Some of the long-acting first-generation antipsychotics may still be useful in co-occurring Psychotic Spectrum Disorders and HPPD II 58. In one study, haloperidol was noted to reduce hallucinations, but an exacerbation of flashbacks in the early phases of treatment was highlighted as well 1,69. HPPD can occur in combination with other mental disorders, such as panic disorder, alcohol use disorder, and depression, according to the DSM-5. Some types of therapy used to treat those conditions may be helpful in managing HPPD symptoms as well.
Living With Hallucinogen Persisting Perception Disorder
Researchers and doctors do not yet have a solid understanding of who develops HPPD and why. The strongest connection points to a history of hallucinogenic drug use, but it’s not clear how the type of drug or the frequency of drug use may affect who develops HPPD. Stress tends to exacerbate symptoms, so stress reduction techniques like regular exercise, mindfulness meditation, and yoga are often beneficial.
A therapist or psychologist can help you learn how to respond to stressors when they occur.
Their symptoms improved significantly after treatment initiation and the improvement persisted during a 6-month follow-up after treatment discontinuation 51.
HPPD (hallucinogen persisting perception disorder) is a condition characterized by seeing strange lights, patterns, or colors long after using drugs like LSD or magic mushrooms.
Here we present the case of a 33-year-old female former LSD user who displayed typical symptoms of HPPD over an extended period of time.
Visual aberrations can occur periodically in healthy individuals – e.g., afterimages after staring at a light, noticing floaters inside the eye, blue field entoptic phenomenon or seeing specks of light in a darkened room.
However, any additional psychopathological symptoms that may have occurred in this patient population were not given any consideration.
Causes of Hallucinogen Persisting Perception Disorder
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.
HPPD however has also been reported after cannabis, 3,4- methylenedioxymethamphetamine (MDMA/“ecstasy”), and other novel psychoactive substances (NPS)456789.
Future clinical research needs to be directed towards randomized controlled trials to establish sound treatment guidelines, in particular for chronic forms of HPPD Halpern and Pope, 2003.
Our caring team of doctors, psychiatrists, therapists, and other addiction professionals are committed to providing comprehensive, evidence-based treatment tailored to each patient’s needs.
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.
Sometimes, these visual disturbances are triggered by stress or anxiety. According to DSM-5, Hallucinogen Persisting Perception Disorder is the recurrence of perceptive disturbances that firstly develop during intoxication. The contents of the perception and visual imagery range extensively 17,19. DSM-5 and previous DSM editions report a list of the most common symptoms experienced by HPPD patients, but only a few symptoms have been described in the professional literature. The main group of symptoms reported by Criterion A of the DSM-5 are visual disturbances. In fact, as in the vast majority of induced psychoses, visual hallucinations are notably more common than auditory 3.
Hallucinogen persisting perception disorder
However, when he left the cemetery and walked about 45 minutes away from the graveyard, he somehow ended up in the exact location. Due to minimal improvement, lamotrigine was increased to 50 milligrams in the regimen. On the seventh day, the same regimen continued, and the patient reported improvements in having fewer intrusive thoughts and flashbacks. On the eighth day, the patient reported having no negative thoughts and feeling much better. He stated, “I am optimistic about the future and have better control over my thoughts.” He denied any perceptual distortion or hallucinations. On the ninth, tenth, and eleventh days, the same regimen continued with the improvement of an elevated mood of 6/10.
The Perception Restoration Foundation
Among those who’ve taken hallucinogenic drugs, only 4% to 4.5% get HPPD.
However, more research is needed to understand exactly how hallucinogens work.
In the clinical trial, 16 HPPD patients were treated with a Clonazepam dosage of 2 mg/day 51.
People typically take the drug in sugar cubes or on small gelatin sheets that dissolve on the tongue.
Pharmacotherapy of this very distressing condition is limited and any recommendations are based almost entirely on uncontrolled studies on small patient populations or even single case observations. Thus far, SSRIs, benzodiazepines, risperidone, olanzapine and naltrexone have all been tried with sometimes contradictory outcomes (Table 2). While research is still ongoing to find a permanent cure for HPPD, several medications that have been tested so far include benzodiazepines like alprazolam and clonazepam, as well as alpha-2 agonists like clonidine. However, our patient’s symptoms started to ameliorate with lamotrigine. Although several studies have reported HPPD symptom improvement with lamotrigine, one study highlights a patient whose complex visual disturbances improved with the maximum dose of 200 milligrams of lamotrigine for six months. Lamotrigine, a commonly prescribed antiepileptic and mood hppd symptoms stabilizer, works by decreasing glutamate-mediated excitatory neurotransmission and sodium and voltage-gated calcium channels.
Tracers and trailing phenomena appear to be the most resistant symptoms. Concomitant coexisting psychiatric disorders can represent a further clinical challenge, with the clinical construct of the lysergic psychoma as a possible heuristic model. Of course, when the psychoma is strong and repeated in its nature, the possibility to determine a full-blown psychosis may become more concrete 93,94. Antidepressant medications could help in the management of co-occurring HPPD II with anxiety and depressive disorders 17,18,20,51,67. There are questionable and controversial results regarding Sertraline, which has been reported to worsen 81 as well as to improve visual disturbances. Amelioration following long-term administration of SSRIs was attributed to the down-regulation of 5-HT2 receptors, providing more evidence to corroborate the serotonergic mechanisms underlying this condition.
Medications like lamotrigine, valproate, clonazepam, and selective serotonin reuptake inhibitors (SSRIs) may help reduce visual disturbances and relieve co-occurring anxiety or depression.
In both cases, Clonazepam (2 mg/day) was effective in improving symptoms, but focal visual disturbances without anxiety (trailing phenomena in one case, and black moving spots in the second case) persisted during and after therapy 19.
