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Since the armed conflict in Ukraine escalated in 2022, UK and US military veterans have volunteered in substantial numbers to support the Ukrainian Armed Forces. They are operating in an exceptionally intense and technologically advanced environment, often exposed to high levels of combat. Little is known about the health impact of this voluntary service. We carried out a mixed-methods observational study of UK and US military veterans who self-reported travelling to Ukraine to support the Ukrainian Armed Forces. Participants were recruited between October and December 2025. Measures assessed probable post-traumatic stress disorder (PTSD), common mental health disorders (CMD), alcohol misuse, moral injury, and health-related quality of life. Open response items were used to qualitatively explore motivations for volunteering, experiences of service in Ukraine, and access to healthcare. Thirty-one UK and US military veterans completed psychometric measures and 21 provided qualitative data. High levels of probable PTSD, CMD alcohol misuse, and moral injury-related distress were identified, alongside low health-related quality of life. Veterans described extremely intense combat exposure, including drone warfare and trench fighting, and frequent physical injury. Physical healthcare was often described as poor or inadequate. Mental health care was widely sought but rarely accessible, both in Ukraine and after return home, with veterans reporting being turned away from support services. Consequently, emotional support primarily came from peers rather than formal care systems. This study provides early evidence on the experiences and health needs of UK and US veterans who volunteered in Ukraine, an under-researched group falling outside existing military care structures. Many report significant unmet mental and physical health needs and face barriers to care both in Ukraine and after returning home. Without targeted support, these veterans risk remaining invisible within health systems, highlighting the need for coordinated pathways and prioritised clinical care.

Pre-prohibition psychedelic research with complex psychiatric patients generated a wealth of treatment methodologies and practices, providing invaluable clinical insights pertaining to the medical administration of psychedelics in various mental health diagnoses. Building upon these early studies, which lack the rigor and research tools available today, contemporary psychedelic research has focused on investigating the safety and efficacy of psychedelics in randomized controlled trials via psychometric measures and symptom assessments. Both then and now, the treatment context and the role of clinicians in psychedelic treatment has been recognized as an essential feature for positive patient outcomes. To broaden the knowledge base of modern psychedelic research and support the training of clinicians conducting medically supervised psychedelic research studies, this paper provides a review of pre-prohibition clinical research narratives pertaining to the phenomenology of psychedelic treatment and the role of the non-pharmacological treatment factors in the patient experience. Lastly, this paper explores a range of clinician perspectives and psychological interventions employed in pre-prohibition psychedelic research to inform future research directions and best practice guidelines.

Background Psychedelic treatment is a rapidly emerging therapeutic approach for a host of chronic, difficult to treat psychiatric disorders, including anorexia nervosa (AN). Trauma and its sequelae, such as dissociation, often contribute to comorbidity and treatment refractoriness. Aims In this report, we describe the therapeutic emergence of previously dissociated traumatic memories of sexual assault in 2 of 10 research participants with AN while receiving psilocybin treatment. Methods Ten female adults who met DSM-5 criteria for AN or pAN (partial remission) participated in an open pilot study evaluating the safety, tolerability and preliminary efficacy of psilocybin-assisted psychotherapy. Participants received a 25-mg dose of investigational drug COMP360, a proprietary pharmaceutical-grade synthetic psilocybin formulation developed by COMPASS Pathfinder Ltd. administered in conjunction with psychological support. Participants also received two integration therapy sessions on days 1 and 7 after dosing, and they were reassessed at 1 and 3 months. Participants were interviewed using a semi-structured interview to understand qualitative perspectives of treatment and its effect on AN. Results/Outcomes Both patients described in this report significantly benefited from the emergence and processing of previously dissociated information (dissociative amnesia), and both patients subsequently attained remission of their AN psychopathology at 3-month follow-up as determined by global scores on the Eating Disorder Examination Questionnaire (EDE-Q) and clinically meaningful weight gain. Conclusions/Interpretation PT may hold promise not only in the treatment of eating disorders but also trauma-related disorders, including PTSD and dissociative amnesia. Potential mechanisms of psilocybin’s facilitation of remembering and processing traumatic material is reviewed.

