Due to the very low prevalence of this disorder, we believe it is valuable to document this case in order to motivate research to understand the etiology and pathophysiology of this phenomenon. First, the patient presented with hallucinations following the cessation of the inducing substance, which, in this case, was LSD. Second, the patient is experiencing significant distress in the social and occupational aspects of his life.
Therapy
The severity of these symptoms can vary and may worsen during periods of stress, fatigue, or anxiety. Diagnosis of HPPD often involves a thorough clinical assessment by a psychiatrist, including a detailed case report of the patient’s history with hallucinogens and the symptoms they are experiencing. The American Psychiatric Association recognizes HPPD, which helps in standardizing the diagnostic criteria.
Pharmacological treatments
- Hallucinogen-persisting perception disorder, or acute hallucinogen-induced psychosis, is a rare disorder characterized by the presence of flashbacks of visual hallucinations as a result of previous hallucinogenic drug use.
- If symptoms involve excessive worry or fear without visual disturbances, an anxiety disorder is more likely.
- At the same time, conflicting evidence exists on the antipsychotics effects in psychotic HPPD patients.
- With a multitude of potential etiologies, it may not be possible to put forward a unified pathophysiological model of HPPD.
Likewise, HPPD patients apparently become aware of their perceptual symptoms when their regular sensory input diminishes. In his model, West emphasized the role of arousal in the release of such endogenous percepts, saying that “The greater the level of arousal, the more vivid the hallucinations” (West, 1962). HPPD symptoms such as derealization and depersonalization might be exceptions to this tenet because of the narrowing of consciousness that characterizes these phenomena. For the reasons mentioned above, we believe this 21-year-old man has been experiencing hallucinogen-persisting perception disorder.
Why Do Some People Develop HPPD and Not Others?
Lamotrigine is a widely used antiepileptic and mood-stabilizing drug which acts by blocking sodium and voltage-gated calcium channels and inhibiting glutamate-mediated excitatory neurotransmission. Additionally, there are data supporting a neuroprotective effect Halonen et al. 2001. Lamotrigine has also been shown to reduce symptoms of depersonalization and derealization Sierra et al. 2001, although the same group was unable to reproduce their results in a placebo-controlled follow-up study Sierra et al. 2003. Given that excitotoxic destruction of inhibitory interneurons may play a role in at least some of the visual symptoms of HPPD (see below), lamotrigine was considered a possible treatment option for this patient. Furthermore, lamotrigine is generally well tolerated with a relative lack of adverse effects, making it a drug of choice for youths and young adults.
Moreover, a case report suggested that reboxetine made a good improvement both in visual disturbances and depressive symptomatology (26). Reboxetine is an α-2-adrenoceptor modulating the effect on both noradrenaline and serotonin release which may affect sympathetic activity, hence facilitating the improvement of HPPD symptomatology (26). Other studies suggest lamotrigine as efficacious in ameliorating HPPD symptomatology (28, 29).
Risk Factors for Developing Hallucinogen Persisting Perception Disorder
If you or someone you care about is struggling with HPPD symptoms, our primary care telemedicine practice is here to provide support. We offer compassionate, convenient care tailored to your needs, all from the comfort of your home. Contact us today to schedule a consultation and take the first step toward relief.
Emotional symptoms
Derealization can be particularly unsettling and may contribute to anxiety or panic. A 2018 paper – whose authors include John H. Halpern and Torsten Passie (two experts on HPPD) – suggests that the risk of HPPD increases if one has a challenging psychedelic experience. This would be a Substance abuse typical ‘bad trip’ including intense reactions of fear, anxiety, dread, paranoia, panic, dysphoria, confusion, overwhelm, and the feeling of ‘going insane’ or dying. Therapy can help individuals manage the psychological effects of HPPD, such as anxiety and panic attacks. Cognitive Behavioral Therapy (CBT) teaches people how to reframe their thoughts and cope with distressing symptoms.
- The HPPD was likewise self-limiting in the cases without comorbid psychiatry.
- Along with that, lamotrigine is widely known for its neuroprotective effect.
- Methodological quality of the case reports as assessed with the MAQ-HPPD.
- Do not disregard or avoid professional medical advice due to content published within Cureus.
One observational study showed that all 16 subjects receiving benzodiazepines reported a reduced intensity and frequency of visual disturbances, and the improvement persisted during a six-month follow-up period 5. Another study showed that high-potency benzodiazepines that have serotonergic properties may be more effective than low-potency benzodiazepines in the treatment of some patients with LSD-induced HPPD 6. The patient, in this case, was given clonazepam, a high-potency benzodiazepine that facilitates gamma-aminobutyric acid (GABA) action by increasing the frequency of chloride channel opening, and his symptoms were relieved after four days 6-9. We included articles in English, Dutch, German, French, and Spanish without date limits as long as the papers reported on original cases or case series on HPPD.
You might still see visual oddities long after the effects of psychedelics wear off. Suicide has been noted in patients who do not receive an accurate diagnosis and comprehensive treatment early in the process. For example, one older case found that risperidone use caused panic in one HPPD patient, while another study found that the use of risperidone taken with sertraline was effective for another patient after six months of treatment. Currently, no cure for HPPD is effective in the treatment of all individuals who are struggling with the disorder. Medications have been identified as effective in helping some people manage pseudo flashbacks caused by HPPD. 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.
Many people suffering from HPPD mistake their symptoms for is hppd schizophrenia a mental disorder like schizophrenia or severe anxiety, leading to confusion and distress. LSD and other hallucinogenic drugs can cause intense and often unpredictable experiences. While some users recover without lasting effects, others develop Hallucinogen-Persisting Perception Disorder (HPPD). This condition causes recurring visual disturbances, often described as flashbacks, that can persist long after the drug has left the body. Several case reports of reoccurring or prolonged persistent visual perceptual disturbances (HPPD) have been described occurring within a certain time frame after cessation of some hallucinogenic drugs (2, 53, 54). Hallucinogen persisting perception disorder (HPPD) signs include the presence of recurring visual disturbances after using a hallucinogen, such as LSD (lysergic acid diethylamide) or PCP (phencyclidine).