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Schindler EAD, Sewell RA, Gottschalk CH, Flynn LT, Zhu Y, Pittman BP, Cozzi NV, D'Souza DC. Psilocybin pulse regimen reduces cluster headache attack frequency in the blinded extension phase of a randomized controlled trial. J Neurol Sci 2024; 460:122993. [PMID: 38581739 DOI: 10.1016/j.jns.2024.122993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/21/2024] [Accepted: 03/31/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND In a recent randomized, double-blind, placebo-controlled study, we observed a nonsignificant reduction of attack frequency in cluster headache after pulse administration of psilocybin (10 mg/70 kg, 3 doses, 5 days apart each). We carried out a blinded extension phase to consider the safety and efficacy of repeating the pulse regimen. METHODS Eligible participants returned to receive a psilocybin pulse at least 6 months after their first round of study participation. Participants kept headache diaries starting two weeks before and continuing through eight weeks after the first drug session. Ten participants completed the extension phase and all ten were included in the final analysis. RESULTS In the three weeks after the start of the pulse, cluster attack frequency was significantly reduced from baseline (18.4 [95% confidence interval 8.4 to 28.4] to 9.8 [4.3 to 15.2] attacks/week; p = 0.013, d' = 0.97). A reduction of approximately 50% was seen regardless of individual response to psilocybin in the first round. Psilocybin was well-tolerated without any unexpected or serious adverse events. DISCUSSION This study shows a significant reduction in cluster attack frequency in a repeat round of pulse psilocybin administration and suggests that prior response may not predict the effect of repeated treatment. To gauge the full potential of psilocybin as a viable medicine in cluster headache, future work should investigate the safety and therapeutic efficacy in larger, more representative samples over a longer time period, including repeating the treatment. CLINICAL TRIALS REGISTRATION NCT02981173.
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Affiliation(s)
- Emmanuelle A D Schindler
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States of America; Neurology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America; Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America.
| | - R Andrew Sewell
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America
| | | | - L Taylor Flynn
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America
| | - Yutong Zhu
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America
| | - Brian P Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Nicholas V Cozzi
- Neuropharmacology Laboratory, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America; Alexander Shulgin Research Institute, Lafayette, CA, United States of America
| | - Deepak C D'Souza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America
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Schindler EAD, Sewell RA, Gottschalk CH, Luddy C, Flynn LT, Zhu Y, Lindsey H, Pittman BP, Cozzi NV, D'Souza DC. Exploratory investigation of a patient-informed low-dose psilocybin pulse regimen in the suppression of cluster headache: Results from a randomized, double-blind, placebo-controlled trial. Headache 2022; 62:1383-1394. [PMID: 36416492 DOI: 10.1111/head.14420] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/25/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Using a patient-informed regimen, we conducted an exploratory randomized, double-blind, placebo-controlled study to systematically investigate the effects of psilocybin in cluster headache. BACKGROUND Sustained reductions in cluster headache burden after limited quantities of psilocybin-containing mushrooms are anecdotally reported, although to date there are no controlled studies investigating these effects. METHODS Participants were randomized to receive psilocybin (0.143 mg/kg) or placebo (microcrystalline cellulose) in a pulse of three doses, each ~5 days apart. Participants maintained headache diaries starting 2 weeks before and continuing through 8 weeks after the first drug session. A total of 16 participants were randomized to receive experimental drug and 14 were included in the final analysis. RESULTS In the 3 weeks after the start of the pulse regimen, the change in cluster attack frequency was 0.03 (95% confidence interval [CI] -2.6 to 2.6) attacks/week with placebo (baseline 8.9 [95% CI 3.8 to 14.0]) and -3.2 (95% CI -8.3 to 1.9) attacks/week with psilocybin (baseline 9.6 [95% CI 5.6 to 13.6]; p = 0.251). Group difference in change from baseline had a moderate effect size (d = 0.69). The effect size was small in episodic participants (d = 0.35) but large in chronic participants (d = 1.25), which remained over the entire 8-week period measured (d = 0.81). Changes in cluster attack frequency were not correlated with the intensity of acute psychotropic effects during psilocybin administration. Psilocybin was well-tolerated without any unexpected or serious adverse events. CONCLUSIONS Findings from this initial, exploratory study provide valuable information for the development of larger, more definitive studies. Efficacy outcomes were negative, owing in part to the small number of participants. The separation of acute psychotropic effects and lasting therapeutic effects underscores the need for further investigation into the mechanism(s) of action of psilocybin in headache disorders.
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Affiliation(s)
- Emmanuelle A D Schindler
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA.,Neurology Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - R Andrew Sewell
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | | | - Christina Luddy
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - L Taylor Flynn
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Yutong Zhu
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Hayley Lindsey
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA.,Neurology Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Brian P Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nicholas V Cozzi
- Neuropharmacology Laboratory, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,Alexander Shulgin Research Institute, Lafayette, California, USA
| | - Deepak C D'Souza
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
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Schindler EAD, Sewell RA, Gottschalk CH, Luddy C, Flynn LT, Lindsey H, Pittman BP, Cozzi NV, D'Souza DC. Exploratory Controlled Study of the Migraine-Suppressing Effects of Psilocybin. Neurotherapeutics 2021; 18:534-543. [PMID: 33184743 PMCID: PMC8116458 DOI: 10.1007/s13311-020-00962-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 01/26/2023] Open
Abstract
While anecdotal evidence suggests that select 5-hydroxytryptamine 2A (5-HT2A) receptor ligands, including psilocybin, may have long-lasting therapeutic effects after limited dosing in headache disorders, controlled investigations are lacking. In an exploratory double-blind, placebo-controlled, cross-over study, adults with migraine received oral placebo and psilocybin (0.143 mg/kg) in 2 test sessions spaced 2 weeks apart. Subjects maintained headache diaries starting 2 weeks before the first session until 2 weeks after the second session. Physiological and psychological drug effects were monitored during sessions and several follow-up contacts with subjects were carried out to assure safety of study procedures. Ten subjects were included in the final analysis. Over the 2-week period measured after single administration, the reduction in weekly migraine days from baseline was significantly greater after psilocybin (mean, - 1.65 (95% CI: - 2.53 to - 0.77) days/week) than after placebo (- 0.15 (- 1.13 to 0.83) days/week; p = 0.003, t(9) = 4.11). Changes in migraine frequency in the 2 weeks after psilocybin were not correlated with the intensity of acute psychotropic effects during drug administration. Psilocybin was well-tolerated; there were no unexpected or serious adverse events or withdrawals due to adverse events. This exploratory study suggests there is an enduring therapeutic effect in migraine headache after a single administration of psilocybin. The separation of acute psychotropic effects and lasting therapeutic effects is an important finding, urging further investigation into the mechanism underlying the clinical effects of select 5-HT2A receptor compounds in migraine, as well as other neuropsychiatric conditions. Clinicaltrials.gov : NCT03341689.
