Naturalistic Psychedelic Use and Psychotic Symptoms: A Cross-Sectional Study of Individuals with a Personal or Family History of Psychotic or Bipolar Disorders

Prior research examining the associations between psychedelic use and general psychotic symptoms has yielded mixed findings. However, no studies have investigated the relationships between psychedelic use and specific psychotic symptoms, and whether these relationships might differ among those with liability to psychosis, namely those with a history of psychotic or bipolar disorders.

Using cross-sectional survey data from a purposive sample (n = 548), we first regressed estimated lifetime psychedelic use occasions and personal and family history of psychotic or bipolar disorders on the Magical Ideation Scale, Referential Thinking Scale, Self-Evaluation of Negative Symptoms, and Continuum of Auditory Hallucinations-State Assessment, unadjusted and adjusted for a range of covariates. We then tested the interactions of estimated lifetime psychedelic use occasions with personal and family history of psychotic or bipolar disorders on these same measures, unadjusted and adjusted for the same set of covariates.

In unadjusted models, the estimated number of lifetime psychedelic use occasions was robustly associated with less referential thinking, whereas personal and family histories of psychotic and bipolar disorders were each associated with moderately or slightly greater scores on all measures. Covariate-adjusted regression models revealed that the estimated number of lifetime psychedelic use occasions was not associated with any of the measured psychotic symptoms. A personal history of psychotic disorders was associated with moderately greater magical ideation, referential thinking, and auditory hallucinations, whereas a family history of psychotic disorders was associated with slightly greater negative symptoms. Neither personal nor family history of bipolar disorder was associated with any psychotic symptoms. Finally, estimated lifetime psychedelic use occasions interacted only with a personal history of psychotic disorders on one measure, such that auditory hallucinations were less severe as psychedelic use occasions increased among those with a personal history of psychotic disorder; there was no relationship between psychedelic use and auditory hallucinations among those without a personal history of psychotic disorder.

Naturalistic psychedelic use may not be associated with psychotic symptoms, even among those with a personal or family history of psychotic or bipolar disorders. Further work probing the risk-benefit profile for people typically excluded from clinical trials involving psychedelics is needed.