Experiences of psychedelic drug use among people with psychotic symptoms and disorders: Personal growth and mystical experiences

Introduction

Earlier waves of psychedelic research included experiments with people diagnosed with schizophrenia and related conditions, but those studies were methodologically inconsistent, often unethical, and reported findings that are difficult to interpret by modern standards. During that era psychedelics were framed as "psychotomimetic"—drugs that mimic psychosis—which contributed to the exclusion of people with psychotic symptoms from contemporary psychedelic-assisted therapy (PAT) research. More recent naturalistic and epidemiological work has documented that psychedelic-induced psychosis is possible but appears rare; at the same time some epidemiological data suggest people with pre-existing psychotic disorders may report worsening after recreational use. These mixed signals, together with the systematic exclusion of this group from trials and the disproportionate impact of such exclusions on ethnoracially marginalised populations, leave an unresolved question about the benefit-to-risk ratio of PAT for people with psychotic symptoms or disorders. Torre and colleagues designed a mixed-methods, cross-sectional, retrospective survey to describe how individuals with psychotic experiences or diagnoses remember and interpret a single notable psychedelic episode. The study aimed to characterise phenomenology (including mystical-type experiences), self-reported changes in wellbeing and symptoms, and contextual factors (dose, set and setting, concomitant substance use) that might relate to positive or adverse outcomes, and to identify recurring qualitative themes in participants' accounts. The authors positioned this work as an exploratory step toward understanding whether supervised PAT could be pursued or avoided for this population and what variables warrant further controlled study.