[Psychedelics in psychiatry: an open debate].

The application of psychedelics in psychiatry and psychotherapy is increasingly the subject of scientific evaluation and discussion in national and international professional and general society, and, internationally, has already been partly applied in the clinical setting. The manuscript provides a basic description of the state of the art regarding evidence and clinical issues; law, ethics and economics are addressed; therapeutic qualification of potential users and a potentially clinical embedding in psychiatry are discussed, taking into consideration current challenges. Thus, the discussion will cover the circumstances under which the application of psychedelics might have a potential to broaden the spectrum of treatments in certain psychiatric conditions, particularly in the context of chronicity and treatment resistance to current methods.

A prospective longitudinal study shows putamen volume is associated with moderate amphetamine use and resultant cognitive impairments.

Background: Amphetamine-type stimulants (ATS) have become a critical public health issue. Animal models have indicated a clear neurotoxic potential of ATSs. In humans, chronic use has been associated with cognitive deficits and structural brain abnormalities.

Modafinil enhances cognitive, but not emotional conflict processing via enhanced inferior frontal gyrus activation and its communication with the dorsomedial prefrontal cortex.

Cognitive control regulates cognitive and emotional systems to facilitate goal-directed behavior in the context of task-irrelevant distractors. Cognitive control deficits contribute to residual functional impairments across psychiatric disorders and represent a promising novel treatment target. Translational evidence suggests that modafinil may enhance performance in executive functions; however, differential effects on regulatory control in cognitive and emotional domains have not been examined.

Inhibition of return (IOR) in patients with schizophrenia and cannabis use.

Research concerning the spatial orientation in patients with schizophrenia has demonstrated a state independent deficit in inhibition of return (IOR), which has been discussed as a vulnerability marker for schizophrenia. Other recent investigations on brain structure and cognitive processing have revealed less deficits in schizophrenia patients with comorbid cannabis use (SCH + CUD) compared to abstinent schizophrenia patients (SCH). It was hypothesized that these results may reflect a premorbid lower vulnerability in at least a subgroup of comorbid patients.

A Longitudinal Study of Self-Reported Psychopathology in Beginning Ecstasy and Amphetamine Users: A Third Follow-up Evaluation.

Background: It is still unknown whether psychopathological symptoms found in ecstasy and amphetamine users were apparent before the first use or developed subsequent to its use.

Objectives: The present study presents the third follow-up evaluation of a longitudinal study to assess the nature of the relationship between ecstasy, amphetamine (AMPH) and psychopathology.

Methods: In this sample, 69 beginning ecstasy and AMPH users were followed over a period of 4 years.

Learning, Memory, and Executive Function in New MDMA Users: A 2-Year Follow-Up Study.

3,4-Methylenedioxymethamphetamine (MDMA) is associated with changes in neurocognitive performance. Recent studies in laboratory animals have provided additional support for the neurodegeneration hypothesis. However, results from animal research need to be applied to humans with caution.

Trans-Sector Integrated Treatment in Psychosis and Addiction.

Background: Patients with psychosis often develop comorbid addiction, with a lifetime prevalence of ca. 50%. Dual diagnoses are considered hard to treat.

Smaller amygdala and medial prefrontal cortex predict escalating stimulant use.

Drug addiction is a chronic, relapsing brain disorder. The identification of biomarkers that render individuals vulnerable for the transition from occasional drug use to addiction is of key importance to develop early intervention strategies. The aim of the present study was to prospectively assess brain structural markers for escalating drug use in two independent samples of occasional amphetamine-type stimulant users.

Interactions between specific parameters of MDMA use and cognitive and psychopathological measures.

The aim of the present study was to investigate the relevance of different parameters of 3,4-methylenedioxymethamphetamine (MDMA) use, including age of first use, cumulative lifetime dose and highest daily dose for predicting cognitive performance and self-reported psychopathology. Moreover, interactions between those parameters were examined. Ninety-six new MDMA users were interviewed to assess their drug use, and they completed a battery of cognitive tests concerning attention and information processing speed, episodic memory and executive functioning and self-reported psychopathology.

