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David Nutt - Psychedelics as Psychiatric Medications

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David Nutt Psychedelics as Psychiatric Medications
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There is substantial contemporary interest in psychedelic agents as medicines for maladies of the mind. This follows research in the 1950s and 1960s exploring the use of LSD and other psychedelics to treat a range of psychiatric illnesses as well as addictions. This research was shut down after prohibition of these drugs, however the last decade has seen a major renewal of interest in the therapeutic use of psychedelics and related drugs in psychiatry.
Psilocybin (found in magic mushrooms) has been used effectively for amelioration of distress in people with depression/anxiety in the context of potentially life-ending cancers, as well as for treatment-resistant depression and also addictions. MDMA (ecstasy) has shown efficacy for severe post-traumatic stress disorder, with enduring benefit. Other psychedelics, both plant-derived (e.g., ayahuasca) and synthetically produced (e.g., LSD) are also being investigated for their potential therapeutic value.
These agents not only herald a new neurobiology but also allow an integration of psychotherapy with biological compounds that is truly novel and that challenges established psychiatric practice. Furthermore, the action of these agents on the brain allows an exploration of how the brain works to open up to psychotherapeutic healing.
Published as part of the Oxford Psychiatry Library series, the book provides an overview of this hugely exciting field, covering the history of psychedelics, clinical aspects, risks and side effects, precautions and processes.

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Great Clarendon Street, Oxford, OX2 6DP,

United Kingdom

Oxford University Press is a department of the University of Oxford.

It furthers the Universitys objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries

Oxford University Press 2023

The moral rights of the authors have been asserted

First Edition published in 2023

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You must not circulate this work in any other form and you must impose this same condition on any acquirer

Published in the United States of America by Oxford University Press

198 Madison Avenue, New York, NY 10016, United States of America

British Library Cataloguing in Publication Data

Data available

Library of Congress Control Number: 2022952041

ISBN 9780192863607

eISBN 9780192678522

DOI: 10.1093/med/9780192863607.001.0001

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast-feeding

Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work.

Preface

We are very pleased to present this book, which provides a current appraisal of a very fast-moving field. We are gratified by having chapters by thought leaders from across the world, who have given a good sense of where we came from, where we are, and where we are going, in terms of psychedelics as treatments for psychiatric maladies and addictions. It should be noted that this book has embraced a very broad definition of psychedelics and related agents, including ketamine (a dissociative anaesthetic) and N-methyl-3,4-methylenedioxyamphetamine (MDMA, an entactogen), along with the classic psychedelics (e.g. psilocybin, D-lysergic acid diethylamide (LSD), dimethyltryptamine (DMT), ibogaine, and mescaline), as well as some lesser-known agents (muscimol, salvinorin A, mescaline, 2C-B, and 5-methoxy-DMT). This has been in part a response to the fact that these agents are all novel in terms of mechanisms of action; that all entail a rethinking of traditional therapeutic wrap around, in terms of the psychotherapeutic component (which, for ease, we refer to as psychedelic-assisted psychotherapy or PAP), and that all are in a stage of excited discovery. Indeed, the excitement associated with the revisiting of these agents as potential treatments for mental health and addictions is evidenced by a massive surge in publications, lectures, and media coverage.

We believe this book will be helpful to specialists and nonspecialists alike. The science and art of psychedelic psychiatry are presented, along with due cautions and concerns for how the future of this fascinating group of compounds can, along with psychotherapeutic support, help patients with a range of mental health and addiction problems.

David Nutt and David Castle

February 2022

Contents

Chase Thompson and Ishrat M. Husain

Laurie Higbed and Ben Sessa

James J. Rucker and David Erritzoe

Michael C. Mithoefer and David E. Presti

Mihai Avram, Felix Mller, and Stefan Borgwardt

Daniel Perkins, Simon G. D. Ruffell, and Jerome Sarris

Deborah C. Mash

James Linden and Daniel Robin

Joshua D. Di Vincenzo, Joshua D. Rosenblat, and Roger S. McIntyre

Joanna C. Neill, Mohammed Shahid, Rosalind Gittins, Anne K. Schlag, and Frank I. Tarazi

David Castle, Nicole Ledwos, and David Nutt

5-HTSerotonin
ACEAdverse childhood experience
ACLSAdvanced Cardiac Life Support
ARAugmented reality
ASIAddiction Severity Index
BDBipolar disorder
BDNFBrain-derived neurotrophic factor
BOLDBlood oxygen level-dependent
CADSSClinician-Administered Dissociative States Scale
CAPSClinician-Administered PTSD Scale
CBCTCognitive-behavioural conjoint therapy
CDLINControlled Drug Local Intelligence Networks
CEQChallenging Experiences Questionnaire
CNSCentral nervous system
CRPC-reactive protein
CSAControlled Substances Act
DAACDrug Abuse Advisory Committee
DMNDefault-mode network
DMTN, N-dimethyltrpyamine
DOSDelirium observation scale
DSM-5Diagnostic and Statistical Manual of Mental Disorders, fifth ed.
EBIEmotional Breakthrough Inventory
ECEndothelial cell
ECGElectrocardiogram
EEGElectroencephalogram
EMAEuropean Medicines Agency
FDAFood and Drug Administration
FMFrequency Modulation
GABA-Aminobutyric acid
GERDGastroesophageal reflux
GLPGood Laboratory Practice
GPCRG-protein coupled receptor
HNKHuman Natural Killer
IASCInventory of Altered Self-Capacities
IBNIntrinsic brain networks
ICD-10International Classification of Diseases, tenth ed.
IPTinterpersonal psychotherapy
LSDD-lysergic acid diethylamide
MAOIMonoamine oxidase-A enzyme inhibitor
MAPSMultidisciplinary Association for Psychedelic Studies
MDA3,4-Methylenedioxyamphetamine
MDDMajor depressive disorder
MDMA3,4-Methyl-enedioxy-methamphetamine
MEGMagnetoencephalography
MEQMystical Experiences Questionnaire
MHRAMedicines and Healthcare products Regulatory Agency
MIMotivational interviewing
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