Hallucinogen Persisting Perception Disorder

Classification according to ICD-10
F16.7	Mental and behavioral disorders due to hallucinogens - residual and delayed psychotic disorder
ICD-10 online (WHO version 2019)

The Hallucinogen Persisting Perception Disorder ( HPPD ; . Dt : persisting perception disorder after Halluzinogengebrauch ) is a mental disorder , which, by definition, by consumption of hallucinogens is triggered. Affected people have so-called flashbacks , i.e. pseudo-hallucinations , at regular intervals or even at any time , which are experienced although the actual drug intoxication is long gone and (presumably) the hallucinogen and its metabolites have left the body.

Other symptoms include: dysphoria , poor concentration , depersonalization , derealization , dissociation , micropsia , macropsia, and depression .

HPPD is defined by DSM-IV and has the diagnosis code 292.89 in this classification system . The pseudohallucinations must limit the person's normal life and other causes such as epilepsy , delirium, or schizophrenia must be ruled out in order for HPPD to be diagnosed. Limitations are, for example, poor concentration or difficult reading. In the ICD-10 , the diagnosis code F16.7 corresponds most closely to the clinical picture. HPPD is little known by both hallucinogen users and psychiatrists and is often misdiagnosed as substance-induced psychosis . HPPD can be differentiated from this in terms of the triggering substances and in that, similar to a model psychosis, people suffering from HPPD are generally aware of their psychotic state.

diagnosis

In Germany, the hallucinogen persisting perception disorder is little known among psychiatrists and is therefore rarely diagnosed . In addition, there are no representative studies on the frequency of this disorder. Those affected often spend years looking for a diagnosis.

Imaging tests are usually without finding. An electroencephalogram (EEG) shows no irregularities even under extreme stress and photostimulation , even if the patient suffers from severe perception disorders during this time.

causes

Most of the documented cases were caused by LSD . It is believed that other hallucinogens with similar effects, such as mescaline , DMT or psilocin , can trigger HPPD.

By definition, only people who have also consumed hallucinogens can get HPPD.

treatment

There is no recognized cure or therapy for HPPD. The rate of spontaneous remissions in HPPD is very high.

There have been reports that various drugs allow partial or complete remission.

• Lamotrigine : An anticonvulsant that has been reported to have been shown to significantly improve HPPD symptoms.
• Clonidine : An antihypertensive agent that, according to a pilot study with eight patients, could provide significant relief from "LSD-related flashbacks".
• Levodopa

In the case of a psychotic form, those measures that are also used to treat a psychosis are often beneficial . There are also indications of measures to alleviate the symptoms:

• Avoid stimulants , including caffeine , taurine, and nicotine . They make symptoms worse, at least in part.
• Psychotropic drugs such as tranquilizers or antipsychotics should only be taken in consultation with an experienced psychiatrist . They often seem paradoxical and can also lead to permanent worsening of symptoms.
• Use of relaxation techniques .
• Depending on the case, it can be useful to avoid sensory deprivation . Some people have reported that just staring at a white wall can cause pseudo-hallucinations. Then distraction or occupation may be helpful. In other cases, however, avoiding too much or stressful stimuli is advisable if processing them leads to excessive demands .

literature

• JH Halpern, AG Lerner, T. Passie: A Review of Hallucinogen Persisting Perception Disorder (HPPD) and an Exploratory Study of Subjects Claiming Symptoms of HPPD. In: Current topics in behavioral neurosciences. Volume 36, 2018, pp. 333-360, doi : 10.1007 / 7854_2016_457 , PMID 27822679 .
• G. Martinotti, R. Santacroce et al. a .: Hallucinogen Persisting Perception Disorder: Etiology, Clinical Features, and Therapeutic Perspectives. In: Brain sciences. Volume 8, number 3, March 2018, p., Doi : 10.3390 / brainsci8030047 , PMID 29547576 , PMC 5870365 (free full text) (review).

Individual evidence

1. ↑ M. Schulte-Markwort, K. Marutt, P. Riedesser: Cross-walk ICD-10 - DSM 4: Classification of mental disorders: a synopsis. Huber, Bern 2002, ISBN 3-456-83574-4 .
2. ↑ ML Espiard et al .: Hallucinogen persisting perception disorder after psilocybin consumption: a case study. In: Eur. Psychiatry. 2005; 20 (5-6), pp. 458-460. PMID 15963699 .
3. ↑ Leo Hermle, Melanie Simon, Martin Ruchsow, Martin Geppert: Hallucinogen-persisting perception disorder . In: Therapeutic Advances in Psychopharmacology . tape 2 , no. 5 , 2012, ISSN  2045-1253 , p. 199–205 , doi : 10.1177 / 2045125312451270 , PMID 23983976 , PMC 3736944 (free full text).
4. ↑ L. Hermle, M. Ruchsow, K. Täschner: Hallucinogen-Induced Persistent Perception Disorder (HPPD) and Flashback Phenomena - Differential Diagnosis and Explanatory Models . In: Advances in Neurology - Psychiatry. 83, 2015, pp. 506-515, doi : 10.1055 / s-0035-1553717 .
5. ↑ AG Lerner, M. Gelkopf, I. Oyffe, B. Finkel, S. Katz, M. Sigal, A. Weizman: LSD-induced hallucinogen persisting perception disorder treatment with clonidine: an open pilot study. In: Int Clin Psychopharmacol . 2000 Jan; 15 (1), pp. 35-37. PMID 10836284 .
6. ↑ HD Abraham, A. Mamen: LSD-like panic from risperidone in post-LSD visual disorder. In: J. Clin. Psychopharmacol. (1996); 16 (3), pp. 238-241. PMID 8784656 .

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !