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Owe-Larsson M, Kamińska K, Buchalska B, Mirowska-Guzel D, Cudnoch-Jędrzejewska A. Psilocybin in pharmacotherapy of obsessive-compulsive disorder. Pharmacol Rep 2024:10.1007/s43440-024-00633-1. [PMID: 39088105 DOI: 10.1007/s43440-024-00633-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/09/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic mental disease that affects approximately 2% of the population. Obsessions and compulsions are troublesome for patients and may disturb their everyday activities. The pathogenesis of this disease is still not fully elucidated, but dysfunctions of serotonin-, dopamine- and glutamate-mediated neurotransmission together with early maladaptive schemas seem of importance. Pharmacological treatment includes drugs affecting the serotoninergic, dopaminergic, and glutamatergic systems, such as selective serotonin reuptake inhibitors (SSRIs). Providing that up to 40% of patients with OCD are resistant to the currently available medications, there is a need for novel and effective therapies. Recent discoveries suggest that psilocybin, a non-physically addictive psychoactive substance, may ameliorate disease symptoms. When used in appropriate doses and under strict clinical control, psilocybin appears as a valuable treatment for OCD. This narrative article provides a thorough overview of OCD's etiology, current treatment options, and the emerging evidence supporting psilocybin's efficacy in managing OCD symptoms.
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Affiliation(s)
- Maja Owe-Larsson
- Laboratory of Center for Preclinical Research, Department of Experimental and Clinical Physiology, Medical University of Warsaw, Banacha 1B, Warszawa, 02-097, Poland.
| | - Katarzyna Kamińska
- Laboratory of Center for Preclinical Research, Department of Experimental and Clinical Physiology, Medical University of Warsaw, Banacha 1B, Warszawa, 02-097, Poland.
| | - Barbara Buchalska
- Laboratory of Center for Preclinical Research, Department of Experimental and Clinical Physiology, Medical University of Warsaw, Banacha 1B, Warszawa, 02-097, Poland
| | - Dagmara Mirowska-Guzel
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warszawa, Poland
| | - Agnieszka Cudnoch-Jędrzejewska
- Laboratory of Center for Preclinical Research, Department of Experimental and Clinical Physiology, Medical University of Warsaw, Banacha 1B, Warszawa, 02-097, Poland
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Kishon R, Modlin NL, Cycowicz YM, Mourtada H, Wilson T, Williamson V, Cleare A, Rucker J. A rapid narrative review of the clinical evolution of psychedelic treatment in clinical trials. NPJ MENTAL HEALTH RESEARCH 2024; 3:33. [PMID: 38956330 PMCID: PMC11220096 DOI: 10.1038/s44184-024-00068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/16/2024] [Indexed: 07/04/2024]
Abstract
Pre-prohibition psychedelic research with complex psychiatric patients generated a wealth of treatment methodologies and practices, providing invaluable clinical insights pertaining to the medical administration of psychedelics in various mental health diagnoses. Building upon these early studies, which lack the rigor and research tools available today, contemporary psychedelic research has focused on investigating the safety and efficacy of psychedelics in randomized controlled trials via psychometric measures and symptom assessments. Both then and now, the treatment context and the role of clinicians in psychedelic treatment has been recognized as an essential feature for positive patient outcomes. To broaden the knowledge base of modern psychedelic research and support the training of clinicians conducting medically supervised psychedelic research studies, this paper provides a review of pre-prohibition clinical research narratives pertaining to the phenomenology of psychedelic treatment and the role of the non-pharmacological treatment factors in the patient experience. Lastly, this paper explores a range of clinician perspectives and psychological interventions employed in pre-prohibition psychedelic research to inform future research directions and best practice guidelines.
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Affiliation(s)
- Ronit Kishon
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Nadav Liam Modlin
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK.
| | - Yael M Cycowicz
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Hania Mourtada
- New York State Psychiatric Institute, New York, NY, USA
- Department of Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Tayler Wilson
- New York State Psychiatric Institute, New York, NY, USA
| | - Victoria Williamson
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
| | - Anthony Cleare
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - James Rucker
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
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McAlpine RG, Sacchet MD, Simonsson O, Khan M, Krajnovic K, Morometescu L, Kamboj SK. Development of a digital intervention for psychedelic preparation (DIPP). Sci Rep 2024; 14:4072. [PMID: 38374177 PMCID: PMC10876638 DOI: 10.1038/s41598-024-54642-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/14/2024] [Indexed: 02/21/2024] Open
Abstract
Psychedelic substances induce profound alterations in consciousness. Careful preparation is therefore essential to limit adverse reactions, enhance therapeutic benefits, and maintain user safety. This paper describes the development of a self-directed, digital intervention for psychedelic preparation. Drawing on elements from the UK Medical Research Council (MRC) framework for developing complex interventions, the design was informed by a four-factor model of psychedelic preparedness, using a person-centred approach. Our mixed-methods investigation consisted of two studies. The first involved interviews with 19 participants who had previously attended a 'high-dose' psilocybin retreat, systematically exploring their preparation behaviours and perspectives on the proposed intervention. The second study engaged 28 attendees of an ongoing psilocybin retreat in co-design workshops, refining the intervention protocol using insights from the initial interviews. The outcome is a co-produced 21-day digital course (Digital Intervention for Psychedelic Preparation (DIPP)), that is organised into four modules: Knowledge-Expectation, Psychophysical-Readiness, Safety-Planning, and Intention-Preparation. Fundamental components of the course include daily meditation practice, supplementary exercises tied to the weekly modules, and mood tracking. DIPP provides a comprehensive and scalable solution to enhance psychedelic preparedness, aligning with the broader shift towards digital mental health interventions.
