General Hospital Psychiatry
July 1, 2003
Bruce Greyson
195 citations
Near-death experiences (NDEs) are reported by 10% of patients who survive cardiac arrest, compared with 1% of other cardiac patients. Those who report NDEs tend to be younger, more likely to have lost consciousness, more likely to report prior paranormal experiences, and show greater approach-oriented death acceptance. However, NDEs are not associated with objective proximity to death, degree of cardiac dysfunction, or coronary prognosis. The findings suggest NDEs are not simply a function of how close a patient is to dying.
General Hospital Psychiatry
September 11, 2021
Jennifer Huberty, Megan E. Puzia, Jeni Green et al.
76 citations
Using a meditation app for eight weeks led to greater improvements in depression and anxiety among 239 adults with insomnia symptoms compared to a control group. The mental health benefits were driven by reductions in both physical and mental arousal before sleep, which fully accounted for the effect on depression and partially for the effect on anxiety. Fatigue and daytime sleepiness did not explain the changes. A meditation app may improve depression and anxiety in adults with sleep disturbance by lowering pre-sleep arousal.
General Hospital Psychiatry
August 12, 2025
Margaret Ross, Ravi Iyer, M.l. Williams et al.
13 citations
Psilocybin-assisted psychotherapy appears safe and may provide lasting relief from depression and anxiety for people facing a life-threatening illness.
General Hospital Psychiatry
August 5, 2025
Jennie Hultgren, Matthias H Hafsteinsson, Joel Gruneau Brulin
13 citations
A review of studies on psychedelic-assisted therapy found no evidence that the number of therapy hours affects depression outcomes. The authors caution that this conclusion is tentative because the studies included small numbers of participants, varied widely in methods, and poorly documented the therapy provided. They call for future research to use more rigorous methods and standardized reporting to better understand the role of therapy.
General Hospital Psychiatry
January 1, 2025
Max Wolff, Hans Rutrecht, Gerhard Gründer et al.
9 citations
As psychedelic treatments move from research settings into hospitals, clinics, and community practices, a new competencies framework outlines the skills needed for safe, effective, and ethically sound therapy. The framework is substance-unspecific and transtheoretical, covering foundational domains including psychotherapy, biomedicine, philosophy, socio-cultural awareness, existential concerns, legal issues, and self-experience. It translates these into practical competencies for multi-professional cooperation, screening, preparation, dosing, integration, and harm-reduction. Developed within the MIND Foundation's Augmented Psychotherapy Training program, the framework awaits systematic evaluation but offers an initial blueprint for future accredited certification and clinician training as these treatments enter mainstream care.
General Hospital Psychiatry
July 24, 2025
Shizhen Wang, Mengru Wu, Jixiang Wei et al.
6 citations
Electronic mindfulness-based cognitive therapy (eMBCT) reduces anxiety and depression in adults with small but significant effects that are sustained over time. A meta-analysis of 12 randomized controlled trials with 2,588 participants found that eMBCT lowered anxiety (standardized mean difference -0.33) and depression (-0.34) compared to usual care, waitlist, or active interventions. Greater baseline symptom severity was linked to larger improvements. Short- and long-term benefits were observed, but medium-term effects were not significant. The findings suggest eMBCT is an effective scalable treatment, though further research is needed to enhance medium- and long-term outcomes and tailor interventions for flexible patient care.
General Hospital Psychiatry
January 1, 2025
Shizhen Wang, Wangjie Xia, Jian Zhang et al.
6 citations
A meta-analysis of 10 randomized controlled trials with 1314 cancer patients found that internet-based mindfulness interventions reduce anxiety and depression. The interventions were most effective when sessions lasted under 45 minutes and the program duration was within 8 weeks. Therapist-guided interventions, especially those with synchronous online interaction, produced greater improvements than unguided ones. The analysis reports moderate effect sizes for both anxiety and depression. The authors note that medium- to long-term efficacy requires further validation through high-quality research.
General Hospital Psychiatry
January 1, 2024
Mina Ansari, Brian Pittman, Daniel S Tylee et al.
6 citations
Blood pressure increases during ketamine infusion for depression, peaking at 40 minutes with average rises of 16.0 mmHg systolic and 11.0 mmHg diastolic. Severe hypertension occurred in 12.5% of patients and 0.98% of infusion sessions, most often during the first three treatments. Older age and a history of hypertension were associated with larger blood pressure surges, indicating that careful cardiovascular monitoring is needed, especially for these patients.
General Hospital Psychiatry
December 9, 2025
Gerasimos Konstantinou, Joshua D. Rosenblat, Sarah Hales et al.
4 citations
Psilocybin-assisted therapy shows promise for treating late-life mental health conditions such as depression, loneliness, and existential distress, where conventional medications often have limited effectiveness and poor tolerability in older adults. The review describes neurobiological mechanisms including serotonergic modulation, enhanced neuroplasticity, and disruption of maladaptive default mode network activity. Clinical trials in general adult populations report sustained improvements in depressive symptoms, existential anxiety, and social connectedness following psilocybin administration. However, older adults are underrepresented in psychedelic research, creating gaps in knowledge about dosing, safety, and long-term outcomes. Age-specific protocols are needed to address pharmacokinetic complexities, cardiovascular risks, drug interactions, and ethical challenges around informed consent in cognitively impaired patients.