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Affiliation(s)
- Emmanuelle A D Schindler
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
- Neurology Service, Veterans Affairs Connecticut Healthcare System, MS 127, 950 Campbell Avenue, West Haven, CT, 06516, USA.
- Veterans Affairs Headache Center of Excellence, West Haven, CT, USA.
| | - R Andrew Sewell
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | | | - Christina Luddy
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - L Taylor Flynn
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Hayley Lindsey
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Neurology Service, Veterans Affairs Connecticut Healthcare System, MS 127, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Veterans Affairs Headache Center of Excellence, West Haven, CT, USA
| | - Brian P Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Nicholas V Cozzi
- Neuropharmacology Laboratory, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Alexander Shulgin Research Institute, Lafayette, CA, USA
| | - Deepak C D'Souza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
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Schindler EAD, Schnakenberg Martin AM, Sewell RA, Ranganathan M, DeForest A, Pittman BP, Perrino A, D'Souza DC. In an exploratory randomized, double-blind, placebo-controlled, cross-over study, psychoactive doses of intravenous delta-9-tetrahydrocannabinol fail to produce antinociceptive effects in healthy human volunteers. Psychopharmacology (Berl) 2020; 237:3097-3107. [PMID: 32632491 DOI: 10.1007/s00213-020-05595-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/17/2020] [Indexed: 01/09/2023]
Abstract
RATIONALE Animal studies and anecdotal human reports suggest that cannabinoids have antinociceptive effects. Controlled human studies have produced mixed results. OBJECTIVES We sought to reduce existing variability by investigating the effects of intravenous delta-9-tetrahydrocannabinol (THC) in several pain paradigms within the same human subjects, addressing some of the limitations to the published literature. METHODS In this exploratory randomized, double-blind, placebo-controlled, cross-over study, healthy human subjects received 0.01 mg/kg or 0.03 mg/kg intravenous THC or placebo (ethanol vehicle) infused over 10 min on three test days, each separated by at least 72 h. Capsaicin (250 μg) was injected intradermally to induce chemical pain and hyperalgesia. Four other forms of acute pain were induced: mechanical (von Frey filament), hot and cold (thermode), and electrical (pulse generator). Pain ratings were obtained before drug administration, at peak drug effects, and 2 h after drug administration and included both objective and subjective measures. THC drug effects and vital signs were also collected during experimental sessions. Nonparametric analysis with repeated measures was performed. RESULTS THC induced euphoria, perceptual and cognitive alterations, and tachycardia in a dose-related manner, but failed to have significant effects in experimentally induced acute chemical, mechanical, thermal, or electrical pain and capsaicin-induced hyperalgesia. CONCLUSIONS In this exploratory controlled study, intravenous THC lacked significant antinociceptive properties in experimental models of acute pain and capsaicin-induced hyperalgesia in healthy human subjects. Continued study of THC and other cannabinoids through high-quality, controlled studies in both healthy volunteers and patients with pain conditions is warranted to inform the growing demand for the clinical application of cannabinoids in pain management.
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Affiliation(s)
- Emmanuelle A D Schindler
- Neurology Service, MS 127, Veterans Affairs (VA) Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA. .,Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
| | - Ashley M Schnakenberg Martin
- Psychology Service, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - R Andrew Sewell
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Mohini Ranganathan
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Anna DeForest
- Neurology Service, MS 127, Veterans Affairs (VA) Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.,Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Brian P Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Albert Perrino
- Anesthesia Service, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Anesthesia, Yale School of Medicine, New Haven, CT, USA
| | - Deepak C D'Souza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA
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Boggs DL, Surti TS, Esterlis I, Pittman B, Cosgrove K, Sewell RA, Ranganathan M, D’Souza DC. Minimal effects of prolonged smoking abstinence or resumption on cognitive performance challenge the "self-medication" hypothesis in schizophrenia. Schizophr Res 2018; 194:62-69. [PMID: 28392208 PMCID: PMC5630481 DOI: 10.1016/j.schres.2017.03.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 01/22/2023]
Abstract
One prominent, long-standing view is that individuals with schizophrenia smoke cigarettes more than the general population to "self-medicate" cognitive deficits and other symptoms. This study tested the self-medication hypothesis by examining the effects of smoking abstinence and resumption on cognition in patients with schizophrenia. Nicotine-dependent smokers with schizophrenia (n=26) were trained on a cognitive battery and then hospitalized to achieve and maintain confirmed abstinence from smoking for ~1 week. Cognition was tested while smoking as usual (baseline), one day after smoking cessation (early abstinence), ~1 week later (extended abstinence), and within ~3 weeks of resuming smoking (resumption). The test battery included measures of processing speed, attention, conflict resolution, verbal memory, working memory, verbal fluency, and executive function to evaluate multiple cognitive domains affected by schizophrenia. Positive and negative symptoms of schizophrenia, depressive symptoms, and dyskinesia were also measured at baseline and after prolonged abstinence. There were no significant changes in global cognitive test performance with smoking cessation, abstinence, or resumption. There were small decreases in a measure of processing speed and delayed verbal recall with abstinence, but these findings failed to survive adjustments for multiple comparisons. Surprisingly, in this within subject "On-Off-Off-On" design, there were no significant effects of early or prolonged abstinence from smoking on cognitive and behavioral measures in smokers with schizophrenia. The results of this study challenge the widely held "self-medication" hypothesis of smoking and schizophrenia, question the extent of pro-cognitive effects of smoking and nicotine in schizophrenia, and support encouraging smoking cessation in schizophrenia.
