The ups and downs of psychedelic mushrooms
Plus: What we really want from therapy (and life); adverse childhood experiences and long-term outcomes in people at risk of psychosis; and homelessness, addiction, and treatment
Ups and downs: what’s it like to take psychedelic mushrooms?
A paper in npj Mental Health Research asks: what’s it like to take psychedelic mushrooms? Given ongoing medical interest in psychedelics, it’s a good question to ask.
Accounts of mushroom-taking were gleaned from the “Erowid Experience Vaults” an online collection of descriptions of psychedelic experiences. So what we have here are accounts of recreational as opposed to clinical use, written by people who are at least pretty likely to be psychedelic fans. Moreover, “All Experience Reports were selected for publication, reviewed, categorized and lightly edited for readability by the Erowid crew”, and “nearly half of the reports submitted to Erowid are not published due to indecipherability, irrelevant content or failure to describe the effects of a substance”. With all those filters and biases in mind, I’m not sure how much the findings here will be useful to clinicians thinking of administering these substances therapeutically.
Still! This is a tremendous read. Very few scientific papers contain sentences such as “My roommates came outside and, again, I was disappointed in their banter.” That’s a very Alan Bennett-esque drug trip. And I think there might well be value in the authors’ finding that “coming up” sounds pretty horrible, while the “comedown” is described as comparatively pleasant.
“The psychedelic mushroom come-up… specifically resembles an acute stress reaction – which is relevant to but not isolated to illness-like states and symptoms. Feelings of anxiety, irritability and excitement, energy coursing through the body, attention to heartbeat and breathing, numbness, nausea and detachment are common symptoms of a stress reaction or disorder”.
It would be useful to know if patients in the clinic experience something similar, and if this process—of induction and then resolution of something like an acute stress reaction—is an adverse side-effect, or an intrinsic part of the therapeutic process.
What do we want? Love, work, and meaning
This letter in The Lancet Psychiatry follows on from a recent meta on client-reported psychotherapy outcomes. The authors use “Latent Dirichlet Allocation” (which is apparently “a natural language processing method”) to boil down the nine clusters identified by the meta into three sentiments expressing what patients really want from the therapeutic process:
· Love: relating to and appreciating oneself and others.
· Work: more productive ways of being.
· Meaning: acceptance and mindful living.
Going beyond the happy conclusion that these three things are what existing psychotherapies tend to aim at anyway, the authors conclude that “to successfully move beyond symptom-based research, future work might wish to examine patient preferences at multiple levels of analysis: from the more general level of sentiments (that represents abstract psychological variables) to the more granular level of clusters (that represents concrete life goals).” Which sounds appealing, if a challenge to operationalise.
Adverse childhood experiences and long-term outcomes in people at risk of psychosis
How do childhood experiences affect long-term outcomes in people with psychosis? This Schizophrenia study looked at associations between adverse childhood events and outcomes in individuals at clinical high risk of psychosis (CHR). The authors administered various questionnaires on childhood adversity to 344 CHR individuals and 67 healthy controls (HC), and followed the CHR group for up to five years.
They found that adverse childhood experiences were significantly more prevalent in the CHR group than in the HC group. Death of a parent and physical abuse were associated with poorer outcomes in the CHR group, although surprisingly, separation from a parent was associated with better outcomes. It’s possible, the authors speculate, that this latter association reflects the removal of at-risk children from unhealthy environments. The study concludes that longer-term, more intensive support may be needed in individuals with a history of adverse experiences who are at risk of psychosis, as well as add-on trauma-focused therapies such as Eye Movement Desensitisation Reprocessing.
Homelessness, addiction, and treatment
Everyone knows that homelessness is associated with a terrible toll of physical and mental ill-health. Better data alone will not solve this problem—you need political will for that—but this new JAMA paper provides useful information on the nexus of homelessness, illicit substance use, and a considerable treatment gap.
In brief, 3200 adults from the total population of 181,000 people experiencing homelessness in California were surveyed between 2021 and 2022. Mean age was 46 years; 91% were single; 67% were male. Three quarters of participants reported having used any illicit substance (cocaine, methamphetamine, opioids) in their lifetime; 65% reported regular lifetime use, and 37% reported regular use (≥3 times per week) in the previous six months. Methamphetamine was the most commonly-used substance. Alarmingly, 20% reported a lifetime history of overdose, and 10% said they had experienced an overdose during their current episode of homelessness.
The stand-out figure for me, though, is that of those reporting regular illicit substance use in the past six months, 21% said they wanted treatment, but had been unable to access it. The authors recommend “low-barrier evidence-based interventions” to tackle this problem; it would be useful to define what precisely these barriers are, and to learn how the Californian situation resembles, or differs from, other settings around the globe.