Posts Tagged ‘psychiatry’

By Jane Ridley

Four years ago, Lillyth Quillan cowered behind a padlocked door as her teenage son, taller and stronger than she is, paced back and forth in a rage.

Suddenly he went quiet. “Don’t let me hurt you, Mom,” he said, his voice sounding chillingly calm.

It was the first time the high school freshman had used that particular tone, but he continued to deploy it as he menaced his mom and dad.

“He used the kind of language of abusive husbands — manipulating and controlling,” says Quillan, who had installed locks on every door in her house except her son’s bedroom. “I was terrified of what he was going to do next.”

The boy — whom Quillan chooses to call Kevin in her interview with The Post in reference to the unnerving Lionel Shriver novel “We Need To Talk About Kevin” about a school shooter in upstate New York — was out of control.

After years of cruel and violent behavior plus multiple suspensions and expulsions from school, psychiatrists finally diagnosed the then-14-year-old Kevin with “conduct disorder,” which, in its most extreme form, can be a precursor to psychopathy.

Psychopathy, which is often used interchangeably with the term sociopathy, is believed to affect 1 percent of adults. Key attributes that sociopaths and psychopaths have in common include a disregard for laws, social mores and the rights of others, a failure to feel remorse or guilt and, in some but not all cases, a tendency to violence.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) dictates that people under the age of 18 cannot be labelled psychopaths. However, in 2013 the American Psychiatric Association decided to include the condition “conduct disorder with callous and unemotional traits” for children ages 12 and over.

According to a 2001 report published in the journal American Family Physician, approximately 6 to 16 percent of boys and 2 to 9 percent of girls meet the diagnostic criteria for conduct disorder — only a fraction of which have the “callous and unemotional” label that can potentially lead to psychopathy in adulthood.

More than 50 studies have found that kids with the latter diagnosis are more likely to become criminals or display aggressive, psychopathic traits later in life. It has been reported that Nikolas Cruz, the 19-year-old who allegedly shot and killed 17 people at Marjory Stoneman Douglas High School in Parkland, Fla., last month showed classic signs of the disorder as a child, including abusing animals.

“Psychopaths don’t just appear when they are 20. They are always different from an early age,” Kent Kiehl, a psychology professor at the University of New Mexico and the author of “The Psychopath Whisperer,” tells The Post.

Characteristics to look for — as detailed in the widely used Hare Psychopathy Checklist Youth Version considered by clinicians and researchers to be the “gold standard” in assessing psychopathy — include lack of empathy, lack of guilt and regret, pathological lying, grandiose self-worth and failure to accept responsibility for actions such as fighting and bullying.

“Individuals who score high on those traits are more likely to produce further violence,” adds Kiehl. “If they are sanctioned but continue on the same path, it’s not a perfect indicator, but it’s enough to cause concern.”

Kiehl notes that research has shown that psychopathy is hereditary roughly half of the time. But his own breakthrough was the discovery that the psychopathic brain has a different structure than a “normal” one.

In 2014, he conducted a major study that found at least two abnormalities in the brains of adult psychopaths. There was a lack of gray matter in the section involved in processing emotions, while the area that reacts to excitement and thrills is overactive. Although the research has not been carried out yet, the pattern is likely to also occur in the brains of “callous and unemotional” children. “Brain science has helped us understand what is different about these kids,” adds Kiehl.

At the moment, there is no such thing as a “cure” for psychopathy or conduct disorder. But early intervention can be key for harm reduction, even with children as young as 2 or 3.

Paul Frick, a psychology professor at Louisiana State University and the author of “Conduct Disorder and Severe Antisocial Behavior,” recommends a range of therapies, most of which revolve around rewards systems rather than punishments.

“There are so-called ‘emotion coaching’ techniques that parents and therapists can employ to help children pay attention to the feelings of others,” he explains. “We find that they miss the cues that another child is upset.