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Affiliation(s)
- Douglas L Boggs
- Psychiatry Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516 USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Toral S. Surti
- Psychiatry Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516 USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Irina Esterlis
- Psychiatry Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516 USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519 USA
| | - Brian Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519 USA
| | - Kelly Cosgrove
- Psychiatry Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516 USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519 USA
| | - R. Andrew Sewell
- Psychiatry Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516 USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519 USA
| | - Mohini Ranganathan
- Psychiatry Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516 USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519 USA
| | - Deepak Cyril D’Souza
- Psychiatry Service, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516 USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519 USA
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Ranganathan M, Radhakrishnan R, Addy PH, Schnakenberg-Martin AM, Williams AH, Carbuto M, Elander J, Pittman B, Andrew Sewell R, Skosnik PD, D'Souza DC. Tetrahydrocannabinol (THC) impairs encoding but not retrieval of verbal information. Prog Neuropsychopharmacol Biol Psychiatry 2017. [PMID: 28642081 DOI: 10.1016/j.pnpbp.2017.06.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Cannabis and agonists of the brain cannabinoid receptor (CB1R) produce acute memory impairments in humans. However, the extent to which cannabinoids impair the component processes of encoding and retrieval has not been established in humans. The objective of this analysis was to determine whether the administration of Δ9-Tetrahydrocannabinol (THC), the principal psychoactive constituent of cannabis, impairs encoding and/or retrieval of verbal information. MATERIALS AND METHODS Healthy subjects were recruited from the community. Subjects were administered the Rey-Auditory Verbal Learning Test (RAVLT) either before administration of THC (experiment #1) (n=38) or while under the influence of THC (experiment #2) (n=57). Immediate and delayed recall on the RAVLT was compared. Subjects received intravenous THC, in a placebo-controlled, double-blind, randomized manner at doses known to produce behavioral and subjective effects consistent with cannabis intoxication. RESULTS Total immediate recall, short delayed recall, and long delayed recall were reduced in a statistically significant manner only when the RAVLT was administered to subjects while they were under the influence of THC (experiment #2) and not when the RAVLT was administered prior. CONCLUSIONS THC acutely interferes with encoding of verbal memory without interfering with retrieval. These data suggest that learning information prior to the use of cannabis or cannabinoids is not likely to disrupt recall of that information. Future studies will be necessary to determine whether THC impairs encoding of non-verbal information, to what extent THC impairs memory consolidation, and the role of other cannabinoids in the memory-impairing effects of cannabis. CLINICAL TRIAL INFORMATION Cannabinoids, Neural Synchrony, and Information Processing (THC-Gamma) http://clinicaltrials.gov/ct2/show/study/NCT00708994 NCT00708994 Pharmacogenetics of Cannabinoid Response http://clinicaltrials.gov/ct2/show/NCT00678730 NCT00678730.
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Affiliation(s)
- Mohini Ranganathan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA.
| | - Rajiv Radhakrishnan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Peter H Addy
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Medical Informatics, VA Connecticut Healthcare System, West Haven, CT, USA; Substance Abuse Treatment Unit, Connecticut Mental Health Center, New Haven, CT, USA
| | - Ashley M Schnakenberg-Martin
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Ashley H Williams
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Michelle Carbuto
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Jacqueline Elander
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Brian Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - R Andrew Sewell
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Patrick D Skosnik
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Deepak Cyril D'Souza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
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7
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Cortes-Briones J, Skosnik PD, Mathalon D, Cahill J, Pittman B, Williams A, Sewell RA, Ranganathan M, Roach B, Ford J, D'Souza DC. Δ9-THC Disrupts Gamma (γ)-Band Neural Oscillations in Humans. Neuropsychopharmacology 2015; 40:2124-34. [PMID: 25709097 PMCID: PMC4613601 DOI: 10.1038/npp.2015.53] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/17/2015] [Accepted: 01/26/2015] [Indexed: 11/09/2022]
Abstract
Gamma (γ)-band oscillations play a key role in perception, associative learning, and conscious awareness and have been shown to be disrupted by cannabinoids in animal studies. The goal of this study was to determine whether cannabinoids disrupt γ-oscillations in humans and whether these effects relate to their psychosis-relevant behavioral effects. The acute, dose-related effects of Δ-9-tetrahydrocannabinol (Δ(9)-THC) on the auditory steady-state response (ASSR) were studied in humans (n=20) who completed 3 test days during which they received intravenous Δ(9)-THC (placebo, 0.015, and 0.03 mg/kg) in a double-blind, randomized, crossover, and counterbalanced design. Electroencephalography (EEG) was recorded while subjects listened to auditory click trains presented at 20, 30, and 40 Hz. Psychosis-relevant effects were measured with the Positive and Negative Syndrome scale (PANSS). Δ(9)-THC (0.03 mg/kg) reduced intertrial coherence (ITC) in the 40 Hz condition compared with 0.015 mg/kg and placebo. No significant effects were detected for 30 and 20 Hz stimulation. Furthermore, there was a negative correlation between 40 Hz ITC and PANSS subscales and total scores under the influence of Δ(9)-THC. Δ(9)-THC (0.03 mg/kg) reduced evoked power during 40 Hz stimulation at a trend level. Recent users of cannabis showed blunted Δ(9)-THC effects on ITC and evoked power. We show for the first time in humans that cannabinoids disrupt γ-band neural oscillations. Furthermore, there is a relationship between disruption of γ-band neural oscillations and psychosis-relevant phenomena induced by cannabinoids. These findings add to a growing literature suggesting some overlap between the acute effects of cannabinoids and the behavioral and psychophysiological alterations observed in psychotic disorders.