A longitudinal study of self-reported psychopathology in early ecstasy and amphetamine users.

Aims: It still remains unclear whether psychopathological abnormalities described in human 3,4-methylenedioxymethamphetamine users (MDMA users) and d-amphetamine users (AMPH users) existed before the beginning of regular use or if they develop with ongoing use.

Objectives: The present study was conducted in order to assess this relationship and to overcome previous methodological shortcomings.

Methods: A longitudinal cohort study in 96 beginning MDMA and d-amphetamine users between 2006 and 2011 with a follow-up duration of 24 months.

Motor Improvement and Emotional Stabilization in Patients With Tourette Syndrome After Deep Brain Stimulation of the Ventral Anterior and Ventrolateral Motor Part of the Thalamus.

Background: Since its first application in 1999, the potential benefit of deep brain stimulation (DBS) in reducing symptoms of otherwise treatment-refractory Tourette syndrome (TS) has been documented in several publications. However, uncertainty regarding the ideal neural targets remains, and the eventuality of so far undocumented but possible negative long-term effects on personality fuels the debate about the ethical implications of DBS.

Methods: In this prospective open-label trial, eight patients (three female, five male) 19-56 years old with severe and medically intractable TS were treated with high-frequency DBS of the ventral anterior and ventrolateral motor part of the thalamus.

Ziprasidone versus clozapine in the treatment of dually diagnosed (DD) patients with schizophrenia and cannabis use disorders: a randomized study.

Background And Objectives: Clozapine is considered to be particularly effective in the treatment of dually diagnosed (DD) patients with psychosis and substance use disorders. However, its use is restricted by potentially severe side effects. The aim of the present pilot study was to compare the effects of clozapine with the newer second generation antipsychotic (SGA) ziprasidone in DD-patients.

Contributions of experimental psychiatry to research on the psychosis prodrome.

In the recent decades, a paradigmatic change in psychosis research and treatment shifted attention toward the early and particularly the prodromal stages of illness. Despite substantial progress with regard to the neuronal underpinnings of psychosis development, the crucial biological mechanisms leading to manifest illness are yet insufficiently understood. Until today, one significant approach to elucidate the neurobiology of psychosis has been the modeling of psychotic symptoms by psychedelic substances in healthy individuals.

Decision-making in polydrug amphetamine-type stimulant users: an fMRI study.

Qualitative poor decision-making and associated altered neuronal activation patterns have been described for the users of several drugs, amongst others for stimulants like amphetamine and MDMA. Deficits in decision-making might be caused by an augmented attraction to short-term rewarding properties despite negative long-term consequences, leading to rigid stimulus-response patterns. In the present imaging study, we investigated decision-making and associated neuronal activation in three groups differing in their exposure to amphetamine and MDMA.

Memory-related hippocampal functioning in ecstasy and amphetamine users: a prospective fMRI study.

Rationale: Recreational use of ecstasy (3,4-methylenedioxymethamphetamine [MDMA]) has been associated with memory impairments. Functional neuroimaging studies with cross-sectional designs reported altered memory-related hippocampal functioning in ecstasy-polydrug users. However, differences might be pre-existing or related to the concomitant use of amphetamine.

A prospective study of learning, memory, and executive function in new MDMA users.

Aims: It is still unclear if cognitive abnormalities in human 3,4-methylenedioxymeth-amphetamine (MDMA) users existed before the beginning of use or if other confounders could explain the deficits. The present study was conducted in order to assess the relationship between beginning MDMA use and subsequent cognitive performance and to overcome previous methodological shortcomings.

Design: A prospective cohort study in new MDMA users between 2006 and 2009 with a follow-up duration of 12 months.

Cortical thinning in amphetamine-type stimulant users.