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Affiliation(s)
- Rosalind G McAlpine
- Clinical Psychopharmacology Unit, Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Matthew D Sacchet
- Meditation Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Otto Simonsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Maisha Khan
- Clinical Psychopharmacology Unit, Clinical, Educational and Health Psychology, University College London, London, UK
| | - Katarina Krajnovic
- Clinical Psychopharmacology Unit, Clinical, Educational and Health Psychology, University College London, London, UK
| | - Larisa Morometescu
- Clinical Psychopharmacology Unit, Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sunjeev K Kamboj
- Clinical Psychopharmacology Unit, Clinical, Educational and Health Psychology, University College London, London, UK
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McAlpine RG, Blackburne G, Kamboj SK. Development and psychometric validation of a novel scale for measuring 'psychedelic preparedness'. Sci Rep 2024; 14:3280. [PMID: 38332334 PMCID: PMC10853197 DOI: 10.1038/s41598-024-53829-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
Preparing participants for psychedelic experiences is crucial for ensuring these experiences are safe and, potentially beneficial. However, there is currently no validated measure to assess the extent to which participants are well-prepared for such experiences. Our study aimed to address this gap by developing, validating, and testing the Psychedelic Preparedness Scale (PPS). Using a novel iterative Delphi-focus group methodology ('DelFo'), followed by qualitative pre-test interviews, we incorporated the perspectives of expert clinicians/researchers and of psychedelic users to generate items for the scale. Psychometric validation of the PPS was carried out in two large online samples of psychedelic users (N = 516; N = 716), and the scale was also administered to a group of participants before and after a 5-7-day psilocybin retreat (N = 46). Exploratory and confirmatory factor analysis identified four factors from the 20-item PPS: Knowledge-Expectations, Intention-Preparation, Psychophysical-Readiness, and Support-Planning. The PPS demonstrated excellent reliability (ω = 0.954) and evidence supporting convergent, divergent and discriminant validity was also obtained. Significant differences between those scoring high and low (on psychedelic preparedness) before the psychedelic experience were found on measures of mental health/wellbeing outcomes assessed after the experience, suggesting that the scale has predictive utility. By prospectively measuring modifiable pre-treatment preparatory behaviours and attitudes using the PPS, it may be possible to determine whether a participant has generated the appropriate mental 'set' and is therefore likely to benefit from a psychedelic experience, or at least, less likely to be harmed.
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Affiliation(s)
- Rosalind G McAlpine
- Clinical Psychopharmacology Unit, Clinical, Educational and Health Psychology, University College London, London, UK.
| | - George Blackburne
- Clinical Psychopharmacology Unit, Clinical, Educational and Health Psychology, University College London, London, UK
- Experimental Psychology, University College London, London, UK
| | - Sunjeev K Kamboj
- Clinical Psychopharmacology Unit, Clinical, Educational and Health Psychology, University College London, London, UK
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Modlin NL, Creed M, Sarang M, Maggio C, Rucker JJ, Williamson V. Trauma-Informed Care in Psychedelic Therapy Research: A Qualitative Literature Review of Evidence-Based Psychotherapy Interventions in PTSD and Psychedelic Therapy Across Conditions. Neuropsychiatr Dis Treat 2024; 20:109-135. [PMID: 38268571 PMCID: PMC10807282 DOI: 10.2147/ndt.s432537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/10/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Post-traumatic stress disorder (PTSD) is associated with significant patient burden. While pharmacotherapies and evidence-based psychotherapy interventions (EBPI) are effective, studies consistently highlight inadequate outcomes and high treatment dropout. Psychedelic therapy (PT) has shown preliminary promise across difficult-to-treat conditions, including MDMA-assisted therapy for PTSD, however trials of classical psychedelics in PTSD are lacking. Understanding patients' experiences of EBPI could help promote safety in PT. Aim To systematically review qualitative research on patients' subjective experience of EBPI for PTSD, and of PT, and examine areas of overlap and divergence between them. Methods Systematic literature searches for studies published between 2010 and 2023 were conducted on OVID, PubMed, Web of Science, and PsycInfo. Included were original studies in English that presented qualitative data of patient experiences of EBPI in PTSD, or PT for any indication. Extracted data from included studies were analysed using thematic synthesis. Syntheses were completed separately for EBPI and PT, before similarities and differences between the therapies were identified. Results 40 research articles were included for review: 26 studies on EBPI for PTSD, and 14 studies on PT. EBPI studied were CBT, EMDR, CPT and PE. Psychedelic compounds studied were psilocybin, ibogaine, LSD, MDMA and ketamine, for treatment of substance use disorders, anxiety relating to physical illness, depression, and PTSD. Core themes from patient experiences of EBPI: 1) patient burden in PTSD treatment; 2) readiness; 3) key mechanisms of change; 4) psychological safety and trust. Themes identified in the review of PT: 1) indirect trauma processing; 2) reorganisation of self-narratives via processes of relatedness and identification; 3) key treatment characteristics. Conclusion This study suggests overlap between patients' experience of EBPI and PT in terms of key mechanisms of change, the importance of psychological safety and readiness to engage in treatment. Trauma-informed care paradigms and practices may improve safety and acceptability of PT research.