General Hospital Psychiatry
July 3, 2025
Kush V. Bhatt, James D Asuncion, Al Alam et al.
4 citations
Classical psychedelics show therapeutic promise for mental health conditions, but their acute subjective effects—while possibly enhancing outcomes—also pose clinical challenges. This review examines the phenomenology, benefits, risks, and implementation issues tied to these subjective experiences. Emerging research on nonhallucinogenic analogues may preserve neuroplastic benefits without inducing intense subjective effects. The authors argue that a debate over the necessity of acute subjective effects may be avoidable, and clinical psychiatry should accommodate both approaches. Future research should explore both the role of subjective experience and alternative compounds to expand treatment options.
General Hospital Psychiatry
June 6, 2025
Daniel Villiger
4 citations
Questioning the necessity of embedding psychedelic use in psychotherapy, this paper examines cost pressures that could limit access to psychedelic-assisted therapy (PAT). It reviews evidence for the therapeutic and ethical importance of the patient-therapist relationship in PAT, then argues that shortening the preparation phase—a likely cost-saving measure—risks weakening that relationship. Three strategies are proposed to preserve the therapeutic bond under financial constraints: retaining relational elements during preparation, ensuring the same therapist works across all phases, and, when feasible, involving the patient's regular therapist.
General Hospital Psychiatry
January 1, 2024
Jeong Hoo Lee, Joji Suzuki
4 citations
For patients with catatonia who do not fully respond to standard treatments like benzodiazepines or electroconvulsive therapy (ECT), NMDA receptor antagonists may offer an alternative. A review of 37 articles found that amantadine (27 cases) and memantine (20 cases) were the most commonly reported agents, often showing quick responses when used alone or alongside benzodiazepines. Ketamine and esketamine were used successfully in a small number of cases (5 cases). These medications may be viable options when benzodiazepines are contraindicated, such as when delirium is present, or when ECT is unavailable or poorly tolerated. Further research is needed to confirm these findings.
General Hospital Psychiatry
December 10, 2025
Justin Dwyer, Robert B. Johnston, Clare O'Callaghan et al.
3 citations
Terminally ill people with extreme death anxiety can feel displaced from their own lives, afraid and alone in an all-encompassing present. Psychedelic-assisted psychotherapy (PAP) can enable them to fully inhabit their life in a more abundant and joyful present, even in the face of death. The psilocybin component is necessary but not sufficient for this outcome. These findings expand the conceptualization of death anxiety and the personal transformation that constitutes successful PAP.
General Hospital Psychiatry
January 1, 2025
Yvan Beaussant, Elise C. Tarbi, Kabir Nigam et al.
3 citations
Psilocybin-assisted therapy (PAT) is promising for cancer-related depression, but little is known about how the therapeutic context affects patient experiences. In interviews with 28 patients with cancer and depression who participated in a clinical trial, participants described the psilocybin experience as intense and demanding. Therapeutic benefits were closely tied to their ability to "surrender"—accepting and remaining open to the experience's intensity and unpredictability. A safe, supportive, and ethical environment was critical for trust and engagement. Preparation and integration were key to maximizing benefit. Music played a variable role, sometimes enhancing and other times distracting. The clinical setting provided safety, while ceremonial elements added meaning.
General Hospital Psychiatry
February 25, 2026
Alan C. Courtes, Blake Myers, Noah Daly et al.
1 citation
Psychological stress worsens cancer outcomes by activating adrenergic signaling between nerves and tumors, a process called tumor-neuron crosstalk. Preclinical models show stress triggers sympathetic pathways that promote cancer progression and treatment resistance. Conventional antidepressants are often less effective for cancer patients, but psilocybin has achieved 60-80% long-term remission of cancer-related depression and anxiety in limited samples, while ketamine provides rapid but short-lived symptom control. These agents may normalize HPA axis function and upregulate neurotrophic factors, reducing sustained adrenergic tone and interrupting stress-driven tumor-neuron signaling. Integrating these drugs into oncology could improve survival, and hospital-based psychiatrists are positioned to lead interdisciplinary research with biomarker-rich trials.
General Hospital Psychiatry
January 1, 2026
Rebeca Cohen, João Bastos, Catarina Cunha et al.
1 citation
A case series of 12 patients with treatment-resistant depression treated with a novel protocol combining ketamine injections (0.5-1.5 mg/kg intramuscularly, 5-8 sessions) and brief psychodynamic psychotherapy found that 67% responded and 58% achieved remission. Half of the patients maintained remission at 3-month and 1-year follow-ups. Ego dissolution during the third ketamine session correlated with symptom improvement and psychological insight. The results suggest that combining ketamine with psychotherapy may enhance and prolong antidepressant effects beyond ketamine alone.
General Hospital Psychiatry
January 1, 2026
David T. Kryszajtys, Carol Strike, Brian Rush et al.
