Background: Substance use is increasingly recognized as a factor associated with the emergence of psychosis, with approximately 25% of first-episode psychoses being substance-induced (SIP). The DSM-5 defines SIP as a transient condition that disappears after sustained abstinence. However, the issue of persistent SIP remains unaddressed, particularly in the context of classical psychedelics. Although there is no concrete evidence of persisting SIP after ingesting classical psychedelics, there is a growing body of research suggesting that frequent use of psychedelic substances in recreational settings could play a role as a contributing factor in the onset of psychosis. Additionally, there is a lack of understanding of how set and setting influence the pathological mechanisms of SIPs induced by classical psychedelics, and integrated transdiagnostic models to explain the underlying psychological mechanisms have yet to be formulated.

Objective: Given the lack of structured psychopathological models that can offer a phenomenological representation of how psychedelics related SIPs can be induced, the purpose of this poster is to present a revised version of the “Psychoma” model proposed by Danilo Cargnello in 1958. We aim to investigate how recent hypotheses on the impact of psychedelic experiences on psychological flexibility in relation to set and setting can be integrated into the psychopathological model of the psychoma and vice versa.

Methods: We will present a graphic model of the psychoma concept and juxtapose it with the psychopathological description. We will then summarize the models inspired by the “learning to let it go” theory and the role of psychological flexibility in psychedelic experiences. Finally, we will propose a synthesis of the aforementioned models and draw some theoretical conclusions.

Conclusions: Based on recent research regarding the role of acceptance/avoidance patterns accompanying psychedelic experiences, we propose to interpret psychedelic-induced psychosis as a reinforcing mechanism of avoidant and evasive patterns from ordinary states of consciousness that are reinforced or “fixed” by the psychedelic experience itself. The psychoma model provides a phenomenological perspective on this assumption and can serve as a useful tool for linking the phenomenological psychopathology tradition to ongoing discussions in the field. While this model does not contradict biological vulnerability, it is proposed as a simple representation to further promote psychopathological reasoning in this area.

 Buonarroti M., D’Alonzo M., Gelao A.