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Affiliation(s)
- Nadav Liam Modlin
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Michael Creed
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Maria Sarang
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Carolina Maggio
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - James J Rucker
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Victoria Williamson
- King’s Centre for Military Health Research, King’s College London, London, SE5 9RJ, UK
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, OX2 6 GG, UK
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Affiliation(s)
- Eduardo Ekman Schenberg
- Instituto Phaneros, São Paulo, Brazil (Schenberg); Massachusetts General Hospital and Harvard Medical School, Boston (King); Psychotherapist in private practice, Lisbon (Fonseca); Department of Psychology, University of Exeter, Exter, United Kingdom; Centre for Psychedelic Research, Imperial College London, London (Roseman)
| | - Franklin King
- Instituto Phaneros, São Paulo, Brazil (Schenberg); Massachusetts General Hospital and Harvard Medical School, Boston (King); Psychotherapist in private practice, Lisbon (Fonseca); Department of Psychology, University of Exeter, Exter, United Kingdom; Centre for Psychedelic Research, Imperial College London, London (Roseman)
| | - João Eusébio da Fonseca
- Instituto Phaneros, São Paulo, Brazil (Schenberg); Massachusetts General Hospital and Harvard Medical School, Boston (King); Psychotherapist in private practice, Lisbon (Fonseca); Department of Psychology, University of Exeter, Exter, United Kingdom; Centre for Psychedelic Research, Imperial College London, London (Roseman)
| | - Leor Roseman
- Instituto Phaneros, São Paulo, Brazil (Schenberg); Massachusetts General Hospital and Harvard Medical School, Boston (King); Psychotherapist in private practice, Lisbon (Fonseca); Department of Psychology, University of Exeter, Exter, United Kingdom; Centre for Psychedelic Research, Imperial College London, London (Roseman)
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Escamilla R, González-Trujano ME, González Mariscal JM, Torres-Valencia JM, Guzmán-González H, Vega JL, Loizaga-Velder A. A Proposal to Study the Safety and Efficacy of Psilocybe cubensis in Preclinical and Clinical Studies as a Therapeutic Alternative for Major Depressive Disorder. J Psychoactive Drugs 2023; 55:570-580. [PMID: 37594163 DOI: 10.1080/02791072.2023.2246459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023]
Abstract
The pharmacological treatment of depression consists of taking antidepressant drugs for prolonged periods; its modest therapeutic effect can often be associated with significant adverse effects, while its discontinuation can lead to relapses. Psilocybin is today a novel and breakthrough therapy for major depression. It is a natural alkaloid in Psilocybe mushrooms, which are endemic to Mexico. Research on a larger scale is lacking in various populations, including the Mexican people. This proposal contemplates the experimental design of a preclinical (toxicity and pharmacological evaluation of an extract in mice) and clinical study by including the chemical analysis of a species of Psilocybe cubensis mushroom to characterize its main constituents. The clinical study will consider the safety evaluation by exploring tolerated doses of Psilocybe cubensis by measuring pharmacokinetic parameters after oral administration in healthy adults and an open trial on a sample of patients with major depressive disorder to assess the safety and efficacy of fully characterized Psilocybe cubensis in a two-single doses treatment, (with assisted psychotherapy), compared with the traditional care model at the Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz in Mexico City. This report presents the design of a research project with preclinical and clinical experimental components.