“By saying: ‘Can you see how Johnny is feeling?’ [when a toy is snatched from him] and getting them to respond correctly, you can motivate them. You give them a star or a sticker as an incentive.

“Even though it doesn’t come naturally to them, they can learn others’ perspectives.”

Experts can identify a callous and unemotional child when they are as young as 3 or 4. Faced with a crying peer, typically developing children either try to comfort them or take flight. But those with the mental condition remain in place, showing apathy and coldness.

Remarkably, the psychology department at King’s College London has been able to trace the characteristics back to infancy. They tested more than 200 babies at 5 months old, tracking whether they preferred looking at a person’s face or at a red ball. The tots who favored the ball displayed more callous traits two and a half years later.

For Quillan, hindsight is 20/20, but she distinctly recalls the first signs that Kevin had behavioral issues at the age of just 8 months.

“He had teeth and would bite me while he was breast-feeding and he would laugh. He thought it was hilarious. I tried looking very sad and mimicking crying to show it was hurting me, but he would only laugh,” says Quillan, who ended up having to put him on formula.

“It didn’t occur to me until much later that this was a child for whom the amusement of my reaction when he bit me was a greater reward than food.”

Now 18, Kevin, who has had numerous run-ins with police, including for shoplifting, was made a ward of state and no longer lives with his parents. He lives in a residential school for “at-risk” youth in California, where he is on a waiting list to receive treatment, such as therapy, to build empathy.

“Because there is no real treatment for conduct disorder. All you can do is wait for your child to be arrested and enter the juvenile system and hope they get better,” says his 40-year-old homemaker mom.

“Luckily, Kevin is no longer violent and is actually cooperative.”

He is doing so well that he is about to receive his high school diploma, recently won an award for wrestling and has encouraged his mother to tell his story.

Now Quillian, who has no other kids, is focusing on advocacy and encouraging parents facing similar nightmares to hers. Three years ago, she formed a support group for families with kids with CD that has 420 members worldwide. More recently, she launched the Society for Treatment Options for Potential Psychopaths to bring awareness and to campaign for treatment for these children before they cause serious harm.

Adds Quillan: “As every news article came out about Parkland and Nikolas Cruz, I thought: ‘My God, this could easily be one of our kids.’”


Longer duration of untreated psychosis was associated with accelerated hippocampal atrophy during initial antipsychotic treatment of first-episode schizophrenia, suggesting that psychosis may have persistent, negative effects on brain structure, according to finding published in JAMA Psychiatry.

“Several factors … have been linked to early psychosis and could mediate an association between [duration of untreated psychosis] and hippocampal volume loss, but evidence from longitudinal studies is lacking,” Donald C. Goff, MD, department of psychiatry, New York University Langone Medical Center, and colleagues wrote. “Whereas the negative association of [duration of untreated psychosis] with clinical course is attenuated by the initiation of antipsychotic treatment, the evidence is mixed as to whether antipsychotics contribute to loss of brain volume or protect against it.”

The extent to which loss of brain volume early in psychosis treatment reflects an illness effect, a drug effect or both remains unknown, according to the researchers. Therefore, Goff and colleagues examined loss of hippocampal volume during the first 8 weeks of treatment for schizophrenia, its link to duration of untreated psychosis and molecular biomarkers related to hippocampal volume loss and duration of untreated psychosis.

At Shanghai Mental Health Center in China, researchers conducted a longitudinal study with age- and sex-matched healthy controls between Mar. 5, 2013, and Oct. 8, 2014. They assessed 71 patients with nonaffective first-episode psychosis treated with second-generation antipsychotics and 73 controls. They reassessed 31 participants with psychosis and 32 controls 8 weeks later, measuring hippocampal volumetric integrity (HVI), duration of untreated psychosis, 13 molecular biomarkers and 14 single-nucleotide polymorphisms from 12 candidate genes.