1 citation
Desperation for relief from persistent depression and anxiety, after standard treatments fail, shapes how people decide to self-treat with psychedelics. Analyzing 108 Reddit discussion threads, members who expressed desperation described a tipping point where worsening mental health and frustration with conventional care made relief feel urgent. This urgency led to rapid, unplanned self-treatment with psychedelics, often without researching options or using harm reduction, despite acknowledged risks. Some reported relief, while others linked worsening mental health to multiple desperation-driven decisions. These interpretations may inform clinical psychedelic models, where access is often granted after other treatments fail, and similar urgency may influence engagement and outcomes.
General Hospital Psychiatry
January 1, 2026
Gabrielle F. M. Lovell, Shreya Vasudeva, Diana Orsini et al.
Ketamine, an anesthetic also used for mood and anxiety disorders, may cause mild, temporary elevations in liver enzymes, but serious liver damage appears rare. A systematic review of 13 studies (5 randomized trials, 3 observational studies, and 5 case reports) involving 1,017 patients—mostly with major depressive disorder or bipolar disorder—found 75 mild liver enzyme elevations across trials, with only a few cases of impaired liver function. No cases met Hy's Law criteria for severe drug-induced liver injury. Case reports described more severe liver issues that improved with dose reduction or stopping treatment. Routine liver monitoring during ketamine treatment remains advisable.
General Hospital Psychiatry
January 1, 2026
Martin L Williams, Karen Hitchcock, Angus H Miller et al.
Classic psychedelics, which primarily activate serotonin receptors but also affect other receptor and transporter systems, can cause physiological responses that pose risks to some individuals. These risks must be balanced against the potential neuropsychological benefits of psychedelic therapies. This analysis critically evaluated medical exclusion criteria used in clinical studies of psychedelic-assisted therapy listed on international registries, examining their rationale and medical basis. The evolution of these criteria over twenty-five years of research was considered, along with their applicability in hospital-based psychiatry as psychedelic therapies move from clinical trials into clinical practice.
General Hospital Psychiatry
January 1, 2026
P R Chai, E Lee, M A Hasdianda et al.
Conducting double-blind placebo-controlled trials of ketamine for alcohol and opioid use disorders in the emergency department is extremely difficult. Over the study period, 180 individuals with alcohol use disorder were screened but none were eligible to enroll. Of 234 emergency department visits for opioid use disorder, only 8 were eligible, 4 consented, and all 4 were randomized and treated with ketamine or placebo, but none completed follow-up. The findings reinforce the need for innovative strategies to conduct such trials in this population.
General Hospital Psychiatry
January 1, 2026
Jonathan R Schettino, Katherine Cheung, Sandeep M. Nayak et al.
A debate exists in psychedelic research about whether the interpersonal interactions with participants before, during, and after acute drug effects should be called 'psychological support' (focused on safety) or 'psychotherapy' (also aiming for efficacy). The authors propose definitions and criteria for both forms, then test them on 11 published classic psychedelic clinical trials. Their procedure categorized 10 of 11 studies as more consistent with one label or the other, but achieved clear distinctions in only 4 studies. They argue that higher-quality data on the interpersonal interaction is needed to distinguish the two, and suggest ways their criteria can be used to empirically test the relative safety and efficacy of psychological support versus psychotherapy in psychedelic medicine.
General Hospital Psychiatry
August 1, 2024
Byung-Jin Park, Yu-Jin Choi, Jin-Seok Lee et al.
A systematic review and meta-analysis of 29 randomized controlled trials with 4,104 participants found that meditation significantly reduced fatigue scores by an average of 6.4 points compared to control conditions, after an average meditation duration of 9.6 weeks. The largest reduction occurred in sub-healthy populations (8.2 points), followed by general (6.9 points) and disease groups (5.7 points). Effects were most pronounced for mental fatigue (10.0 points), especially when meditation was guided by an expert and included supplementary homework. The authors conclude that meditation is an effective nonpharmacological intervention for fatigue management.
General Hospital Psychiatry
January 1, 2011
Biswa Ranjan Mishra, Sukanto Sarkar, Sayali Mishra et al.
Sleep-related hallucinations that occur when falling asleep or waking up are usually brief and happen in healthy people. In rare cases, they become severe and troubling, linked to conditions such as narcolepsy. This case report describes a person who had prominent auditory hallucinations upon waking that gradually became constant and distressing, resembling hallucinations seen in schizophrenia. These hallucinations improved with a low dose of the antipsychotic medication olanzapine.
General Hospital Psychiatry
January 1, 2009
Hal A Droogleever Fortuyn, G A Lappenschaar, Fokko J Nienhuis et al.
Hypnagogic hallucinations in narcolepsy are multisensory and holistic, unlike the predominantly verbal-auditory hallucinations in schizophrenia. Among 60 narcolepsy patients, 102 schizophrenia patients, and 120 matched controls, psychotic symptoms such as delusions were no more frequent in narcolepsy than in controls, and the prevalence of formal psychotic disorders was not increased. Almost half of narcoleptics reported moderate interference with functioning due to hypnagogic hallucinations, mostly from related anxiety. These phenomenological differences aid in differential diagnosis.