Use of MDMA and Psychedelics in Psychiatry Flashcards Preview

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Flashcards in Use of MDMA and Psychedelics in Psychiatry Deck (31)
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Name 2 serotoninergic drugs

Psilocybin, 3,4-methylenedioxymethamphetamine (MDMA)/ ecstasy


Describe the effects of MDMA

Increased energy, euphoria, emotional warmth, empathy, distortions in sensory perception


Which receptors does MDMA stimulate?

5HT1A, 5HT2A


What is the mode of action of MDMA?

It acutely increases the amount of serotonin in the synapse by increasing its release, but then inhibits the synthesis of more serotonin resulting in a longer-term low serotoninergic state. It has a minor effect on dopamine


How many different receptors are there in the serotonin system?



Describe the effects of MDMA compared to placebo on the brain's resting state in fMRI (Carhart-Harris et al, 2015)

MDMA decreased cerebral blood flow, particularly within the default mode network, frontal areas, and medial temporal areas. In certain medial temporal areas (amygdala and hippocampus), the decrease in blood flow correlated with intensity of subjective positive effects


When is the default mode network activated?



Describe the effect of MDMA on brain connectivity (Berman et al, 2011)

It decreases connectivity between the medial prefrontal cortex and posterior cingulate cortex - connectivity associated with rumination


Describe the effect of MDMA on memories (Carhart-Harris et al, 2014)

It makes them more vivid, emotional, and positive


Describe the effect of MDMA on facial expression processing (Bedi et al, 2009, 2010)

When given to regular users, it decreases the accuracy of facial fear recognition and enhances the ventral striatal response to happy expressions


Describe the psychological effects of MDMA on cognition and memory (Oehen et al, 2013)

Increased imagination and association, increased contemplativeness, increased recall and tolerance of traumatic memories


Describe the psychological effects of MDMA on an individuals sense of self (Oehen et al, 2013)

Increased self-esteem and self-acceptance


Name 2 mental health conditions that MDMA has been trialled in treating

PTSD, alcohol dependence


State some risks of MDMA

Water poisoning due to hyperthermia encouraging excess consumption, serotonin depletion and toxicity


Why might animal studies overestimate the risk of MDMA?

They tend to use very high doses and inject it rather than giving it orally, leading to higher toxicity


Where do serotoninergic neurons arise from?

Raphe nucleus


Name a biomarker for the health of the serotonin system

Serotonin transporter (SERT)


Describe the effect of MDMA on the serotonin transporter (Erritzoe et al, 2011)

The greater the lifetime use of MDMA, the fewer serotonin transporters found in the brain. Studies have suggested this may cause compensatory upregulation of 5-HT2A receptors due to chronic serotonin depletion


Why might MDMA-induced serotoningeric changes be overestimated in trials? (Szigeti et al, 2018)

The subset of users studied in trials represent the top 5-10% of users, consuming 720% more pills in a year than the average user


Describe the relationship between ecstasy use and mood disorders (Lieb et al, 2002; Huzink et al, 2006)

Ecstasy is associated with mental health conditions including depression and anxiety, but studies have suggested that childhood anxiety and depression often precede starting the use - mental health disorders may promote risk-taking behaviour


What is a psychedelic? (Grinspoon & Barker, 1997)

A drug which, without causing physical addiction, craving, major psychological disturbances, delirium, disorientation, or amnesia, more-or-less reliably produces thought, mood, and perceptual changes rarely experienced except in dreams, contemplative and religious exaltation, flashes of involuntary memory, and acute psychosis


Describe the differences in hallucinations between psychosis and psychedelic use

Psychedelics tend to cause visual hallucinations, whereas psychosis tends to cause auditory hallucinations


Describe the mode of action of psychedelics

They act on the 5HT2A receptor, with a correlation between receptor affinity and psychedelic potency


Describe the effects of the psychedelic 'peak'

Sense of unity, transcendence of time and space, deeply-felt positive mood, sense of sacredness, sense of paradoxicality, sense of transiency, long-lasting positive effects on behaviour and attitudes towards one's self, others, and life


Name the active compound produced from psilocybin



Why would the psychedelic DMT not be suitable for therapeutic use?

Too short-lasting


Describe the effect of psilocybin on the brain on fMRI

It decreased cerebral blood flow, particularly in the default mode network and medial prefrontal cortex. It also decreased connectivity between the posterior cingulate cortex and medial prefrontal cortex, a connection associated with rumination


Describe the effect of psilocybin on memory, and how this could be useful in depression

It enhances recollection of autobiographical memories, making them more vivid, visual, and emotional. Depression causes a difficulty in recalling autobiographical memories


Describe the association between psychedelic use and psychological distress (Hendricks et al, 2015)

Lifetime psychedelic use is associated with significantly reduced odds of reporting psychological distress in the past month or suicidal ideation in the past year - the opposite to most illicit drugs


Describe the impact of psilocybin on treatment resistant depression (Carhart-Harris et al)

It reduced the depression severity by QIDS score, although this reduction in severity only remained for some participants