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Affiliation(s)
- Jose Cortes-Briones
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Patrick D Skosnik
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Daniel Mathalon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA,Mental Health Service Line, San Francisco VA Medical Center, San Francisco, CA, USA
| | - John Cahill
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Brian Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Ashley Williams
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - R Andrew Sewell
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Mohini Ranganathan
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Brian Roach
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA,Mental Health Service Line, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Judith Ford
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA,Mental Health Service Line, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Deepak Cyril D'Souza
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA,Psychiatry Service 116A, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA, Tel: +1 203 932 5711 (2594), Fax: +1 203 937 4860, E-mail:
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Cortes-Briones JA, Cahill JD, Ranganathan M, Sewell RA, D'Souza DC, Skosnik PD. Testing differences in the activity of event-related potential sources: important implications for clinical researchers. Clin Neurophysiol 2014; 126:215-8. [PMID: 24840905 DOI: 10.1016/j.clinph.2014.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 04/15/2014] [Accepted: 04/16/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Jose A Cortes-Briones
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06510, USA; VA Connecticut Healthcare System, 116A, 950 Campbell Avenue, West Haven, CT 06516, USA
| | - John D Cahill
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06510, USA; VA Connecticut Healthcare System, 116A, 950 Campbell Avenue, West Haven, CT 06516, USA
| | - Mohini Ranganathan
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06510, USA; VA Connecticut Healthcare System, 116A, 950 Campbell Avenue, West Haven, CT 06516, USA
| | - R Andrew Sewell
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06510, USA; VA Connecticut Healthcare System, 116A, 950 Campbell Avenue, West Haven, CT 06516, USA
| | - Deepak C D'Souza
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06510, USA; VA Connecticut Healthcare System, 116A, 950 Campbell Avenue, West Haven, CT 06516, USA
| | - Patrick D Skosnik
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06510, USA; VA Connecticut Healthcare System, 116A, 950 Campbell Avenue, West Haven, CT 06516, USA.
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D'Andrea D, Andrew Sewell R. Transient resolution of treatment-resistant posttraumatic stress disorder following ketamine infusion. Biol Psychiatry 2013; 74:e13-4. [PMID: 23706680 DOI: 10.1016/j.biopsych.2013.04.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/11/2013] [Indexed: 11/25/2022]
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Boggs DL, Ranganathan M, Sewell RA, Madonick S, D'Souza DC. Pilot study of intravenous nicotine effects on cognitive performance in schizophrenia. Schizophr Res 2013; 150:323-4. [PMID: 23953216 DOI: 10.1016/j.schres.2013.07.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/15/2013] [Accepted: 07/24/2013] [Indexed: 01/03/2023]
Affiliation(s)
- Douglas L Boggs
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA.
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Sewell RA, Schnakenberg A, Elander J, Radhakrishnan R, Williams A, Skosnik PD, Pittman B, Ranganathan M, D’Souza DC. Acute effects of THC on time perception in frequent and infrequent cannabis users. Psychopharmacology (Berl) 2013. [PMID: 23179965 PMCID: PMC3581701 DOI: 10.1007/s00213-012-2915-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
RATIONALE Cannabinoids have been shown to alter time perception, but existing literature has several limitations. Few studies have included both time estimation and production tasks, few control for subvocal counting, most had small sample sizes, some did not record subjects' cannabis use, many tested only one dose, and used either oral or inhaled administration of Δ⁹-tetrahydrocannabinol (THC), leading to variable pharmacokinetics, and some used whole-plant cannabis containing cannabinoids other than THC. Our study attempted to address these limitations. OBJECTIVES This study aims to characterize the acute effects of THC and frequent cannabis use on seconds-range time perception. THC was hypothesized to produce transient, dose-related time overestimation and underproduction. Frequent cannabis smokers were hypothesized to show blunted responses to these alterations. METHODS IV THC was administered at doses from 0.015 to 0.05 mg/kg to 44 subjects who participated in several double-blind, randomized, counterbalanced, crossover, placebo-controlled studies. Visual time estimation and production tasks in the seconds range were presented to subjects three times on each test day. RESULTS All doses induced time overestimation and underproduction. Chronic cannabis use had no effect on baseline time perception. While infrequent/nonsmokers showed temporal overestimation at medium and high doses and temporal underproduction at all doses, frequent cannabis users showed no differences. THC effects on time perception were not dose related. CONCLUSIONS A psychoactive dose of THC increases internal clock speed as indicated by time overestimation and underproduction. This effect is not dose related and is blunted in chronic cannabis smokers who did not otherwise have altered baseline time perception.
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Affiliation(s)
- R. Andrew Sewell
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
| | - Ashley Schnakenberg
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
| | - Jacqueline Elander
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
| | - Rajiv Radhakrishnan
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
| | - Ashley Williams
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
| | - Patrick D. Skosnik
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
| | - Brian Pittman
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
| | - Mohini Ranganathan
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
| | - D. Cyril D’Souza
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Clinical Neuroscience Research Unit, New Haven, CT, United States
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Ranganathan M, Schnakenberg A, Skosnik PD, Cohen B, Pittman B, Sewell RA, D’Souza DC. Dose-related behavioral, subjective, endocrine, and psychophysiological effects of the κ opioid agonist Salvinorin A in humans. Biol Psychiatry 2012; 72:871-9. [PMID: 22817868 PMCID: PMC3638802 DOI: 10.1016/j.biopsych.2012.06.012] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 05/10/2012] [Accepted: 06/07/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Salvia divinorum (Salvia) is an increasingly popular recreational drug amongst adolescents and young adults. Its primary active ingredient, Salvinorin A (SA)-a highly selective agonist at the κ opiate receptor-is believed to be one of the most potent naturally occurring hallucinogens. However, there is little experimental data on the effects of SA in humans. METHODS In a 3-day, double-blind, randomized, crossover, counterbalanced study, the behavioral, subjective, cognitive, psychophysiological, and endocrine effects of 0 mg, 8 mg, and 12 mg of inhaled SA were characterized in 10 healthy individuals who had previously used Salvia. RESULTS SA produced psychotomimetic effects and perceptual alterations, including dissociative and somaesthetic effects, increased plasma cortisol and prolactin, and reduced resting electroencephalogram spectral power. The SA administration was associated with a rapid increase of its levels in the blood. SA did not produce euphoria, cognitive deficits, or changes in vital signs. The effects were transient and not dose-related. SA administration was very well-tolerated without acute or delayed adverse effects. CONCLUSIONS SA produced a wide range of transient effects in healthy subjects. The perceptual altering effects and lack of euphoric effects would explain its intermittent use pattern. Such a profile would also suggest a low addictive potential similar to other hallucinogens and consistent with κ opiate receptor agonism. Further work is warranted to carefully characterize a full spectrum of its effects in humans, to elucidate the underlying mechanisms involved, and to explore the basis for individual variability in its effects.