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Affiliation(s)
- Raul Escamilla
- Servicios Clínicos. Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico city, Mexico
| | | | | | | | - Héctor Guzmán-González
- Servicios Clínicos. Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico city, Mexico
| | - José Luis Vega
- Servicios Clínicos. Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico city, Mexico
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Hirschfeld T, Prugger J, Majić T, Schmidt TT. Dose-response relationships of LSD-induced subjective experiences in humans. Neuropsychopharmacology 2023; 48:1602-1611. [PMID: 37161078 PMCID: PMC10516880 DOI: 10.1038/s41386-023-01588-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/19/2023] [Accepted: 04/12/2023] [Indexed: 05/11/2023]
Abstract
Lysergic acid diethylamide (LSD) is a potent classic serotonergic psychedelic, which facilitates a variety of altered states of consciousness. Here we present the first meta-analysis establishing dose-response relationship estimates of the altered states of consciousness induced by LSD. Data extracted from articles identified by a systematic literature review following PRISMA guidelines were obtained from the Altered States Database. The psychometric data comprised ratings of subjective effects from standardized and validated questionnaires: the Altered States of Consciousness Rating Scale (5D-ASC, 11-ASC) and the Mystical Experience Questionnaire (MEQ30). We performed meta-regression analyses using restricted cubic splines for data from studies with LSD doses of up to 200 μg base. Most scales revealed a sigmoid-like increase of effects, with a plateauing at around 100 μg. The most strongly modulated factors referred to changes in perception and illusory imagination, followed by positively experienced ego-dissolution, while only small effects were found for Anxiety and Dread of Ego Dissolution. The considerable variability observed in most factors and scales points to the role of non-pharmacological factors in shaping subjective experiences. The established dose-response relationships may be used as general references for future experimental and clinical research on LSD to compare observed with expected subjective effects and to elucidate phenomenological differences between psychedelics.
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Affiliation(s)
- Tim Hirschfeld
- Psychedelic Substances Research Group, Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johanna Prugger
- Psychedelic Substances Research Group, Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
- International Graduate Program Medical Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tomislav Majić
- Psychedelic Substances Research Group, Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry und Neurosciences, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Timo T Schmidt
- Psychedelic Substances Research Group, Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Department of Education and Psychology, Freie Universität Berlin, 14195, Berlin, Germany.
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Garakani A, Alexander JL, Sumner CR, Pine JH, Gross LS, Raison CL, Aaronson ST, Baron DA. Psychedelics, With a Focus on Psilocybin: Issues for the Clinician. J Psychiatr Pract 2023; 29:345-353. [PMID: 37678363 DOI: 10.1097/pra.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
There has been a burgeoning interest in psychedelics among the public, state legislatures, psychiatrists and other clinical providers, and within the research community. Increasing numbers of studies evaluating psychedelics for depression, anxiety, posttraumatic stress disorder, and substance use disorders have been conducted or are underway. While discussing psychedelics in general, the focus of this paper is on psilocybin and its mechanism, how it exerts a psychedelic effect, dosing, and a review of the treatment studies of psilocybin, which were primarily for treatment-resistant depression and cancer-related anxiety. Future directions and potential limitations of studying and regulating psilocybin and other psychedelics are also discussed.
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Kalfas M, Taylor RH, Tsapekos D, Young AH. Psychedelics for treatment resistant depression: are they game changers? Expert Opin Pharmacother 2023; 24:2117-2132. [PMID: 37947195 DOI: 10.1080/14656566.2023.2281582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION A new era of treatment for adults with treatment-resistant depression (TRD), which involves psychedelic substances, is dawning. Emerging evidence indicates that psychedelics can exert antidepressant effects through multiple neurobiological and psychological mechanisms. However, it remains to be seen if these new treatments will revolutionize the treatment of TRD. AREAS COVERED The present review focuses on the efficacy of serotoninergic psychedelics psilocybin, lysergic acid diethylamide (LSD), N,N-dimethyltryptamine (DMT), ayahuasca, 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) and mescaline (3,4,5-trimethoxyphenethylamine), as well as 3,4-methylenedioxymethamphetamine (MDMA), for TRD. A systematic search was conducted for psilocybin in TRD as emerging trials had not yet been subject to review. A narrative review summarized findings on other psychedelics. EXPERT OPINION Psychedelic therapy has created a paradigm shift in the treatment of TRD, as it can maximize therapeutic benefits and minimize potential risks. Psilocybin holds promise as a potential game-changer in the treatment of TRD, with initial evidence suggesting a rapid antidepressant effect sustained for some responders for at least 3 months. Nevertheless, further adequately powered, double-blind, comparator-controlled trials are required to explore and clarify the mechanisms of action and long-term effects of psychedelics in TRD. Psychedelics also hold promise for other psychiatric conditions, such as bipolar depression and post-traumatic stress disorder.
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Affiliation(s)
- Michail Kalfas
- Department of Psychological Medicine, King's College London, London, UK
| | - Rosie H Taylor
- Department of Psychological Medicine, King's College London, London, UK
| | | | - Allan H Young
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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