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History, rationale and potential of human experimental hallucinogenic drug research in psychiatry.

Systematic scientific interest in psychedelic substances has a tradition of about 100 years. Numerous human experimental studies have confirmed the existence of a common nucleus of experiences in hallucinogen-induced states and the acute stages of schizophrenic psychoses. However, the degree of resemblance between endogenous and drug-induced psychotic states has been an issue of controversial debate. After the scheduling of psychedelics in the 1960s, human research became highly restricted worldwide and scientific interest in this field faded. The debate about the appropriateness of the psychedelic state as a model for endogenous psychosis therefore seemed to have little practical relevance. Currently there is a revival of scientific interest in human experimental psychedelic research. Consequently, the appropriateness of hallucinogen-induced states as models for psychosis needs to be reappraised. The arguments for and against are summarized in this paper. In conclusion, the drug-induced model psychosis is shown to be a useful model for acute psychotic stages, but not for the nosological entity schizophrenia.

Hallucinogens↗

[Hallucinogen induced psychic disorders. Subjective experiences, psychopathology and differential diagnosis].

The concepts of intoxication, intoxication psychosis, and drug-induced psychosis are frequently used to refer to psychopathological states caused by the intake of hallucinogenic substances. The considerable increase of intoxications with substances of the chemical class of amphetamines (in particular, "Ecstasy") in western countries should cause major concern. Moreover, the number of schizophrenic patients who also use hallucinogenic drugs is increasing. High incidence and comorbidity cause clinical problems and call for detailed knowledge of the drug related acute and chronic effects of the various agents currently in use. Clinical findings and subjective reports from research in experimental psychoses are used to discuss differential diagnosis and types of drug-induced mental disorders within the framework of present day classificatory systems, such as DSM-IV and ICD-10.

Adolescent↗

'Designer drugs'. Treating the damage caused by basement chemists.

Use of "designer drugs" has created a new dilemma for physicians. Generally, it is possible to recognize symptoms and signs of intoxication that fit a specific class of substances, such as amphetamine-like effects for the phenylethylamines and opioid effects for the fentanyl analogues. Designer compounds have crossed these boundaries, and toxicology laboratories cannot readily identify them. For now, physicians must rely on clinical presentation and treat accordingly.

Clinical Protocols↗

'Designer drugs'. Recognizing and managing their toxic effects.

"Adam," "Eve," "ecstasy," "China white." Illicit street drugs such as these are called designer drugs because they are designed to elicit certain effects and to bypass legal classification. Unfortunately, use and abuse of such substances can lead to serious medical problems and even death. Drs Sternbach and Varon describe the best-known compounds and discuss clinical characteristics and management of designer drug intoxication.

Amphetamines↗

Big and Little Moon Peyotism as health care delivery systems.

Big Moon Peyotism was introduced in the 1880s to the Delaware, Osage and Quapaw of Northeast Oklahoma by John Wilson, a Delaware-Caddo from Southwest Oklahoma. This form of Peyotism and the Little Moon ritual developed by the Apache, Kiowa, and Comanche of Southwest Oklahoma formed the basis of the two major variations of this religion as practiced by Native Americans throughout North America. An ethnographic and historic comparison of these religious traditions in Northeast Oklahoma presents these as health care delivery systems and highlights the importance of health care as a factor in the acceptance and persistence of Peyotism.

Health Services, Indigenous↗

Swallowing the scroll: legal implications of the recent Supreme Court peyote cases.

Two cases decided by the United States Supreme Court in the past two years, with the same factual bases and involving the religious use of peyote by Native American Church members, are described and analyzed. In 1990 the Supreme Court ruled that states may prohibit the use of peyote for religious purposes. These cases are examined by applying traditional equal-protection and First Amendment religious liberty analyses as well as by traditional Western interpretations of sacrament. The Supreme Court now has established a legal precendent running contrary to previous lower court cases that has implications for the religious use of peyote, specifically, and for nontraditional use of sacramental drugs, generally.

Cultural Characteristics↗