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Affiliation(s)
- Mohini Ranganathan
- Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516, USA.
| | - Ashley Schnakenberg
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Patrick D. Skosnik
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Bruce Cohen
- Harvard Medical School, MA, USA,McLean Hospital, Belmont, MA
| | - Brian Pittman
- Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - R. Andrew Sewell
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Deepak Cyril D’Souza
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Esterlis I, Hannestad JO, Bois F, Sewell RA, Tyndale RF, Seibyl JP, Picciotto MR, Laruelle M, Carson RE, Cosgrove KP. Imaging changes in synaptic acetylcholine availability in living human subjects. J Nucl Med 2012; 54:78-82. [PMID: 23160789 DOI: 10.2967/jnumed.112.111922] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED In vivo estimation of β(2)-nicotinic acetylcholine receptor availability with molecular neuroimaging is complicated by competition between the endogenous neurotransmitter acetylcholine and the radioligand (123)I-3-[2(S)-2-azetidinylmethoxy]pyridine ((123)I-5-IA). We examined whether binding of (123)I-5-IA is sensitive to increases in extracellular levels of acetylcholine in humans, as suggested in nonhuman primates. METHODS Six healthy subjects (31 ± 4 y) participated in a (123)I-5-IA SPECT study. After baseline scans, physostigmine (1-1.5 mg) was administered intravenously over 60 min, and 9 additional scans were obtained. RESULTS We observed a significant reduction in the total volume of distribution after physostigmine administration (29% ± 17% in the cortex, 19% ± 15% in the thalamus, 19% ± 15% in the striatum, and 36% ± 30% in the cerebellum; P < 0.05). This reduction reflected a combination of a region-specific 7%-16% decrease in tissue concentration of tracer and a 9% increase in plasma parent concentration. CONCLUSION These data suggest that increases in acetylcholine compete with (123)I-5-IA for binding to β(2)-nicotinic acetylcholine receptor. Additional validation of this paradigm is warranted, but it may be used to interrogate changes in extracellular acetylcholine.
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Affiliation(s)
- Irina Esterlis
- Department of Psychiatry, Yale University, New Haven, Connecticut, USA.
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Johnson MW, Sewell RA, Griffiths RR. Psilocybin dose-dependently causes delayed, transient headaches in healthy volunteers. Drug Alcohol Depend 2012; 123:132-40. [PMID: 22129843 PMCID: PMC3345296 DOI: 10.1016/j.drugalcdep.2011.10.029] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 10/03/2011] [Accepted: 10/31/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Psilocybin is a well-characterized classic hallucinogen (psychedelic) with a long history of religious use by indigenous cultures, and nonmedical use in modern societies. Although psilocybin is structurally related to migraine medications, and case studies suggest that psilocybin may be efficacious in treatment of cluster headache, little is known about the relationship between psilocybin and headache. METHODS This double-blind study examined a broad range of psilocybin doses (0, 5, 10, 20, and 30 mg/70 kg) on headache in 18 healthy participants. RESULTS Psilocybin frequently caused headache, the incidence, duration, and severity of which increased in a dose-dependent manner. All headaches had delayed onset, were transient, and lasted no more than a day after psilocybin administration. CONCLUSIONS Possible mechanisms for these observations are discussed, and include induction of delayed headache through nitric oxide release. These data suggest that headache is an adverse event to be expected with the nonmedical use of psilocybin-containing mushrooms as well as the administration of psilocybin in human research. Headaches were neither severe nor disabling, and should not present a barrier to future psilocybin research.
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Affiliation(s)
- Matthew W Johnson
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Behavioral Biology Research Center, Baltimore, MD 21224-6823, USA.
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Abstract
Pharmacogenetic analyses of treatments for alcohol dependence attempt to predict treatment response and side-effect risk for specific medications. We review the literature on pharmacogenetics relevant to alcohol dependence treatment, and describe state-of-the-art methods of pharmacogenetic research in this area. Two main pharmacogenetic study designs predominate: challenge studies and treatment-trial analyses. Medications studied include US FDA-approved naltrexone and acamprosate, both indicated for treating alcohol dependence, as well as several investigational (and off-label) treatments such as sertraline, olanzapine and ondansetron. The best-studied functional genetic variant relevant to alcoholism treatment is rs1799971, a single-nucleotide polymorphism in exon 1 of the OPRM1 gene that encodes the μ-opioid receptor. Evidence from clinical trials suggests that the presence of the variant G allele of rs1799971 may predict better treatment response to opioid receptor antagonists such as naltrexone. Evidence from clinical trials also suggests that several medications interact pharmacogenetically with variation in genes that encode proteins involved in dopaminergic and serotonergic neurotransmission. Variation in the DRD4 gene, which encodes the dopamine D(4) receptor, may predict better response to naltrexone and olanzapine. A polymorphism in the serotonin transporter gene SLC6A4 promoter region appears related to differential treatment response to sertraline depending on the subject's age of onset of alcoholism. Genetic variation in SLC6A4 may also be associated with better treatment response to ondansetron. Initial pharmacogenetic efforts in alcohol research have identified functional variants with potential clinical utility, but more research is needed to further elucidate the mechanism of these pharmacogenetic interactions and their moderators in order to translate them into clinical practice.
