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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1

Name 2 serotoninergic drugs

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

2

Describe the effects of MDMA

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

3

Which receptors does MDMA stimulate?

5HT1A, 5HT2A

4

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

5

How many different receptors are there in the serotonin system?

14

6

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

7

When is the default mode network activated?

Self-reflection

8

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

9

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

It makes them more vivid, emotional, and positive

10

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

11

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

12

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

Increased self-esteem and self-acceptance

13

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

PTSD, alcohol dependence

14

State some risks of MDMA

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

15

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

16

Where do serotoninergic neurons arise from?

Raphe nucleus

17

Name a biomarker for the health of the serotonin system

Serotonin transporter (SERT)

18

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

19

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

20

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

21

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

22

Describe the differences in hallucinations between psychosis and psychedelic use

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

23

Describe the mode of action of psychedelics

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

24

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

25

Name the active compound produced from psilocybin

Psilecin

26

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

Too short-lasting

27

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

28

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

29

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

30

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