The psychedelic drug in "magic mushrooms" can quickly and effectively help treat anxiety and depression in cancer patients, an effect that may last for months, two small studies show. It worked for Dinah Bazer, who endured a terrifying hallucination that rid her of the fear that her ovarian cancer would return. A single dose of psilocybin, the active ingredient of magic mushrooms, can lift the anxiety and depression experienced by people with advanced cancer for six months or even longer, two new studies show. Researchers involved in the two trials in the United States say the results are remarkable. The volunteers had “profoundly meaningful and spiritual experiences” which made most of them rethink life and death, ended their despair and brought about lasting improvement in the quality of their lives. The results of the research are published in the Journal of Psychopharmacologytogether with no less than ten commentaries from leading scientists in the fields of psychiatry and palliative care, who all back further research. While the effects of magic mushrooms have been of interest to psychiatry since the 1950s, the classification of all psychedelics in the US as schedule 1 drugs in the 1970s, in the wake of the Vietnam war and the rise of recreational drug use in the hippy counter-culture, has erected daunting legal and financial obstacles to running trials. “I think it is a big deal both in terms of the findings and in terms of the history and what it represents. It was part of psychiatry and vanished and now it’s been brought back,” said Dr Stephen Ross, director of addiction psychiatry at NYU Langone Medical Center and lead investigator of the study that was based there. Around 40-50% of newly diagnosed cancer patients suffer some sort of depression or anxiety. Antidepressants have little effect, particularly on the “existential” depression that can lead some to feel their lives are meaningless and contemplate suicide. The main findings of the NYU study, which involved 29 patients, and the larger one from Johns Hopkins University with 51 patients, that a single dose of the medication can lead to immediate reduction in the depression and anxiety caused by cancer and that the effect can last up to eight months, “is unprecedented,” said Ross. “We don’t have anything like it.” The results of the studies were very similar, with around 80% of the patients attributing moderately or greatly improved wellbeing or life satisfaction to a single high dose of the drug, given with psychotherapy support. Professor Roland Griffiths, of the departments of psychiatry and neuroscience who led the study at Johns Hopkins University school of medicine, said he did not expect the findings, which he described as remarkable. “I am bred as a sceptic. I was sceptical at the outset that this drug could produce long-lasting changes,” he said. These were people “facing the deepest existential questions that humans can encounter - what is the nature of life and death, the meaning of life.” But the results were similar to those they had found in earlier studies in healthy volunteers. “In spite of their unique vulnerability and the mood disruption that the illness and contemplation of their death has prompted, these participants have the same kind of experiences, that are deeply meaningful, spiritually significant and producing enduring positive changes in life and mood and behaviour,” he said. Patients describe the experiences as “re-organisational”, said Griffiths. Some in the field had used the term “mystical”, which he thought was unfortunate. “It sounds unscientific. It sounds like we’re postulating mechanisms other than neuroscience and I’m certainly not making that claim.” Ross said psilocybin activates a sub-type of serotonin receptor in the brain. “Our brains are hard-wired to have these kinds of experiences - these alterations of consciousness. We have endogenous chemicals in our brain. We have a little system that, when you tickle it, it produces these altered states that have been described as spiritual states, mystical states in different religious branches. “They are defined by a sense of oneness – people feel that their separation between the personal ego and the outside world is sort of dissolved and they feel that they are part of some continuous energy or consciousness in the universe. Patients can feel sort of transported to a different dimension of reality, sort of like a waking dream.” Some patients describe seeing images from their childhood and very commonly, scenes or images from a confrontation with cancer, he said. The doctors warn patients that it may happen and not to be scared, but to embrace it and pass through it, he said. The commentators writing in the journal include two past presidents of the American Psychiatric Association, the past president of the European College of Neuropsychopharmacology, a previous deputy director of the Office of USA National Drug Control Policy and a previous head of the UK Medicines and Healthcare Regulatory Authority. The journal editor, Professor David Nutt, was himself involved in a small trial of psilocybin in a dozen people with severe depression in the UK in May. The ten commentators in the journal, he writes in an editorial, “all essentially say the same thing: it’s time to take psychedelic treatments in psychiatry and oncology seriously, as we did in the 1950s and 1960s.” Much more research needs to be done, he writes. “But the key point is that all agree we are now in an exciting new phase of psychedelic psychopharmacology that needs to be encouraged not impeded.” The studies were funded by the Heffter Research Institute in the USA. “These findings, the most profound to date in the medical use of psilocybin, indicate it could be more effective at treating serious psychiatric diseases than traditional pharmaceutical approaches, and without having to take a medication every day,” said its medical director George Greer.