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Affiliation(s)
- Albert J. Arias
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,VA Connecticut Healthcare System, West Haven, CT, USA
| | - R. Andrew Sewell
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,VA Connecticut Healthcare System, West Haven, CT, USA
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Carbuto M, Sewell RA, Williams A, Forselius-Bielen K, Braley G, Elander J, Pittman B, Schnakenberg A, Bhakta S, Perry E, Ranganathan M, D'Souza DC. The safety of studies with intravenous Δ⁹-tetrahydrocannabinol in humans, with case histories. Psychopharmacology (Berl) 2012; 219:885-96. [PMID: 21845389 DOI: 10.1007/s00213-011-2417-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 07/13/2011] [Indexed: 12/19/2022]
Abstract
RATIONALE Delta-9-tetrahydrocannabinol (THC) is one of the few cannabinoid receptor ligands that can be used to probe the cannabinoid system in humans. Despite increasing interest in the cannabinoid receptor system, use of intravenous THC as a research tool has been limited by concerns about its abuse liability and psychoactive effects. OBJECTIVES This study aims to evaluate the safety of all intravenous THC studies conducted at this center for the past 13 years. METHODS Included were 11 studies with 266 subjects (14 schizophrenia patients and 252 healthy subjects, of whom 76 were frequent cannabis users), 351 active THC infusions, and 226 placebo infusions. Subjects were monitored for subjective and physical adverse events and followed up to 12 months beyond study participation. RESULTS There was one serious and 70 minor adverse events in 9.7% of subjects and 7.4% of infusions, with 8.5% occurring after the end of the test day. Nausea and dizziness were the most frequent side effects. Adverse events were more likely to be associated with faster infusion rates (2-5 min) and higher doses (>2.1 mg/70 kg). Of 149 subjects on whom long-term follow-up data were gathered, 94% reported either no change or a reduction in their desire to use cannabis in the post-study period, 18% stated that their cannabis use decreased, and 3% stated that it increased in the post-study period. CONCLUSIONS With careful subject selection and screening, risk to subjects is relatively low. Safeguards are generally sufficient and effective, reducing both the duration and severity of adverse events.
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Affiliation(s)
- Michelle Carbuto
- Psychiatry Service, VA Connecticut Healthcare System, 116A, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA
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Sewell RA, Perry EB, Karper LP, Bell MD, Lysaker P, Goulet JL, Brenner L, Erdos J, d'Souza DC, Seibyl JP, Krystal JH. Clinical significance of neurological soft signs in schizophrenia: factor analysis of the Neurological Evaluation Scale. Schizophr Res 2010; 124:1-12. [PMID: 20855185 DOI: 10.1016/j.schres.2010.08.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 08/16/2010] [Accepted: 08/23/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nonlocalizing neurologic deficits detectable by clinical evaluation-"soft signs"-are a robust finding in patients diagnosed with schizophrenia, but their conceptual and neuroanatomical correlates remain unclear. The purpose of this study was to evaluate the organization of these deficits and their clinical correlates using the Neurological Evaluation Scale (NES). METHODS Ninety-three male veterans with schizophrenia and schizoaffective disorder were evaluated using a detailed clinical assessment that included the NES, the Extrapyramidal Symptom Rating Scale, the Abnormal Involuntary Movement Scale (AIMS), the Barnes Akathisia Scale, the Positive and Negative Syndrome Scale, the Wisconsin Card Sorting Test (WCST), the Schedule for the Deficit Syndrome (SDS), and the Digit Symbol Substitution Task (DSST). RESULTS Four factors explained 73% of the variance and had distinct clinical and neuropsychological correlates. Factor 1 reflected deficits involved with memory and sensory integration, and was associated with lower PANSS positive and higher AIMS scores. Factor 2 reflected impairments in motor control, and was associated with lower intelligence, more cognitive deficits, and deficit-syndrome schizophrenia. Factor 3 was related to lower intelligence and more perseverative errors on the WCST. Factor 4 was related to increasing age, more extrapyramidal symptoms, more perseverative errors, and worse scores on the DSST. CONCLUSIONS Neurologic deficits in schizophrenia have an intrinsic organization that appears to have clinical significance, highlighting the continued utility of the NES in studies of neurological deficits in schizophrenia patients. The theoretical underpinning of this organization remains unclear.
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Affiliation(s)
- R Andrew Sewell
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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Sewell RA, Skosnik PD, Garcia-Sosa I, Ranganathan M, D'Souza DC. Efeitos comportamentais, cognitivos e psicofisiológicos dos canabinoides: relevância para a psicose e a esquizofrenia. Rev Bras Psiquiatr 2010. [DOI: 10.1590/s1516-44462010000500005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Avanços recentes no conhecimento sobre a função do receptor de canabinoide renovaram o interesse na associação entre cannabis e psicose. Linhas convergentes de evidências sugerem que os canabinoides podem produzir uma ampla gama de sintomas transitórios positivos, negativos e cognitivos assemelhados aos de esquizofrenia. Os canabinoides também produzem alguns déficits psicofisiológicos sabidamente presentes na esquizofrenia. É igualmente claro que em indivíduos com um transtorno psicótico estabelecido, os canabinoides podem exacerbar sintomas, desencadear recaídas e ter consequências negativas no curso da doença. Evidências crescentes sugerem que a exposição precoce e pesada à cannabis pode aumentar o risco de se desenvolver um transtorno psicótico como a esquizofrenia. A relação entre exposição à cannabis e esquizofrenia preenche alguns, mas não todos os critérios usuais de causalidade. Porém, a maioria das pessoas que utilizam cannabis não desenvolve esquizofrenia e muitas pessoas diagnosticadas com esquizofrenia nunca utilizaram cannabis. Portanto, é provável que a exposição à cannabis seja uma "causa componente" que interage com outros fatores para "causar" esquizofrenia ou outro transtorno psicótico, mas não é nem necessária nem suficiente para fazê-lo sozinha. No entanto, na ausência de causas conhecidas da esquizofrenia e com as implicações de políticas de saúde pública, se tal vínculo for estabelecido, as causas componentes, tais como a exposição a canabinoide, devem continuar sendo um foco de estudos futuros. Finalmente, são necessárias mais pesquisas para identificar os fatores subjacentes à vulnerabilidade à psicose relacionada a canabinoide e para elucidar os mecanismos biológicos subjacentes a esse risco.
