Psychedelics and psychosis: A systematic review of recent-era studies (1984-2025).
José Augusto Silva Reis, Lara Zancaner Ueta, José Carlos Bouso, Jaime Eduardo Cecilio Hallak, Rafael Guimarães Dos Santos
Journal of Psychopharmacology October 27, 2026 DOI: 10.1177/02698811261488575 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Peer reviewed |
|---|---|
| Population | People using classic psychedelics, drawn from population surveys, controlled clinical trials, emergency and toxicology data, and published case reports |
| Topics | Ayahuasca DMT LSD Psilocybin |
| Keywords | Adverse events Psychedelics Psychosis Safety Schizophrenia |
| Key findings | Population-based data showed no consistent correlation between lifetime psychedelic use and psychosis, and controlled clinical settings showed minimal risk, with one documented case of transient delusions across all trials. Among case reports, 58% of individuals had a personal or family psychiatric history. The authors argue that personal or family history of psychosis and unsupervised, naturalistic use are risk factors, and that causality remains difficult to establish. |
Abstract
This systematic review evaluates the relationship between classical psychedelic drugs (D-Lysergic acid N,N-diethylamide, psilocybin, ayahuasca/N-N-dimethyl-tryptamine, and mescaline) and the emergence of psychotic symptoms, aiming to synthesize evidence from contemporary studies (1984-2025) regarding the risk factors, prevalence, and clinical characteristics of psychosis related to psychedelic use, to provide clinicians, therapists, and policymakers with a framework for identifying and mitigating risks related to these substances. Fifty-two papers were included, comprising 1 larger-scale studies involving over 100,000 individuals and 34 case reports. Population-based data showed no consistent correlation between lifetime psychedelic use and psychosis. Controlled clinical settings showed minimal risk, with one documented case of transient delusions across all trials. Emergency and toxicological data reported higher rates of psychotic symptoms, likely reflecting the severity of cases prompting medical attention. Among case reports, 58% of individuals had a personal or family psychiatric history. First-episode psychosis, although rare, was documented in otherwise healthy individuals. The risk of prolonged psychosis remains remarkably low in controlled clinical settings where rigorous screening and supervision are employed. Personal/family history of psychosis and unsupervised, naturalistic use appear to be risk factors for psychosis. Although causality remains difficult to establish, these findings support the need for careful risk stratification, the adoption of clear diagnostic parameters, and trained clinical oversight as psychedelic-assisted therapies advance toward broader clinical populations.
Comparable studies
Other systematic reviews and meta-analyses on DMT, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Risk assessment of ritual use of oral dimethyltryptamine (DMT) and harmala alkaloids Humans (ritual ayahuasca use) | 2006 | Systematic review | |
| Ayahuasca, dimethyltryptamine, and psychosis: a systematic review of human studies | 2017 | Systematic review | |
| A critical review of reports of endogenous psychedelic N, N-dimethyltryptamines in humans: 1955-2010. | 2012 | Systematic review | |
| United States National Institutes of Health grant funding for psychedelic-assisted therapy clinical trials from 2006-2020. | 2022 | Systematic review | |
| Effects of ayahuasca and its alkaloids on substance use disorders: an updated (2016-2020) systematic review of preclinical and human studies. Rodents and humans (healthy ritual ayahuasca users and patients with substance use... | 2022 | Systematic review | n = 9 |