The need for establishing best practices and gold standards in psychedelic medicine

Psychedelic substances are under investigation in several drug development programs. Controlled clinical trials are providing evidence for safe and effective use of psychedelic therapies for treating mental health conditions. With the anticipated FDA approval of MDMA-assisted therapy for posttraumatic stress disorder in 2023 and psilocybin therapy for depression disorders soon after, now is the time for the medical community to become informed on best practices and to actively participate in developing standards of care for these new treatments. Given the emergence of numerous drug sponsors and other companies developing therapeutic modalities for combination with psychedelic medications, it is essential that the medical professional field is at the forefront of communicating unbiased information related to safety and effectiveness. Gold standards have long been a part of medicine and serve to distinguish treatments and assessments as the highest quality by which all others can be compared to. For a treatment to be established as a gold standard, several factors are considered including the quantity and quality of the supporting data, the rigor of trials, and the safety and efficacy compared to other treatments. In this article, we review the origins of psychedelic-assisted therapy (PAT), minimum requirements for safe use of psychedelics, criteria for gold standards in mental health, and the nuances regarding how to establish gold standards in psychedelic medicine and guide clinical decision making.

Scaling Up: Multisite Open-Label Clinical Trials of MDMA-Assisted Therapy for Severe Posttraumatic Stress Disorder

Background: Posttraumatic stress disorder (PTSD) is a debilitating mental health condition associated with serious adverse health outcomes and functional impairment. Previous MDMA–assisted therapy (MDMA-AT) studies have shown promising results in single site studies. Two open-label studies tested this modality in multisite clinical trials to assess the feasibility of scaling this manualized therapy across 14 North American sites. Method: Cotherapist dyads were trained in the manualized MDMA-AT protocol and administered three experimental sessions 3 to 5 weeks apart among participants with severe PTSD. Cotherapist dyads were provided clinical supervision and evaluated for protocol adherence by centralized raters. Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) assessed change in symptoms severity. Results: Adherence rating scores were high across cotherapist dyads ( M = 95.08%, SD = 3.70%) and sites ( M = 95.23%, SD = 2.20%). CAPS-5 scores decreased following 3 MDMA-AT sessions at 18 weeks post baseline (Δ M = −29.99, Δ SD = 13.45, p < .0001, n = 37, Cohen’s d = 2.2, confidence interval [1.97, 2.47]). MDMA was well tolerated. Conclusions: These findings corroborate previous results that MDMA-AT can achieve significant improvements in PTSD symptom severity and demonstrate scalability of manualized therapy across clinic sites in the United States and Canada.

Fossils and avian evolution

Discoveries of archaic Mesozoic fossil birds ('opposite' birds, or enantiornithines) during the past decade have revolutionized our understanding of early avian evolution, but the rarity of Early Cretaceous ornithurines - birds that are closely related to the modern avian radiation - has meant that information about these species has lagged behind.

Nonavian feathers in a late Triassic archosaur

Longisquama insignis was an unusual archosaur from the Late Triassic of central Asia. Along its dorsal axis Longisquama bore a series of paired integumentary appendages that resembled avian feathers in many details, especially in the anatomy of the basal region. The latter is sufficiently similar to the calamus of modern feathers that each probably represents the culmination of virtually identical morphogenetic processes. The exact relationship of Longisquama to birds is uncertain. Nevertheless, we interpret Longisquama's elongate integumentary appendages as nonavian feathers and suggest that they are probably homologous with avian feathers. If so, they antedate the feathers of Archaeopteryx, the first known bird from the Late Jurassic.

Early Adaptive Radiation of Birds: Evidence from Fossils from Northeastern China

Late Jurassic and Early Cretaceous birds from northeastern China, including many complete skeletons of Confuciusornis, provide evidence for a fundamental dichotomy in the class Aves that may antedate the temporal occurrence of the Late Jurassic Archaeopteryx. The abundance of Confuciusornis may provide evidence of avian social behavior. Jurassic skeletal remains of an ornithurine bird lend further support to the idea of an early separation of the line that gave rise to modern birds. Chaoyangia, an ornithurine bird from the Early Cretaceous of China, has premaxillary teeth.

Evidence from Claw Geometry Indicating Arboreal Habits of Archaeopteryx

The Late Jurassic Archaeopteryx has been thought to have been a feathered predator adapted to running that represented a terrestrial stage in the evolution of true birds from coelurosaurian dinosaurs. Examination of claw geometry, however, shows that (i) modern ground- and tree-dwelling birds can be distinguished on the basis of claw curvature, in that greater claw arcs characterize tree-dwellers and trunk-climbers, and (ii) the claws of the pes (hind foot) and manus (front hand) of Archaeopteryx exhibit degrees of curvature typical of perching and trunk-climbing birds, respectively. On this basis, Archaeopteryx appears to have been a perching bird, not a cursorial predator.

Feathers of Archaeopteryx: Asymmetric Vanes Indicate Aerodynamic Function

Vanes in the primary flight feathers of Archaeopteryx conform to the asymmetric pattern in modern flying birds. The asymmetry has aerodynamic functions and can be assumed to have evolved in the selective context of flight.