Participants in the first-episode psychosis group had lower baseline median left HVI (n = 57) compared with those in the control group (n = 54; P = .001). Left HVI decreased in 24 participants with psychosis at a median annualized rate of –.03791 throughout the 8 weeks of treatment, whereas left HVI increased in 31 controls at a rate of 0.00115 (P = .001). Furthermore, researchers observed an inverse association between the change in left hippocampal volume and duration of untreated psychosis (P = .002).

Although they observed similar results in the right HVI, the relationship between change in right HVI and duration of psychosis was not significant. According to the results of analyses that looked at left-side hippocampal volume only, left HVI was associated with molecular biomarkers of inflammation, oxidative stress, brain-derived neurotrophic factor, glial injury and those reflecting dopaminergic and glutamatergic transmission.

“We found significantly lower HVI at baseline in participants with [first episode psychosis] compared with healthy controls and additional HVI reduction during antipsychotic treatment that correlated with [duration of untreated psychosis], consistent with a persistent, possibly deleterious, effect of untreated psychosis on brain structure,” Goff and colleagues wrote. “Larger longitudinal studies of longer duration are needed to examine the association between [duration of untreated psychosis], hippocampal volume and clinical outcomes.” – by Savannah Demko


Bipolar Disorder (BD) is a multifactorial brain disorder in which patients experience radical shifts in mood and undergo periods of depression followed by periods of mania. It has been known for some time that both environmental and genetic factors play important roles in the disease. For instance, being exposed to high levels of stress for long periods, and especially during childhood, has been associated with the development of BD.

Immediate early genes (IEGs) are a class of genes that respond very rapidly to environmental stimuli, and that includes stress. IEGs respond to a stressor by activating other genes that lead to neuronal plasticity, the ability of brain cells to change in form and function in response to changes in the environment. Ultimately, it is the process of neuronal plasticity that gives the brain the ability to learn from and adapt to new experiences.

One type of protein produced by IEGs is the so-called Early Growth Response (EGR) proteins, which translate environmental influence into long-term changes in the brain. These proteins are found throughout the brain and are highly produced in response to environmental changes such as stressful stimuli and sleep deprivation. Without the action played out by these proteins, brain cells and the brain itself cannot appropriately respond to the many stimuli that are constantly received from the environment.

Effective neuronal plasticity also depends on neurotrophins, which are regulatory factors that promote development and survival of brain cells. Brain-derived neurotrophic factor (BDNF) is the neurotrophin mostly found in the brain. It has been extensively investigated in BD patients and has been suggested as a hallmark of BD. Indeed, some studies have shown that the levels of BDNF in the serum of BD patients are reduced whenever patients undergo a period of depression, hypomania, or mania. Other studies have shown that regardless of mood state, BD patients present reduced levels of BDNF. Overall, changes in BDNF levels seem to be a characteristic found in BD patients that may contribute to the pathophysiology of the disease.

Now an international team of researchers from Universidade Federal do Rio Grande do Sul in Brazil, University of Arizona College of Medicine in the United States and McMaster University in Canada have published an article connecting the dots between these two players to explain the impaired cellular resilience observed in BD that in the grand scheme of things may relate to the impaired resilience presented by BD patients to respond to events, including stress.

In a previous study done by the group in 2016, one type of IEG gene known as EGR3, that normally responds to environmental events and stressful stimuli, was found repressed in the brain of BD patients, suggesting that when facing a stressor, the EGR3 in BD patients does not respond to the stimulus appropriately. Indeed, BD patients are highly prone to stress and have more difficulties dealing with stress or adapting to it if compared to healthy individuals. What the research group is now suggesting is that both EGR3 and BDNF may each play a critical role in the impaired cellular resilience seen in BD, and that each of these two genes may affect each other’s expression in the cell. “We believe that the reduced level of BDNF that has been extensively observed in BD patients is caused by the fact that EGR3 is repressed in the brain of BD patients. The two molecules are interconnected in a regulatory pathway that is disrupted in BD patients,” says Fabio Klamt, leading author of the article entitled “EGR3 immediate early gene and the brain-derived neurotrophic factor in bipolar disorder” and published on February 5th in the journal Frontiers in Behavioral Neuroscience.