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Affiliation(s)
- R. Andrew Sewell
- VA Connecticut Healthcare System, EUA; Connecticut Mental Health Center, EUA; Yale University School of Medicine, EUA
| | - Patrick D. Skosnik
- VA Connecticut Healthcare System, EUA; Connecticut Mental Health Center, EUA; Yale University School of Medicine, EUA
| | - Icelini Garcia-Sosa
- VA Connecticut Healthcare System, EUA; Connecticut Mental Health Center, EUA; Yale University School of Medicine, EUA
| | - Mohini Ranganathan
- VA Connecticut Healthcare System, EUA; Connecticut Mental Health Center, EUA; Yale University School of Medicine, EUA
| | - Deepak Cyril D'Souza
- VA Connecticut Healthcare System, EUA; Connecticut Mental Health Center, EUA; Yale University School of Medicine, EUA
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Sewell RA, Skosnik PD, Garcia-Sosa I, Ranganathan M, D'Souza DC. [Behavioral, cognitive and psychophysiological effects of cannabinoids: relevance to psychosis and schizophrenia]. Braz J Psychiatry 2010; 32 Suppl 1:S15-S30. [PMID: 20512267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Recent advances in knowledge about cannabinoid receptor function have renewed interest in the association between cannabis and psychosis. Converging lines of evidence suggest that cannabinoids can produce a full range of transient schizophrenia-like positive, negative and cognitive symptoms. Cannabinoids also produce some psychophysiological deficits also known to be present in schizophrenia. Also clear is that in individuals with an established psychotic disorder, cannabinoids can exacerbate symptoms, trigger relapse, and have negative consequences on the course of the illness. Increasing evidence suggests that early and heavy cannabis exposure may increase the risk of developing a psychotic disorder such as schizophrenia. The relationship between cannabis exposure and schizophrenia fulfills some, but not all, of the usual criteria for causality. However, most people who use cannabis do not develop schizophrenia, and many people diagnosed with schizophrenia have never used cannabis. Therefore, it is likely that cannabis exposure is a "component cause" that interacts with other factors to "cause" schizophrenia or other psychotic disorder, but is neither necessary nor sufficient to do so alone. In the absence of known causes of schizophrenia, however, and the implications for public health policy should such a link be established the role of component causes such as cannabinoid exposure should remain a focus of further study. Finally, further work is necessary to identify the factors that underlie individual vulnerability to cannabinoid-related psychosis and to elucidate the biological mechanisms underlying this risk.
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Affiliation(s)
- R Andrew Sewell
- Serviço de Psiquiatria, VA Connecticut Healthcare System, West Haven, CT 06516, EUA
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Abstract
The prevalence of both alcohol and cannabis use and the high morbidity associated with motor vehicle crashes has lead to a plethora of research on the link between the two. Drunk drivers are involved in 25% of motor vehicle fatalities, and many accidents involve drivers who test positive for cannabis. Cannabis and alcohol acutely impair several driving-related skills in a dose-related fashion, but the effects of cannabis vary more between individuals than they do with alcohol because of tolerance, differences in smoking technique, and different absorptions of Delta(9)-tetrahydrocannabinol (THC), the active ingredient in marijuana. Detrimental effects of cannabis use vary in a dose-related fashion, and are more pronounced with highly automatic driving functions than with more complex tasks that require conscious control, whereas alcohol produces an opposite pattern of impairment. Because of both this and an increased awareness that they are impaired, marijuana smokers tend to compensate effectively while driving by utilizing a variety of behavioral strategies. Combining marijuana with alcohol eliminates the ability to use such strategies effectively, however, and results in impairment even at doses which would be insignificant were they of either drug alone. Epidemiological studies have been inconclusive regarding whether cannabis use causes an increased risk of accidents; in contrast, unanimity exists that alcohol use increases crash risk. Furthermore, the risk from driving under the influence of both alcohol and cannabis is greater than the risk of driving under the influence of either alone. Future research should focus on resolving contradictions posed by previous studies, and patients who smoke cannabis should be counseled to wait several hours before driving, and avoid combining the two drugs.
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Affiliation(s)
- R Andrew Sewell
- VA Connecticut Healthcare/Yale University School of Medicine, West Haven, Connecticut, USA.
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Abstract
No pharmacotherapies are approved for stimulant use disorders, which are an important public health problem. Stimulants increase synaptic levels of the monoamines dopamine (DA), serotonin and norepinephrine (NE). Stimulant reward is attributable mostly to increased DA in the reward circuitry, although DA stimulation alone cannot explain the rewarding effects of stimulants. The noradrenergic system, which uses NE as the main chemical messenger, serves multiple brain functions including arousal, attention, mood, learning, memory and stress response. In pre-clinical models of addiction, NE is critically involved in mediating stimulant effects including sensitization, drug discrimination and reinstatement of drug seeking. In clinical studies, adrenergic blockers have shown promise as treatments for cocaine abuse and dependence, especially in patients experiencing severe withdrawal symptoms. Disulfiram, which blocks NE synthesis, increased the number of cocaine-negative urines in five randomized clinical trials. Lofexidine, an alpha(2)-adrenergic agonist, reduces the craving induced by stress and drug cues in drug users. In addition, the NE transporter (NET) inhibitor atomoxetine attenuates some of d-amphetamine's subjective and physiological effects in humans. These findings warrant further studies evaluating noradrenergic medications as treatments for stimulant addiction.
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Affiliation(s)
- Mehmet Sofuoglu
- Department of Psychiatry, School of Medicine, Yale University, USA and VA Connecticut Healthcare System, USA.
