The therapeutic benefits of psychedelics for neuropsychiatric conditions have gathered significant attention in Europe and around the world, with treatments using psilocybin, MDMA, and ketamine as notable examples. However, the mind-altering effects of these substances, and the complexity of their regulatory frameworks, both within and outside of therapeutic use, imply careful clinical guidance. Across Europe, associations dedicated to therapeutic use of psychedelics are flourishing, and have produced clinical recommendations, while more generalist professional boards have contributed with various clinical reports, statements and guidelines. In Portugal this prompted a unique collaborative movement of professional associations of Pharmacists, Psychologists and Physicians to work with national ethics authorities, scientific societies and both research and clinical stakeholders, to produce a consensual recommendation addressing core aspects of psychedelic treatments. This statement reflects positions regarding informed consent, the determinants of medical and psychological interventions, ethical considerations and regulatory recommendations. The initial document was open for public consultation, inviting other stakeholders to contribute to the final version, published in Portuguese and translated here into English towards broader access. The statement underscores the importance of multidisciplinary and multiprofessional collaboration among psychiatrists, psychologists and pharmacists, towards establishing common guidelines and regulations to ensure safe and effective clinical applications. By addressing these factors, the recommendations aim to foster responsible therapeutic use, while safeguarding patient well-being.
In 2020, a novel Coronavirus, Severe Acute Respiratory Syndrome-Covid-2 (SARS-CoV-2), spread globally to provoke a pandemic that infected over 750 million people. The associated disorder, Coronavirus-19 (COVID-19), has caused at least 7 million deaths and around a hundred million people have developed a variable yet sometimes incapacitating condition called Long Covid. This multi-organ syndrome, often referred to as “Brain Fog”, encompasses symptoms of extreme fatigue, anxiety, poor sleep and, most prominently, cognitive impairment. Long Covid emerges three or more months after SARS-CoV-2 infection and bears a marked resemblance to the suite of neurological symptoms that evolves several years after infection with Human Immunodeficiency Virus (HIV). Accordingly, by analogy to “HIV Associated Neurological Disorder” (HAND), the acronym,” SAND” is proposed for SARS-CoV-2 Associated Neurological Disorder. Mimicking HIV infection/HAND, SARS-CoV-2 infection/SAND is on a collision course with aging, leading to their mutual aggravation and an increased risk of disorders like Alzheimer’s and Parkinson’s disease. In contrast to HIV, where the virus crosses the blood-brain-barrier in T-lymphocytes and monocytes to infect microglia and other cell types, there is little evidence that SARS-CoV-2 enters the brain. Nonetheless, in addition to the indirect effects of a somatic hyper-inflammation (“cytokine storm”) and the disruption of blood- and CSF-brain barriers, SARS-CoV-2-encoded S1 Spike protein and other virally-encoded proteins enter the brain to directly interfere with cerebral function. Microglia and astrocytes adopt a pro-inflammatory phenotype, neurotoxic proteins accumulate, mitochondrial energy generation declines, and synaptic transmission is perturbed. These findings for SAND mirror observations seen with aging and dementia. A broad-based programme of “R and D”, healthcare and social support would appear desirable to better understand the complex set of interacting mechanisms underlying SAND, to prevent its onset, to alleviate the debilitating symptoms, and to improve our readiness for countering the impact of those novel, brain-damaging viruses that will inevitably arise in the future.
