PDF(Pubmed)
Abstract：
Recent controversies have arisen regarding claims of uncritical positive regard and hype surrounding psychedelic drugs and their therapeutic potential. Criticisms have included that study designs and reporting styles bias positive over negative outcomes. The present study was motivated by a desire to address this alleged bias by intentionally focusing exclusively on negative outcomes, defined as self-perceived \'negative\' psychological responses lasting for at least 72 h after psychedelic use. A strong justification for this selective focus was that it might improve our ability to capture otherwise missed cases of negative response, enabling us to validate their existence and better examine their nature, as well as possible causes, which could inspire risk-mitigation strategies. Via advertisements posted on social media, individuals were recruited who reported experiencing negative psychological responses to psychedelics (defined as classic psychedelics plus MDMA) lasting for greater than 72 h since using. Volunteers were directed to an online questionnaire requiring quantitative and qualitative input. A key second phase of this study involved reviewing all of the submitted cases, identifying the most severe-e.g., where new psychiatric diagnoses were made or pre-existing symptoms made worse post psychedelic-use-and inviting these individuals to participate in a semi-structured interview with two members of our research team, during which participant experiences and backgrounds were examined in greater depth. Based on the content of these interviews, a brief summary of each case was compiled, and an explorative thematic analysis was used to identify salient and consistent themes and infer common causes. 32 individuals fully completed an onboarding questionnaire (56% male, 53% < age 25); 37.5% of completers had a psychiatric diagnosis that emerged after their psychedelic experience, and anxiety symptoms arose or worsened in 87%. Twenty of the seemingly severer cases were invited to be interviewed; of these, 15 accepted an in-depth interview that lasted on average 60 min. This sample was 40% male, mean age = 31 ± 7. Five of the 15 (i.e., 33%) reported receiving new psychiatric diagnoses after psychedelic-use and all fifteen reported the occurrence or worsening of psychiatric symptoms post use, with a predominance of anxiety symptoms (93%). Distilling the content of the interviews suggested the following potential causal factors: unsafe or complex environments during or surrounding the experience, unpleasant acute experiences (classic psychedelics), prior psychological vulnerabilities, high- or unknown drug quantities and young age. The current exploratory findings corroborate the reality of mental health iatrogenesis via psychedelic-use but due to design limitations and sample size, cannot be used to infer on its prevalence. Based on interview reports, we can infer a common, albeit multifaceted, causal mechanism, namely the combining of a pro-plasticity drug-that was often \'over-dosed\'-with adverse contextual conditions and/or special psychological vulnerability-either by young age or significant psychiatric history. Results should be interpreted with caution due to the small sample size and selective sample and study focus.
摘要：
最近出现了关于对迷幻药及其治疗潜力的不加批判的积极评价和炒作的争议。批评包括研究设计和报告风格偏向正面而不是负面结果。本研究的动机是希望通过故意专注于负面结果来解决这种所谓的偏见，定义为迷幻药使用后持续至少72小时的自我感知的“消极”心理反应。这种选择性聚焦的一个强有力的理由是，它可能会提高我们捕捉否则错过的负面反应案例的能力，使我们能够验证它们的存在并更好地检查它们的性质，以及可能的原因，这可以激发风险缓解策略。通过在社交媒体上发布的广告，招募的个体报告自使用以来对迷幻药(定义为经典迷幻药加MDMA)的负面心理反应持续超过72小时.志愿者被引导到需要定量和定性输入的在线问卷。这项研究的关键第二阶段涉及审查所有提交的案件，确定最严重的-例如，在进行新的精神病诊断或先前存在的症状在迷幻药使用后变得更糟，并邀请这些人参加与我们研究小组两名成员的半结构化访谈，在此期间，对参与者的经验和背景进行了更深入的检查。根据这些采访的内容，对每个案例进行了简要总结，探索性主题分析用于确定突出和一致的主题并推断常见原因。32名个人完全完成了入职问卷(56%为男性，53％<25岁）；37.5％的完成者在迷幻经历后出现了精神病诊断，87%的人出现或恶化了焦虑症状。20个看似严重的案件被邀请接受采访；其中，15接受了平均持续60分钟的深入采访。这个样本是40%的男性，平均年龄=31±7。15个中的五个(即，33％）报告在使用迷幻药后接受了新的精神病诊断，并且所有15个报告在使用后出现或恶化了精神病症状，以焦虑症状为主（93%）。对访谈内容的提炼提出了以下潜在的因果因素：经验期间或周围的不安全或复杂的环境，不愉快的急性经历（经典迷幻药），先前的心理脆弱，高或未知的药物数量和年轻的年龄。当前的探索性发现证实了通过迷幻药使用但由于设计限制和样本量的原因，不能用来推断其患病率。根据采访报道,我们可以推断一个共同的，尽管是多方面的，因果机制，即一种促可塑性药物-通常“过量”-与不利的背景条件和/或特殊的心理脆弱性-年龄小或重要的精神病史相结合。由于样本量小，选择性样本和研究重点，因此应谨慎解释结果。