IntroductionPsilocybin-assisted therapy may be a new treatment for major depressive disorder (MDD), with encouraging data from pilot trials. In this trial (short name: PsiDeR) we aimed to test the feasibility of a parallel-group, randomised, placebo-controlled design. The primary outcomes in this trial are measures of feasibility: recruitment rates, dropout rates and the variance of the primary outcome measure of depression.Methods and analysisWe are recruiting up to 60 participants at a single centre in London, UK who are unresponsive to, or intolerant of, at least two evidence-based treatments for MDD. Participants are randomised to receive a single dosing session of 25 mg psilocybin or a placebo. All participants receive a package of psychological therapy. The primary outcome measure for depression is the Montgomery Asberg Depression Rating Scale collected by blinded, independent raters. The primary endpoint is at 3 weeks, and the total follow-up is 6 weeks. With further informed consent, this study collects neuroimaging and omics data for mechanism and biomarker analyses and offers participants an open label extension consisting of a further, open label dose of 25 mg of psilocybin.Ethics and disseminationAll participants will be required to provide written informed consent. The trial has been authorised by the National Research Ethics Committee (20-LO/0206), Health Research Authority (252750) and Medicine’s and Healthcare Products Regulatory Agency (CTA 14523/0284/001-0001) in the UK. Dissemination of results will occur via a peer-reviewed publication and other relevant media.Trial registration numbersEUDRACT2018-003573-97; NCT04959253.

Post-traumatic stress disorder (PTSD) and associated trauma and stressor-related disorders are common and debilitating, presenting significant treatment challenges due to their complex interplay of biological, cognitive, affective, somatic and social factors. Current treatments, while advancing and effective, yield limited efficacy for many individuals, underscoring the need for novel therapeutic approaches. This review explores the multifaceted nature of PTSD, emphasising its intricate predisposing and maintaining factors and explores the potential of psilocybin, a classical psychedelic, as a therapeutic agent. This review synthesises recent literature on the safety, efficacy and proposed mechanisms of action and change of psychedelic therapies for psychiatric conditions associated with traumatic stress, including treatment-resistant depression, end-of-life anxiety and anorexia nervosa. Correspondingly, it proposes a conceptual framework for psilocybin treatment in PTSD, framing the condition as a complex, maladaptive interpretive framework that is both predetermined and over-determined. A clinical narrative illustrates how psilocybin’s unique psychopharmacological properties and catalysed subjective effects may facilitate therapeutic progress by disrupting this rigid and restricting framework. Finally, we offer recommendations for the safe administration of psilocybin for traumatised patients in medical research settings, emphasising the importance of rigorous and trauma-informed protocols and comprehensive patient care.

Post-traumatic stress disorder (PTSD) is associated with significant patient burden. While pharmacotherapies and evidence-based psychotherapy interventions (EBPI) are effective, studies consistently highlight inadequate outcomes and high treatment dropout. Psychedelic therapy (PT) has shown preliminary promise across difficult-to-treat conditions, including MDMA-assisted therapy for PTSD, however trials of classical psychedelics in PTSD are lacking. Understanding patients' experiences of EBPI could help promote safety in PT. To systematically review qualitative research on patients' subjective experience of EBPI for PTSD, and of PT, and examine areas of overlap and divergence between them. Systematic literature searches for studies published between 2010 and 2023 were conducted on OVID, PubMed, Web of Science, and PsycInfo. Included were original studies in English that presented qualitative data of patient experiences of EBPI in PTSD, or PT for any indication. Extracted data from included studies were analysed using thematic synthesis. Syntheses were completed separately for EBPI and PT, before similarities and differences between the therapies were identified. 40 research articles were included for review: 26 studies on EBPI for PTSD, and 14 studies on PT. EBPI studied were CBT, EMDR, CPT and PE. Psychedelic compounds studied were psilocybin, ibogaine, LSD, MDMA and ketamine, for treatment of substance use disorders, anxiety relating to physical illness, depression, and PTSD. Core themes from patient experiences of EBPI: 1) patient burden in PTSD treatment; 2) readiness; 3) key mechanisms of change; 4) psychological safety and trust. Themes identified in the review of PT: 1) indirect trauma processing; 2) reorganisation of self-narratives via processes of relatedness and identification; 3) key treatment characteristics. This study suggests overlap between patients' experience of EBPI and PT in terms of key mechanisms of change, the importance of psychological safety and readiness to engage in treatment. Trauma-informed care paradigms and practices may improve safety and acceptability of PT research.