability, psychotic disorder, and cannabis use disorder was diagnosed with narcolepsy and cataplexy; his hallucinations included sexual themes, breathing difficulty, moving sensations, and chest pressure. Literature review indicates a lifetime prevalence of 0.11% in the general population versus 0.41% in psychiatric patients, suggesting the phenomenon is four times more common in those with psychiatric history and should not be mistaken for psychotic disorder. Recognizing it is important for proper treatment with anxiolytics, antidepressants, anticholinergics, or anti-epileptics, along with sleep hygiene.
European Psychiatry
November 17, 2023
G. Simões, S. Jesús, R. Silva
Perception transforms raw sensory stimuli into meaningful information at the cortical level, while imagery is an internal mental representation actively drawn from memory. Although often distinguished by their differential features, many characteristics are shared rather than unique. The authors analyze the similarities and differences between imagery and perception at the phenomenological level and examine their roles in psychopathological alterations such as hallucinations, pseudohallucinations, pareidolic illusions, abnormal imagery, sensory deprivation, and dreams. Understanding imagery and its formal characteristics is necessary for better recognizing the nature of perceptions and related psychopathological alterations, as well as the mechanisms uniting these concepts.