The authors also add that the fact that EGR3 responds very quickly to environmental stimuli renders the molecule a potential drug target. “It is possible to imagine that EGR3 may be modulated in order to increase its expression and that of BDNF, which may have a positive impact on BD patients,” says Bianca Pfaffenseller, a scientist working at Hospital de Clínicas de Porto Alegre, in Brazil, and the first author of the study.

The idea that mental disorders should be seen as any other chronic disease in which the underlying biology plays an important role has replaced the old descriptions of mental illnesses as the result of bad psychological influences. As Nobel prize laureate Eric Kandel has said, “all mental processes are brain processes and therefore all disorders of mental functioning are biological diseases.” The perspective article authored by Fabio Klamt and colleagues supports this view by offering new insights into the underlying biology of this lifelong and devastating mental disorder affecting millions of people worldwide.

This article has been republished from materials provided by Universidade Federal do Rio Grande do Sul. Note: material may have been edited for length and content. For further information, please contact the cited source.

Pfaffenseller, B., Kapczinski, F., Gallitano, A., & Klamt, F. (2018). EGR3 immediate early gene and the brain-derived neurotrophic factor in bipolar disorder. Frontiers in Behavioral Neuroscience, 12, 15.


Meet Helen Lavretsky, Professor of Psychiatry at UCLA, recently completed a pilot study of Kundalini yoga vs memory training in older adults with subjective memory complaints and mild cognitive impairment.

Patients assigned to yoga practice for 12 weeks with daily meditation for 12 minutes in weekly one hour classes did better than those who participated in memory training classes in verbal and visual memory, executive function, mood resilience, anxiety, and connectivity of the brain.

Results suggest that yoga can be a cognitive enhancement or brain fitness exercise that can confer similar or even more extensive cognitive resilience than memory training—the gold standard—in older adults.

Meditation in this study was practiced with music recorded on the White Sun album, which received a Grammy award this year.

Dr Lavretsky is Professor of Psychiatry at UCLA. She also directs the Late Life Mood, Stress, and Wellness Research Program at the Semel Institute at UCLA.

Eyre HA1, Siddarth P1, Acevedo B1, et al. A randomized controlled trial of Kundalini yoga in mild cognitive impairment. Int Psychogeriatr. 2017;29:557-567.

Yang H, Leaver AM, Siddarth P, et al. Neurochemical and Neuroanatomical Plasticity Following Memory Training and Yoga Interventions in Older Adults with Mild Cognitive Impairment. Front Aging Neurosci. 2016;8:277. eCollection 2016.


When someone commits suicide, their family and friends can be left with the heartbreaking and answerless question of what they could have done differently. Colin Walsh, data scientist at Vanderbilt University Medical Center, hopes his work in predicting suicide risk will give people the opportunity to ask “what can I do?” while there’s still a chance to intervene.

Walsh and his colleagues have created machine-learning algorithms that predict, with unnerving accuracy, the likelihood that a patient will attempt suicide. In trials, results have been 80-90% accurate when predicting whether someone will attempt suicide within the next two years, and 92% accurate in predicting whether someone will attempt suicide within the next week.

The prediction is based on data that’s widely available from all hospital admissions, including age, gender, zip codes, medications, and prior diagnoses. Walsh and his team gathered data on 5,167 patients from Vanderbilt University Medical Center that had been admitted with signs of self-harm or suicidal ideation. They read each of these cases to identify the 3,250 instances of suicide attempts.

This set of more than 5,000 cases was used to train the machine to identify those at risk of attempted suicide compared to those who committed self-harm but showed no evidence of suicidal intent. The researchers also built algorithms to predict attempted suicide among a group 12,695 randomly selected patients with no documented history of suicide attempts. It proved even more accurate at making suicide risk predictions within this large general population of patients admitted to the hospital.

