# Reconsidering evidence for psychedelic-induced psychosis: an overview of reviews, a systematic review, and meta-analysis of human studies

Review · Michel Sabé, Adi Sulstarova, Alban Glangetas, Marco De Pieri, Luc Mallet, Logos Curtis, Hélène Richard-Lepouriel, Louise E. Penzenstadler, Federico Seragnoli, Gabriel Thorens, DANIELE FABIO ZULLINO, Katrin H. Preller, Kerem Böge, Stefan Leucht, Christoph Ulrich Correll, Marco Solmi, Stefan Kaiser, Matthias Kirschner

- Archive id: doi:10.1038/s41380-024-02800-5
- Published: 2024-11-26
- Venue: Molecular Psychiatry
- DOI: https://doi.org/10.1038/s41380-024-02800-5
- PMID: 39592825
- Citations: 53
- Source URL: https://doi.org/10.1038/s41380-024-02800-5
- PDF: https://www.nature.com/articles/s41380-024-02800-5.pdf
- Provenance: openalex

## Abstract

BACKGROUND: Persons with schizophrenia are excluded from psychedelic-assisted therapy due to concerns about the risk of triggering or worsening psychosis. However, there is limited meta-analytic data on the risk of psychedelic-induced psychosis in individuals with pre-existing psychotic disorders. METHODS: We conducted a systematic review, meta-analysis, and overview of reviews to assess the incidence of psychedelic-induced psychosis and symptom exacerbation in schizophrenia. Our pre-registered protocol (CRD42023399591) covered: LSD, psilocybin, mescaline, DMT, and MDMA, using data from Embase, PubMed, PsyARTICLES, PsyINFO, and trial registries up to November 2023. A random-effects model was used to calculate psychosis incidence, with standardized assessments of study quality. RESULTS: From 131 publications, we analyzed 14 systematic reviews, 20 reviews, 35 randomized-controlled trials (RCTs), 10 case-control studies, 30 uncontrolled trials (UCTs), and 22 cohort studies, most of which were low quality. Meta-analysis of nine studies showed an incidence of psychedelic-induced psychosis at 0.002% in population studies, 0.2% in UCTs, and 0.6% in RCTs. In UCTs including individuals with schizophrenia, 3.8% developed long-lasting psychotic symptoms. Of those with psychedelic-induced psychosis, 13.1% later developed schizophrenia. Sensitivity analyses confirmed the results. CONCLUSION: In summary, the reviewed evidence suggests that schizophrenia might not be a definite exclusion criterion for clinical trials exploring safety and efficacy of psychedelics for treatment-resistant depression and negative symptoms. However, given the low quality and limited number of studies, more high-quality research is needed, and a conservative approach is recommended until further data is available.

_Abstract reproduced under CC-BY (publisher license, via OpenAlex)._

Topics: [Novel Psychiatric Therapeutics](https://space-kitty.com/topics/psychiatric-therapeutics)

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