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23
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Abstract
Recent advances in knowledge about cannabinoid receptor function have renewed interest in the association between cannabis and psychosis. Case series, autobiographical accounts, and surveys of cannabis users in the general population suggest an association between cannabis and psychosis. Cross-sectional studies document an association between cannabis use and psychotic symptoms, and longitudinal studies suggest that early exposure to cannabis confers a close to two-fold increase in the risk of developing schizophrenia. Pharmacological studies show that cannabinoids can induce a full range of transient positive, negative, and cognitive symptoms in healthy individuals that are similar to those seen in schizophrenia. There is considerable evidence that in individuals with an established psychotic disorder such as schizophrenia, exposure to cannabis can exacerbate symptoms, trigger relapse, and worsen the course of the illness. Only a very small proportion of the general population exposed to cannabis develop a psychotic illness. It is likely that cannabis exposure is a 'component cause' that interacts with other factors to 'cause' schizophrenia or other psychotic disorder, but is neither necessary nor sufficient to do so alone. Further work is necessary to identify the factors that underlie individual vulnerability to cannabinoid-related psychosis and to elucidate the biological mechanisms underlying this risk.
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Affiliation(s)
- R Andrew Sewell
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, Connecticut 06516, USA
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25
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Abstract
A 34-year-old man with right-sided cluster headache presented with a stroke from right-sided moyamoya. Following surgery on the right, both moyamoya and cluster headache remitted, but eighteen months later a cluster attack and symptoms of cerebral ischemia from moyamoya recurred on the left. Again, following surgery on the left, both moyamoya symptoms and cluster attacks disappeared. Cluster headache secondary to moyamoya has not previously been described.
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Affiliation(s)
- R Andrew Sewell
- Department of Psychiatry, VA Connecticut Healthcare/Yale University School of Medicine, West Haven, CT 06516, USA.
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26
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Meyer F, Chang T, Sewell RA, Price BH, Cunningham M. Should electroconvulsive therapy be given to patients with intracranial vascular lesions? Rev Neurol Dis 2007; 4:43-50. [PMID: 17514158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The risk of rupture and hemorrhage of intracranial vascular lesions during electroconvulsive therapy (ECT) is currently unknown. We describe 2 cases in which ECT was discontinued because of perceptual disturbances, confusion, and the subsequent discovery of intracranial angiomas. ECT has been associated with nonconvulsive status epilepticus and prolonged altered mental status following treatment, but there has been scant documentation of side effects associated with intracranial vascular malformations. We review the literature on ECT in patients with such lesions and present 2 cases in which lesions were found in the context of perceptual disturbances and altered states of consciousness following ECT.
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Affiliation(s)
- Fremonta Meyer
- Cambridge Health Alliance, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Abstract
The authors interviewed 53 cluster headache patients who had used psilocybin or lysergic acid diethylamide (LSD) to treat their condition. Twenty-two of 26 psilocybin users reported that psilocybin aborted attacks; 25 of 48 psilocybin users and 7 of 8 LSD users reported cluster period termination; 18 of 19 psilocybin users and 4 of 5 LSD users reported remission period extension. Research on the effects of psilocybin and LSD on cluster headache may be warranted.
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Affiliation(s)
- R Andrew Sewell
- Clinical Research Laboratory, Alcohol and Drug Abuse Research Center, McLean Hospital/Harvard Medical School, Belmont, MA 02478, USA.
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Cunningham MG, Sewell RA, Price BH. Mechanisms of Mind: Highlights of the 17th Annual Meeting of the American Neuropsychiatric Association, February 18-21, 2006, San Diego, CA. Rev Neurol Dis 2006; 3:123-8. [PMID: 17047578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Points of interest from the 17th Annual American Neuropsychiatric Association are reviewed, including several cognitive neuroscience frameworks that have been proposed to account for the neural basis of moral cognition. Also discussed are the brain mechanisms behind creative innovation, and an overview is presented of several of this year's outstanding contributions to clinical and basic neuroscience.
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Affiliation(s)
- Miles G Cunningham
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
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29
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Abstract
Botanical sources for medicines in America have been known since long before the arrival of Columbus. Nevertheless, both scientists and the general public are often unaware that some of these botanical drugs are also potent intoxicants. We provide a quick overview of hallucinogenic and dissociative drugs harvested from nature or that are openly and legally cultivated in the United States. Examples of harmful outcomes reported in the media are contrasted with existing responsible ingestion by others, some of whom have the protected right to do so for traditional or sacramental religious purposes. Despite an ongoing and expensive effort to warn people of the potential harms of recreational drug use, little is known about the extent of use of these psychoactive botanicals, and the recent explosion of information available via the Internet could herald a storm of morbidity to come. Mounting more targeted research and educational efforts today may reduce later use and abuse, inform society about the special circumstances of religious use, and better prepare clinicians and other health care providers about the issues involved when people choose to indigenously source psychoactive drugs for human consumption.
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Affiliation(s)
- John H Halpern
- Biological Psychiatry Laboratory, Alcohol and Drug Abuse Research Center, Harvard Medical School, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA.
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Sewell RA, Cozzi NV. More about parkinsonism after taking ecstasy. N Engl J Med 1999; 341:1400; author reply 1401. [PMID: 10577096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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31
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Abstract
Extended biopsy followup of 17 relatively young men with resectable prostatic cancer treated by external supervoltage radiotherapy is presented. Although 6 of the 8 surviving patients now have negative biopsies, the over-all survival rate and the over-all incidence of negative biopsies are not so encouraging, with only 35 per cent rendered free of tumor. Thus, the role of radiotherapy in resectable prostatic carcinoma should be critically scrutinized. More accurate staging is needed. Hopefully, more sophisticated studies of diagnostic and prognostic value will be available in the near future.
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Sewell RA, Killen DA, Foster JH. Small bowel injury by angiographic contrast medium. Surgery 1968; 64:459-65. [PMID: 5673061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Welborn MB, Sewell RA, Killen DA, Foster JH. Experimental evaluation of a new angiographic contrast medium--isopaque 440. Am J Roentgenol Radium Ther Nucl Med 1967; 101:224-8. [PMID: 6037337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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