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By Kathryn Doyle Many patients who have their appendix removed can safely go home from the hospital the same day, according to a new study.
"The results are not surprising and rather reaffirm the practice that patients may be discharged on the same day as the surgery if the treating team feels it is appropriate," said senior author Dr. Armen Aboulian of Kaiser Permanente Woodland Hills Medical Center in California. "The decision for a patient to be discharged is based on numerous things and many teams, including the operating surgeon, the anesthesiologist, the recovery room team and any other consultants that may have been involved," Aboulian said. "It is a complex decision but with this study, we showed that if patients are discharged without spending the night, they do well and do not end up returning to the emergency room at higher rates." The researchers studied more than 12,000 patients from Kaiser Permanente medical centers in Southern California with acute appendicitis who underwent laparoscopic appendectomy between 2010 and 2014. Roughly half of the patients were discharged from the hospital on the same day and half were hospitalized overnight. About 2 percent of those discharged on the same day were readmitted to the hospital within 30 days, compared to 3 percent of the overnight group. Complications like wound infection and postoperative visits to the emergency treatment or diagnostic imaging studies were equally common in both groups. Wound infection happened in 2.2 percent of the group that went home and 2.7 percent of the hospitalized group, for example. Imaging was done on 11 percent of the group that went home and 12.3 percent of those who stayed overnight. The patients who stayed overnight after their surgery were a bit older, on average, and slightly more likely to have diabetes or high blood pressure, the authors note. The biggest difference between groups was in hospital costs. Those discharged on the same day had an average cost of $1,994 compared to $2,343 for overnight stays, as reported November 16 in the Journal of the American College of Surgeons. According to recent published studies, usual hospital stays after laparoscopic appendectomy can be more than two or three days, and same-day discharge may not be widely accepted yet, said Dr. Jae Gil Lee of Yonsei University College of Medicine in Seoul, South Korea, who was not part of the new study. Countries where medical fees are not so high as the U.S. may feel less pressure to reduce hospital stays, Lee told Reuters Health by email. "Currently in the Southern California Kaiser Permanente Medical System, approximately 60 percent of patients with non-perforated appendicitis leave the hospital on the same day as the surgery," Aboulian told Reuters Health by email. "However, this is not the traditional approach and even through the time period of our study, there has been an annual increase in the tendency to discharge on the day of the surgery." "These changes are part of the art of medicine and continued education that is engrained in the American medical system," he said. It's hard to say if and why earlier hospital discharge leads to better outcomes, other than reduced healthcare expenses, he said. "For example, getting a good night sleep in your own bed without the disturbance of the IV beeping or the 5 AM vitals check is difficult to obtain as a measurable metric," Aboulian said. "However, previous studies have shown that an earlier discharge does correlate to a faster recovery and an earlier return to normal activities such as work." Surgeons may offer same-day hospital discharge, but patients and family should not request it, he said. "Patients usually are willing to stay (longer) at hospital, wanting to feel less pain and to be controlled during the hospitalization," Lee said. Older people and people with many additional medical conditions are most often hospitalized for longer periods, Lee added. SOURCE: http://bit.ly/2fSFD7J J Am Coll Surg 2016. |
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