Walsh’s paper, published in Clinical Psychological Science in April, is just the first stage of the work. He’s now working to establish whether his algorithm is effective with a completely different data set from another hospital. And, once confidant that the model is sound, Walsh hopes to work with a larger team to establish a suitable method of intervening. He expects to have an intervention program in testing within the next two years. “I’d like to think it’ll be fairly quick, but fairly quick in health care tends to be in the order of months,” he adds.

Suicide is such an intensely personal act that it seems, from a human perspective, impossible to make such accurate predictions based on a crude set of data. Walsh says it’s natural for clinicians to ask how the predictions are made, but the algorithms are so complex that it’s impossible to pull out single risk factors. “It’s a combination of risk factors that gets us the answers,” he says.

That said, Walsh and his team were surprised to note that taking melatonin seemed to be a significant factor in calculating the risk. “I don’t think melatonin is causing people to have suicidal thinking. There’s no physiology that gets us there. But one thing that’s been really important to suicide risk is sleep disorders,” says Walsh. It’s possible that prescriptions for melatonin capture the risk of sleep disorders—though that’s currently a hypothesis that’s yet to be proved.

The research raises broader ethical questions about the role of computers in health care and how truly personal information could be used. “There’s always the risk of unintended consequences,” says Walsh. “We mean well and build a system to help people, but sometimes problems can result down the line.”

Researchers will also have to decide how much computer-based decisions will determine patient care. As a practicing primary care doctor, Walsh says it’s unnerving to recognize that he could effectively follow orders from a machine. “Is there a problem with the fact that I might get a prediction of high risk when that’s not part of my clinical picture?” he says. “Are you changing the way I have to deliver care because of something a computer’s telling me to do?”

For now, the machine-learning algorithms are based on data from hospital admissions. But Walsh recognizes that many people at risk of suicide do not spend time in hospital beforehand. “So much of our lives is spent outside of the health care setting. If we only rely on data that’s present in the health care setting to do this work, then we’re only going to get part of the way there,” he says.

And where else could researchers get data? The internet is one promising option. We spend so much time on Facebook and Twitter, says Walsh, that there may well be social media data that could be used to predict suicide risk. “But we need to do the work to show that’s actually true.”

Facebook announced earlier this year that it was using its own artificial intelligence to review posts for signs of self-harm. And the results are reportedly already more accurate than the reports Facebook gets from people flagged by their friends as at-risk.

Training machines to identify warning signs of suicide is far from straightforward. And, for predictions and interventions to be done successfully, Walsh believes it’s essential to destigmatize suicide. “We’re never going to help people if we’re not comfortable talking about it,” he says.

But, with suicide leading to 800,000 deaths worldwide every year, this is a public health issue that cannot be ignored. Given that most humans, including doctors, are pretty terrible at identifying suicide risk, machine learning could provide an important solution.


By Richard Schiffman

In one of the largest and most rigorous clinical investigations of psychedelic drugs to date, researchers at Johns Hopkins University and New York University have found that a single dose of psilocybin—the psychoactive compound in “magic” mushrooms—substantially diminished depression and anxiety in patients with advanced cancer.

Psychedelics were the subject of a flurry of serious medical research in the 1960s, when many scientists believed some of the mind-bending compounds held tremendous therapeutic promise for treating a number of conditions including severe mental health problems and alcohol addiction. But flamboyant Harvard psychology professor Timothy Leary—one of the top scientists involved—started aggressively promoting LSD as a consciousness expansion tool for the masses, and the youth counterculture movement answered the call in a big way. Leary lost his job and eventually became an international fugitive. Virtually all legal research on psychedelics shuddered to a halt when federal drug policies hardened in the 1970s.

