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Nonopioid and Adjuvant Analgesic Agents
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
One of the main problems with ketamine is that its use may be associated with psychotomimetic side effects. These are dose-dependent effects and include dreaming and nightmares (pleasant or unpleasant), hallucinations, and dysphoria. Other adverse effects that have been described include nystagmus, blurred vision, and diplopia (Brinck et al, 2018). These side effects may be reduced by the concurrent administration of a benzodiazepine.
Stimulants and psychedelics
Published in Ilana B. Crome, Richard Williams, Roger Bloor, Xenofon Sgouros, Substance Misuse and Young People, 2019
Hallucinogens produce sensory perception abnormalities in a variety of modalities, including visual and auditory senses. A variety of terms have been used for these drugs including ‘psychedelic’ and ‘psychomimetic’ (Farré et al., 2015). It is believed that the majority of the effects of hallucinogens are mediated by the serotonin 5-HT2A receptor (Halberstadt, 2015) despite the fact that hallucinogenic substances come from multiple chemical families. Hallucinogens can produce alterations and distortions in sensory processing and are reported to produce synaesthesias, in which, for example, music may be perceived as colour patterns (Nichols, 2015).
The Drug Choice
Published in Albert A. Kurland, S. Joseph Mulé, Psychiatric Aspects of Opiate Dependence, 2019
Albert A. Kurland, S. Joseph Mulé
Little will be said about other psychotropic drugs, since the emphasis is primarily on the opiates. However, briefly noted are comparisons with other drugs which are abused. Amphetamines give rise to feelings of increased self-assertion, spontaneity, and a sense of accomplishment. Alcohol, on the other hand, can be a stimulant or depressant depending on the amount consumed. The consciousness-altering drugs, the hallucinogens or psychotomimetics (i.e., LSD, psilocybin, and mescaline), which induce cognitive and perceptual changes, are accompanied by emotional experiences ranging from states of exaltation taking one beyond earthbound experiences to that of episodes of apprehension, unreality, and paranoia. Other compounds appear to facilitate the induction of gratifying fantasies and daydreams with their associated emotional overtones, such as marijuana and barbiturates. The anxiolytic drugs such as chlordiazepoxide (Librium®) and its congeners appear to exert a particular appeal to those chronically experiencing anxiety, tension, and irritability.
Can the revival of serotonergic psychedelic drugs as treatments for mental disorders help to characterize their risks and benefits?
Published in Expert Opinion on Drug Safety, 2022
M. Ishrat Husain, Madeha Umer, Benoit H. Mulsant
Current clinical trials have been conducted under highly controlled conditions. When using moderate to high psychedelic doses, acute psychotomimetic effects would be anticipated in close to 100% of individuals [20–23]. These effects include changes in five broad domains: cognition, perception, emotion, mystical experience, and social connectedness. All domains may have negative or positive effects with a dose-response that vary greatly between individuals. Cognitive changes associated with psychedelics may include increased flexibility and creativity, or disorganized and distractible thought patterns. Perceptual disturbances may be hallucinatory (primarily visual and auditory) or dissociative (derealization, depersonalization, time distortion). Negative emotions can include anxiety, irritability, mood lability, agitation, or frank paranoia; these negative emotions may be markedly distressing and drive patients to want to ‘escape,’ requiring close monitoring during treatment sessions.
Impact of chronic medications in the perioperative period: mechanisms of action and adverse drug effects (Part I)
Published in Postgraduate Medicine, 2021
Ofelia Loani Elvir-Lazo, Paul F White, Hillenn Cruz Eng, Firuz Yumul, Raissa Chua, Roya Yumul
Ketamine, a psychomimetic dissociative IV anesthetic, and its more potent isomer (esketamine) have also been used in low-doses to treat depression and stress disorders, as well as a preventative treatment for postoperative depression [106]. It acts predominantly as a noncompetitive NMDA receptor antagonist, and it has also been shown to bind and act on opioid mu and sigma receptors. In recent studies, the S(+) enantiomer of ketamine (esketamine) has been recently approved by the FDA for the treatment of MDD. Ketamine is also known to increase brain-derived neurotrophic factor (BDNF) levels in the hippocampus, which may be important for producing a rapid onset of antidepressant action. Although low (sub-anesthetic) doses of ketamine administered as a bolus injection in a series of infusions have been shown to be a safe approach for treating patients with traumatic brain injuries and anxiety disorders, the long-term benefits of low-dose ketamine therapy for psychiatric and neurological disorders have not been established. Common side effects associated with ketamine include tachycardia, hypertension, dizziness, psychotomimetic, and dissociative psychiatric symptoms, confusion, inebriation, euphoria, and increased libido [107,108].
Embracing Neurodiversity in Psychedelic Science: A Mixed-Methods Inquiry into the MDMA Experiences of Autistic Adults
Published in Journal of Psychoactive Drugs, 2019
Unlike classic hallucinogens, such as LSD (lysergic acid diethylamide) and psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine), MDMA has never been considered psychotomimetic (mimicking psychosis). MDMA also produces subjective empathogenic effects that are distinct. For example, Vollenweider et al. (1998) reported that MDMA produced acute “increased responsiveness to emotions, a heightened openness, and a sense of closeness to other people” (247). MDMA is less likely to cause problematic anxiety (Johansen and Krebs 2009), and the duration of effects is shorter than with most other psychedelics, which may be advantageous in clinical settings. Unlike amphetamines, MDMA is not considered physically addictive, but there have been reports of both acute and chronic psychological abreactions in vulnerable individuals (Parrott 2007).