Hallucinogen Persisting Perception Disorder, as defined by the DSM-5, is specifically caused by hallucinogenic drugs, primarily but not exclusively by LSD (lysergic acid diethylamide). The disorder occurs in about 4.2 percent of people who take hallucinogens. The mental disorder affects a small percentage of people with a history of psychedelic drug use.

Hallucinogen Persisting Perception Disorder Types

The number of people who experience flashbacks shortly following the use of hallucinogens can range from 5% to 50%, but research estimates that between 1% and 3% of people will develop HPPD. In addition to medication, mental health professionals frequently recommend talk therapy as a treatment for HPPD. hppd symptoms Therapy can help people with the disorder learn to manage stress and develop coping strategies for dealing with HPPD vision symptoms. Studies show LSD (also called acid) is the most common hallucinogenic drug that can cause HPPD. LSD is a lab-made chemical that is in a class of drugs called psychedelics. In its pure state, it’s a white crystalline substance, but you only need a very small amount to feel the effects.

What Is Hallucinogen Persisting Perception Disorder (HPPD)?

• The mental disorder affects a small percentage of people with a history of psychedelic drug use.
• Among the innumerable triggers able to precipitate HPPD, prospectively, the use of natural and synthetic cannabinoids appears to be the most frequent.
• Each single dose was probably limited to 100 µg and consumed in a peer group setting.
• The FHE Health team is committed to providing accurate information that adheres to the highest standards of writing.
• A person fearful of having acquired HPPD may be much more conscious about any visual disturbance, including those that are normal.

Future research is necessary to test the possible effectiveness of the rTMS neuromodulatory effect on HPPD. Putative targets of stimulation could be hypothesized to be located in the visual cortical areas, as well as in the occipitotemporal sulcus 87. Functional neuroimaging may be beneficial in localizing a specific target for stimulation and may prevent wasting time and money on targets which are not as likely to be involved in the pathogenesis. Calcium Channel Blockers and Beta Blockers may be helpful in patients with co-occurring HPPD II and anxiety disorders 18.

• There is also a correlation between the number of times a hallucinogenic drug is used and the onset of HPPD.
• Clonazepam may act on serotonergic systems, improving, enhancing, and augmenting transmission 17,18,51,67, thus promoting alleviation and a marked improvement 51,67.
• Talking about the experiences can help a person with HPPD process their own feelings and may reduce anxiety and stress about having the condition.
• Objects might also appear either too big (macropsia) or too small (micropsia).
• HPPD can affect mental health and cause ongoing stress and concern.
• As such, the doctor may ask a number of questions to reach a diagnosis.

Other Symptoms

In fact, as in the vast majority of induced psychoses, visual hallucinations are notably more common than auditory 3. Regardless, every perceptual alcoholism treatment symptom that was experienced during intoxication may re-occur following hallucinogen withdrawal. We report a list of the main literature-reported visual disturbances in Table 2. The unifying symptomatology of all cases of HPPD (Types I/II) are a wide range visual disturbances. These include, but are certainly not limited to micropsia, macropsia, floaters, fractals, monochromatic vision, acquired dyslexia, visual snow, and other strange visual perceptions13.

Thus, the serotonergic antidepressants administered during this period proved largely ineffective. However, the patient noticed a reduction in her anxiety and phobias that was also reflected in her psychological test scores. As for her personality, the patient’s self esteem deteriorated even further during the 18-month observation period whereas obsessive–compulsive and anti-social traits receded. It is important to note that in contrast to classical psychotic disorders, patients with HPPD recognize the unreal nature of their visual disturbances which qualifies them as pseudohallucinations. Researchers believe that people are at risk of experiencing HPPD if they take hallucinogenic drugs recreationally. However, they do not yet understand the type or frequency of drug use that causes it.

Symptoms Reported by DSM V

There is also a correlation between the number of times a hallucinogenic drug is used and the onset of HPPD. Research suggests that using hallucinogens 15 or more times is a risk factor for developing the disorder. Second line medications include naltrexone, calcium channel blockers, and beta blockers11. These are particularly helpful in treatment of HPPD II with co-morbid anxiety disorders11. Non-pharmacological management could include brain stimulation treatment, but this has not been fully substantiated or investigated. Alleviation of symptoms for patients with HPPD has been reported with pre-synaptic α2 adrenergic agonists, such as clonidine2.

Results

With HPPD, you re-experience the visual aspects of a drug trip, even though you haven’t taken any kind of substance in months or even years. Visual oddities and disturbances with sudden paroxysmal onset have been interpreted as visual seizures and prompted the use of antiepileptic drugs in HPPD. This consideration helped to explicate the efficacy of benzodiazepines and led to the prescription of Phenytoin 75,76. Today, Phenytoin is not used for HPPD treatment due to its troubled side effect profile. Levetiracetam has shown to reduce some visual symptoms as well as HPPD related-depersonalization and derealization 80. Lamotrigine has shown to be efficacious in a recent severe case of HPPD with some EEG abnormalities (Anderson et al., 2018).

What Are Hallucinogens?

• However, more research is needed to understand exactly how hallucinogens work.
• These selective serotonin reuptake inhibitors (SSRIs) alleviated depression but did not relieve the HPPD symptoms.
• As a consequence, the patient became depressed with latent suicidal impulses.
• To date, no studies have investigated the potential use of rTMS in HPPD.
• The contents of the perception and visual imagery range extensively 17,19.

Those who have Type 2 experience continuous changes to their vision that come and go without warning. The kind of hallucinogen used as well as how much and whether they are taken with other substances can affect whether a person experiences HPPD and for how long they experience it. However, it is not just chronic use of psychedelics like these that can contribute to the development of HPPD, also sometimes called “Alice in Wonderland Syndrome,” or AIWS. Heavy marijuana use can also trigger the disorder, as can use of other substances that cause alterations in perception.

• Another hypothesis is that HPPD could be caused by deconditioning.
• Furthermore, lamotrigine is generally well tolerated with a relative lack of adverse effects, making it a drug of choice for youths and young adults.
• Dr. Nelson has worked in the behavioral health field for more than 22 years.
• The Perception Restoration Foundation promotes and funds research, support and awareness-raising around HPPD.

What are the odds of developing HPPD?

On a macroscopic level, the lateral geniculate nucleus (LGN) of the thalamus, which is important in visual processing, has also been implicated in the pathophysiology of HPPD17. The crucial movement towards a comprehensive clinical understanding of Hallucinogen Persisting Perception Spectrum Disorders (HPPSD) 23 is the establishment of an accepted operative nomenclature. This wide spectrum of disorders encompasses different subtypes, ranging from HPPD I to HPPD II, according to our hypothetical distinction. Among the innumerable triggers able to precipitate HPPD, prospectively, the use of natural and synthetic cannabinoids appears to be the most frequent. This is consistent with the rapid and vast diffusion of these novel psychoactive compounds, nowadays easily available without specific cultural filters and references 91,92.