Episode 956: Psychedelics and Risk of Schizophrenia

Contributor: Jorge Chalit-Hernandez, OMS3 Educational Pearls:

• Psychedelics are being studied for their therapeutic effects in mental illnesses, including major depressive disorder, post-traumatic stress disorder, anxiety, and many others
• Classic psychedelics include compounds like psilocybin, LSD, and ayahuasca
  • MDMA and ketamine are often included in psychedelic research, but have a different mechanism of action than the others
  • Their mechanism of action involves agonism of the 5HT2A receptor, among others
  • Given their resurgence, there is an increase in recreational use of these substances
• A recent study assessed the risks of recreational users developing subsequent psychotic disorders
  • Individuals who visited the ED for hallucinogen use had a greater risk of being diagnosed with a schizophrenia spectrum disorder in the following 3 years
  • Hazard ratio (HR) of 21.32
  • After adjustment for comorbid substance use and other mental illness, the hazard ratio was 3.53 - still a significant increase compared with the general population
  • They also found an elevated risk for psychedelics when compared to alcohol (HR 4.66) and cannabis (HR 1.47)
• The study did not assess whether patients received antipsychotics or other treatments in the ED

References

1. Lieberman JA. Back to the Future - The Therapeutic Potential of Psychedelic Drugs. N Engl J Med. 2021;384(15):1460-1461. doi:10.1056/NEJMe2102835
2. Livne O, Shmulewitz D, Walsh C, Hasin DS. Adolescent and adult time trends in US hallucinogen use, 2002-19: any use, and use of ecstasy, LSD and PCP. Addiction. 2022;117(12):3099-3109. doi:10.1111/add.15987
3. Myran DT, Pugliese M, Xiao J, et al. Emergency Department Visits Involving Hallucinogen Use and Risk of Schizophrenia Spectrum Disorder. JAMA Psychiatry. 2025;82(2):142-150. doi:10.1001/jamapsychiatry.2024.3532

Summarized & Edited by Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/