Accumulating evidence supports the hypothesis of ecstasy and amphetamine exhibiting neurotoxic properties in human recreational users. The extent and exact location of neuronal degeneration might also be associated with a specific profile of cognitive deterioration described in polydrug users. Voxel-based morphometry and cortical thickness analyses constantly gain attention for answering the question of associated neurological sequelae.

Increased gray matter density in patients with schizophrenia and cannabis use: a voxel-based morphometric study using DARTEL.

Alterations in gray matter density as well as cognitive impairments are commonly described in patients with schizophrenia (SCH patients). Both gray matter deficits and cognitive impairments have recently been discussed to represent vulnerability markers of schizophrenia. The counterintuitive finding of better cognitive performance in patients with schizophrenia and cannabis use (SCH+CAN patients) compared to cannabis naïve patients is discussed as a reflection of lower vulnerability for schizophrenia in at least one subgroup of SCH+CAN patients.

Clinical effectiveness of unilateral deep brain stimulation in Tourette syndrome.

Dysfunctional basal ganglia loops are thought to underlie the clinical picture of Tourette syndrome (TS). By altering dopaminergic activity in the affected neural structures, bilateral deep brain stimulation is assumed to have a modulatory effect on dopamine transmission resulting in an amelioration of tics. While the majority of published case reports deals with the application of bilateral stimulation, the present study aims at informing about the high effectiveness of unilateral stimulation of pallidal and nigral thalamic territories in TS.

Medial prefrontal gray matter volume reductions in users of amphetamine-type stimulants revealed by combined tract-based spatial statistics and voxel-based morphometry.

Amphetamine-type stimulants (ATS) refer to a group of drugs whose principal members include amphetamine, methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA). Worldwide, ATS are among the most common illicit drugs. Therefore, understanding whether and to what extent ATS exposure affects brain structure and functioning in recreational users has become a critical public health issue.

Interactions between specific parameters of cannabis use and verbal memory.

Recently, the impact of different parameters of cannabis use, including the age of first use, the average frequency of use, the cumulative lifetime dose, the average dose per occasion, and the duration of regular use upon cognitive functions has been discussed. However, to date no study has systematically investigated the interactions of these parameters with regard to cognitive performance. To determine whether these interactions exist, 142 healthy young adult cannabis users participated in a neuropsychological assessment study with a German version of the Rey Auditory Verbal Learning Test (RAVLT).

The impact of early-onset cannabis use on functional brain correlates of working memory.

Cannabis is the most commonly used illicit drug. Prevalence rates are particularly high among adolescents. Neuropsychological studies have identified cannabis-associated memory deficits, particularly linked to an early onset of use.

Altered parahippocampal functioning in cannabis users is related to the frequency of use.

Rationale: Converging lines of evidence suggest an association between cannabis use and impaired episodic memory as well as related associative learning. These deficits have been associated with the duration, frequency, and age of onset of cannabis use. However, it remains unclear whether these parameters of use differently impact memory-related hippocampal functioning.

[Prevalence of psychosis/substance abuse comorbidity. Clinical-epidemiological findings from different treatment settings in a large German city].

Comorbid substance use disorders in schizophrenia are of high clinical relevance, because they are common and they are mostly associated with an unfavourable long-term prognosis. Whereas the clinical impression suggests a continuous increase of substance use disorders in patients with schizophrenia over the last 10-20 years, results from epidemiological studies have been inconsistent. The aim of the present investigation was to study the prevalence of substance use disorders within a large sample of patients with schizophrenia in a large German city (Cologne).

Unilateral deep brain stimulation of the nucleus accumbens in patients with treatment-resistant obsessive-compulsive disorder: Outcomes after one year.

Objective: To investigate the effects of unilateral deep brain stimulation (DBS) in the right nucleus accumbens in patients with obsessive-compulsive disorder (OCD). Predominantly bilateral stimulation of the anterior limb of the internal capsule was utilized.

Methods: The study was designed as a double-blind sham-controlled crossover study.