The decades-long research blackout ended in 1999 when Roland Griffiths of Johns Hopkins was among the first to initiate a new series of studies on psilocybin. Griffiths has been called the grandfather of the current psychedelics research renaissance, and a 21st-century pioneer in the field—but the soft-spoken investigator is no activist or shaman/showman in the mold of Leary. He’s a scientifically cautious clinical pharmacologist and author of more than 300 studies on mood-altering substances from coffee to ketamine.

Much of Griffiths’ fascination with psychedelics stems from his own mindfulness meditation practice, which he says sparked his interest in altered states of consciousness. When he started administering psilocybin to volunteers for his research, he was stunned that more than two-thirds of the participants rated their psychedelic journey one of the most important experiences of their lives.

Griffiths believes that psychedelics are not just tools for exploring the far reaches of the human mind. He says they show remarkable potential for treating conditions ranging from drug and alcohol dependence to depression and post-traumatic stress disorder.

They may also help relieve one of humanity’s cruelest agonies: the angst that stems from facing the inevitability of death. In research conducted collaboratively by Griffiths and Stephen Ross, clinical director of the NYU Langone Center of Excellence on Addiction, 80 patients with life-threatening cancer in Baltimore and New York City were given laboratory-synthesized psilocybin in a carefully monitored setting, and in conjunction with limited psychological counseling. More than three-quarters reported significant relief from depression and anxiety—improvements that remained during a follow-up survey conducted six months after taking the compound, according to the double-blind study published December 1 in The Journal of Psychopharmacology.

“It is simply unprecedented in psychiatry that a single dose of a medicine produces these kinds of dramatic and enduring results,” Ross says. He and Griffiths acknowledge that psychedelics may never be available on the drugstore shelf. But the scientists do envision a promising future for these substances in controlled clinical use. In a wide-ranging interview, Griffiths told Scientific American about the cancer study and his other work with psychedelics—a field that he says could eventually contribute to helping ensure our survival as a species.

[An edited transcript of the interview follows.]

What were your concerns going into the cancer study?
The volunteers came to us often highly stressed and demoralized by their illness and the often-grueling medical treatment. I felt very cautious at first, wondering if this might not re-wound people dealing with the painful questions of death and dying. How do we know that this kind of experience with this disorienting compound wouldn’t exacerbate that? It turns out that it doesn’t. It does just the opposite. The experience appears to be deeply meaningful spiritually and personally, and very healing in the context of people’s understanding of their illness and how they manage that going forward.

Could you describe your procedure?
We spent at least eight hours talking to people about their cancer, their anxiety, their concerns and so on to develop good rapport with them before the trial. During the sessions there was no specific psychological intervention—we were just inviting people to lie on the couch and explore their own inner experience.

What did your research subjects tell you about that experience?
There is something about the core of this experience that opens people up to the great mystery of what it is that we don’t know. It is not that everybody comes out of it and says, ‘Oh, now I believe in life after death.’ That needn’t be the case at all. But the psilocybin experience enables a sense of deeper meaning, and an understanding that in the largest frame everything is fine and that there is nothing to be fearful of. There is a buoyancy that comes of that which is quite remarkable. To see people who are so beaten down by this illness, and they start actually providing reassurance to the people who love them most, telling them ‘it is all okay and there is no need to worry’— when a dying person can provide that type of clarity for their caretakers, even we researchers are left with a sense of wonder.

Was this positive result universal?
We found that the response was dose-specific. The larger dose created a much larger response than the lower dose. We also found that the occurrence of mystical-type experiences is positively correlated with positive outcomes: Those who underwent them were more likely to have enduring, large-magnitude changes in depression and anxiety.

Did any of your volunteers experience difficulties?
There are potential risks associated with these compounds. We can protect against a lot of those risks, it seems, through the screening and preparation procedure in our medical setting. About 30 percent of our people reported some fear or discomfort arising sometime during the experience. If individuals are anxious, then we might say a few words, or hold their hand. It is really just grounding them in consensual reality, reminding them that they have taken psilocybin, that everything is going to be alright. Very often these short-lived experiences of psychological challenge can be cathartic and serve as doorways into personal meaning and transcendence—but not always.