He denied any intrusive thoughts or auditory or visual hallucinations.
Ever since the first description Cooper, 1955, reports about the incidence of post-toxic flashbacks show a wide variation. Between 5% and 50% of hallucinogen users are reported to have experienced at least one flashback Alarcon et al. 1982; McGee, 1984. HPPD patients appear to be sensitive to first-generation antipsychotics at low doses, requiring monitoring of extrapyramidal side effects. Haloperidol 69 and Trifluoperazine 70 were reported to be helpful. Perphenazine (4–8 mg/day) 17,23, Sulpiride (50–100 mg/day) 23, and Zuclopenthixol (2–10 mg/day) 17,23, at very low doses, are well tolerated and may be an effective treatment.
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. Distinct substances, with completely different mechanisms of action, might lead or precipitate the genesis of HPPD, therefore suggesting a multifaceted etiology. Thus, it is accordingly conceivable alcoholism that different medications could be useful and helpful in the treatment of different subtypes of HPPD.
Hallucinogen-Induced Persisting Perception Disorder: A Case Report
Some of the long-acting first-generation antipsychotics may still be useful in co-occurring Psychotic Spectrum Disorders and HPPD II 58. In one study, haloperidol was noted to reduce hallucinations, but an exacerbation of flashbacks in the early phases of treatment was highlighted as well 1,69. HPPD can occur in combination with other mental disorders, such as panic disorder, alcohol use disorder, and depression, according to the DSM-5. Some types of therapy used to treat those conditions may be helpful in managing HPPD symptoms as well.
Living With Hallucinogen Persisting Perception Disorder
Researchers and doctors do not yet have a solid understanding of who develops HPPD and why. The strongest connection points to a history of hallucinogenic drug use, but it’s not clear how the type of drug or the frequency of drug use may affect who develops HPPD. Stress tends to exacerbate symptoms, so stress reduction techniques like regular exercise, mindfulness meditation, and yoga are often beneficial.
Causes of Hallucinogen Persisting Perception Disorder
Sometimes, these visual disturbances are triggered by stress or anxiety. According to DSM-5, Hallucinogen Persisting Perception Disorder is the recurrence of perceptive disturbances that firstly develop during intoxication. The contents of the perception and visual imagery range extensively 17,19. DSM-5 and previous DSM editions report a list of the most common symptoms experienced by HPPD patients, but only a few symptoms have been described in the professional literature. The main group of symptoms reported by Criterion A of the DSM-5 are visual disturbances. In fact, as in the vast majority of induced psychoses, visual hallucinations are notably more common than auditory 3.
Hallucinogen persisting perception disorder
However, when he left the cemetery and walked about 45 minutes away from the graveyard, he somehow ended up in the exact location. Due to minimal improvement, lamotrigine was increased to 50 milligrams in the regimen. On the seventh day, the same regimen continued, and the patient reported improvements in having fewer intrusive thoughts and flashbacks. On the eighth day, the patient reported having no negative thoughts and feeling much better. He stated, “I am optimistic about the future and have better control over my thoughts.” He denied any perceptual distortion or hallucinations. On the ninth, tenth, and eleventh days, the same regimen continued with the improvement of an elevated mood of 6/10.
The Perception Restoration Foundation
Pharmacotherapy of this very distressing condition is limited and any recommendations are based almost entirely on uncontrolled studies on small patient populations or even single case observations. Thus far, SSRIs, benzodiazepines, risperidone, olanzapine and naltrexone have all been tried with sometimes contradictory outcomes (Table 2). While research is still ongoing to find a permanent cure for HPPD, several medications that have been tested so far include benzodiazepines like alprazolam and clonazepam, as well as alpha-2 agonists like clonidine. However, our patient’s symptoms started to ameliorate with lamotrigine. Although several studies have reported HPPD symptom improvement with lamotrigine, one study highlights a patient whose complex visual disturbances improved with the maximum dose of 200 milligrams of lamotrigine for six months. Lamotrigine, a commonly prescribed antiepileptic and mood hppd symptoms stabilizer, works by decreasing glutamate-mediated excitatory neurotransmission and sodium and voltage-gated calcium channels.
Tracers and trailing phenomena appear to be the most resistant symptoms. Concomitant coexisting psychiatric disorders can represent a further clinical challenge, with the clinical construct of the lysergic psychoma as a possible heuristic model. Of course, when the psychoma is strong and repeated in its nature, the possibility to determine a full-blown psychosis may become more concrete 93,94. Antidepressant medications could help in the management of co-occurring HPPD II with anxiety and depressive disorders 17,18,20,51,67. There are questionable and controversial results regarding Sertraline, which has been reported to worsen 81 as well as to improve visual disturbances. Amelioration following long-term administration of SSRIs was attributed to the down-regulation of 5-HT2 receptors, providing more evidence to corroborate the serotonergic mechanisms underlying this condition.
Ever since the first description Cooper, 1955, reports about the incidence of post-toxic flashbacks show a wide variation. Between 5% and 50% of hallucinogen users are reported to have experienced at least one flashback Alarcon et al. 1982; McGee, 1984. HPPD patients appear to be sensitive to first-generation antipsychotics at low doses, requiring monitoring of extrapyramidal side effects. Haloperidol 69 and Trifluoperazine 70 were reported to be helpful. Perphenazine (4–8 mg/day) 17,23, Sulpiride (50–100 mg/day) 23, and Zuclopenthixol (2–10 mg/day) 17,23, at very low doses, are well tolerated and may be an effective treatment.
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. Distinct substances, with completely different mechanisms of action, might lead or precipitate the genesis of HPPD, therefore suggesting a multifaceted etiology. Thus, it is accordingly conceivable alcoholism that different medications could be useful and helpful in the treatment of different subtypes of HPPD.