Where do you go from here?
The Heffter Research Institute, which funded our study, has just opened a dialogue with the FDA (Food and Drug Administration) about initiating a phase 3 investigation. A phase 3 clinical trial is the gold standard for determining whether something is clinically efficacious and meets the standards that are necessary for it to be released as a pharmaceutical. Approval would be under very narrow and restrictive conditions initially. The drug might be controlled by a central pharmacy, which sends it to clinics that are authorized to administer psilocybin in this therapeutic context. So this is not writing a prescription and taking it home. The analogy would be more like an anesthetic being dispensed and managed by an anesthesiologist.

You are also currently conducting research on psilocybin and smoking.
We are using psilocybin in conjunction with cognitive behavioral therapy with cigarette smokers to see if these deeply meaningful experiences that can happen with psilocybin can be linked with the intention and commitment to quit smoking, among people who have failed repeatedly to do so. Earlier we ran an uncontrolled pilot study on that in 50 volunteers, in which we had 80 percent abstinence rates at six months. Now we are doing a controlled clinical trial in that population.

How do you account for your remarkable initial results?
People who have taken psilocybin appear to have more confidence in their ability to change their own behavior and to manage their addictions. Prior to this experience, quite often the individual feels that they have no freedom relative to their addiction, that they are hooked and they don’t have the capacity to change. But after an experience of this sort—which is like backing up and seeing the larger picture—they begin to ask themselves ‘Why would I think that I couldn’t stop cigarette smoking? Why would I think that this craving is so compelling that I have to give in to it?’ When the psilocybin is coupled with cognitive behavioral therapy, which is giving smokers tools and a framework to work on this, it appears to be very helpful.

You are also working with meditation practitioners. Are they having similar experiences?
We have done an unpublished study with beginning meditators. We found that psilocybin potentiates their engagement with their spiritual practice, and it appears to boost dispositional characteristics like gratitude, compassion, altruism, sensitivity to others and forgiveness. We were interested in whether the psilocybin used in conjunction with meditation could create sustained changes in people that were of social value. And that appears to be the case.

So it is actually changing personality?
Yes. That is really interesting because personality is considered to be a fixed characteristic; it is generally thought to be locked down in an individual by their early twenties. And yet here we are seeing significant increases in their “openness” and other pro-social dimensions of personality, which are also correlated with creativity, so this is truly surprising.

Do we know what is actually happening in the brain?
We are doing neuro-imaging studies. Dr. Robin Carhart-Harris’s group at Imperial College in London is also doing neuro-imaging studies. So it is an area of very active investigation. The effects are perhaps explained, at least initially, by changes in something [in the brain] called “the default mode network,” which is involved in self-referential processing [and in sustaining our sense of ego]. It turns out that this network is hyperactive in depression. Interestingly, in meditation it becomes quiescent, and also with psilocybin it becomes quiescent. This may correlate with the experience of clarity of coming into the present moment.

That is perhaps an explanation of the acute effects, but the enduring effects are much less clear, and I don’t think that we have a good handle on that at all. Undoubtedly it is going to be much more complex than just the default mode network, because of the vast interconnectedness of brain function.

What are the practical implications of this kind of neurological and therapeutic knowledge of psychedelics?
Ultimately it is not really about psychedelics. Science is going to take it beyond psychedelics when we start understanding the brain mechanisms underlying this and begin harnessing these for the benefit of humankind.

The core mystical experience is one of the interconnectedness of all people and things, the awareness that we are all in this together. It is precisely the lack of this sense of mutual caretaking that puts our species at risk right now, with climate change and the development of weaponry that can destroy life on the planet. So the answer is not that everybody needs to take psychedelics. It is to understand what mechanisms maximize these kinds of experiences, and to learn how to harness them so that we don’t end up annihilating ourselves.


Two new randomized and controlled trials show that just one dose of psilocybin—the compound in psychedelic mushrooms—can produce dramatic and long-lasting improvements in depression and anxiety symptoms.

The findings, published in The Journal of Psychopharmacology, are being hailed as unprecedented and potentially transformative for the treatment of psychiatric disorders.

“These findings, the most profound to date in the medical use of psilocybin, indicate it could be more effective at treating serious psychiatric diseases than traditional pharmaceutical approaches, and without having to take a medication every day,” said George R. Greer, MD, Medical Director of the Heffter Research Institute, which funded and reviewed the studies.

Psych Congress Steering Committee member Andrew Penn, RN, MS, NP, CNS, APRN-BC, said that if the findings can be replicated in larger studies, “we may be living witnesses to an event in psychiatry that is no less significant than when Alexander Fleming discovered penicillin.”

“These studies represent a new dawn of hope for our profession and our ability to help some of our most desperate patients, those whose lives are disrupted not only by cancer, but by the existential distress of dying, not only find relief from their suffering, but to find meaning in their illness,” said Penn, Psychiatric Nurse Practitioner at Kaiser Permanente in Redwood City, California.

The 2 studies were led by researchers at Johns Hopkins University School of Medicine in Baltimore, Maryland, and the New York University (NYU) Langone Medical Center in New York City. The participants in both trials had life-threatening cancer diagnoses and related mood disturbances.

Fifty-one adults participated in the double-blind Johns Hopkins study. They received a capsule of psilocybin in what is considered a moderate or high dose (22 or 30 mg/70 kg) during 1 of 2 treatment sessions. At the other session, they received a low dose of psilocybin as a control.

Researchers reported they had considerable relief from their anxiety or depression symptoms for up to 6 months. About 80% of the participants continued to show clinically significant decreases in symptoms 6 months after the final treatment session.

“The most interesting and remarkable finding is that a single dose of psilocybin, which lasts four to six hours, produced enduring decreases in depression and anxiety symptoms, and this may represent a fascinating new model for treating some psychiatric conditions,” says Roland Griffiths, PhD, professor of Behavioral Biology in the Departments of Psychiatry and Behavioral Sciences and Neuroscience at the Johns Hopkins medical school.

The NYU double-blind crossover study involved 29 participants, who all received tailored counseling, a 0.3 mg/kg dose of psilocybin at one of 2 treatment sessions, and a vitamin placebo at the other session. Eighty percent of the participants experienced relief for more than 6 months, researchers reported.

“That a drug administered once can have this effect for so long is unprecedented. We have never had anything like it in the psychiatric field,” said Stephen Ross, MD, principal investigator of the NYU study and director of substance abuse services in the Department of Psychiatry at the Langone Medical Center.

Psych Congress co-chair Charles Raison, MD, said he has “had the privilege of being involved in the next stages of the work to explore whether psilocybin holds true potential for treating depression and anxiety.”

“This has given me an insider’s view of this area of research and from that perspective I think there is a very good chance that psychedelic medicines—which were abandoned long ago by psychiatry—may hold promise as some of the more powerful treatments for emotional disorders that we will identify in the 21st century,” said Dr. Raison, Professor of Human Development and Family Studies and of Psychiatry at the University of Wisconsin-Madison.

The Journal of Psychopharmacology published 11 commentaries with the study results, which generally support the research into psilocybin and its use in a clinical setting, according to a Johns Hopkins statement.

Penn noted that “few mental health professionals trained in the last 4 decades know anything about these drugs, beyond their use as an intoxicant.”

“When the sun set on psychedelic drug research amidst the hysteria of the ‘drug war’ begun in the 1960s, the promise of these compounds, including psilocybin, was almost lost to history,” Penn said.

– Terri Airov