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Arturo G. Lerner - One of the best experts on this subject based on the ideXlab platform.
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Hallucinogen Persisting Perception Disorder: Etiology, Clinical Features, and Therapeutic Perspectives
Brain sciences, 2018Co-Authors: Giovanni Martinotti, Rita Santacroce, Mauro Pettorruso, Chiara Montemitro, Maria Chiara Spano, Marco Lorusso, Massimo Di Giannantonio, Arturo G. LernerAbstract:Hallucinogen Persisting Perception Disorder (HPPD) is a rare, and therefore, poorly understood condition linked to hallucinogenic drugs consumption. The prevalence of this Disorder is low; the condition is more often diagnosed in individuals with a history of previous psychological issues or substance misuse, but it can arise in anyone, even after a single exposure to triggering drugs. The aims of the present study are to review all the original studies about HPPD in order to evaluate the following: (1) the possible suggested etiologies; (2) the possible hallucinogens involved in HPPD induction; (3) the clinical features of both HPPD I and II; (4) the possible psychiatric comorbidities; and (5) the available and potential therapeutic strategies. We searched PubMed to identify original studies about psychedelics and Hallucinogen Persisting Perception Disorder (HPPD). Our research yielded a total of 45 papers, which have been analyzed and tabled to provide readers with the most updated and comprehensive literature review about the clinical features and treatment options for HPPD.
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A Review of Hallucinogen Persisting Perception Disorder (HPPD) and an Exploratory Study of Subjects Claiming Symptoms of HPPD.
Current topics in behavioral neurosciences, 2018Co-Authors: John H. Halpern, Arturo G. Lerner, Torsten PassieAbstract:Hallucinogen persisting Perception Disorder (HPPD) is rarely encountered in clinical settings. It is described as a re-experiencing of some perceptual distortions induced while intoxicated and suggested to subsequently cause functional impairment or anxiety. Two forms exist: Type 1, which are brief “flashbacks,” and Type 2 claimed to be chronic, waxing, and waning over months to years. A review of HPPD is presented. In addition, data from a comprehensive survey of 20 subjects reporting Type-2 HPPD-like symptoms are presented and evaluated. Dissociative Symptoms are consistently associated with HPPD. Results of the survey suggest that HPPD is in most cases due to a subtle over-activation of predominantly neural visual pathways that worsens anxiety after ingestion of arousal-altering drugs, including non-hallucinogenic substances. Individual or family histories of anxiety and pre-drug use complaints of tinnitus, eye floaters, and concentration problems may predict vulnerability for HPPD. Future research should take a broader outlook as many perceptual symptoms reported were not first experienced while intoxicated and are partially associated with pre-existing psychiatric comorbidity.
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LSD-associated "Alice in Wonderland Syndrome"(AIWS): A Hallucinogen Persisting Perception Disorder (HPPD) Case Report.
The Israel journal of psychiatry and related sciences, 2015Co-Authors: Arturo G. Lerner, Shaul Lev-ranAbstract:A side effect associated with the use of LSD is the return of perceptual disturbances which anteriorly emerged during intoxication, despite absence of present use. Here we present the case of a patient with a previous history of sporadic and recreational cannabis, alcohol and LSD consumption who reported LSD associated "Alice in Wonderland Syndrome" (AIWS) or Todd's syndrome. AIWS is basically characterized by four frequent visual illusions: macropsia, micropsia, pelopsia and teleopsia. AIWS only appeared during LSD consumption and continued after LSD suspension, namely, Hallucinogen Persisting Perception Disorder (HPPD). This phenomenon did not cause a major functional impairment but provoked sufficient worry and concern due to its persistent continuation. The patient refused medical treatment and continued psychiatric follow-up. At the one year follow-up he reported complete remission. To the best of our knowledge this is the first reported case of AIWS which persist after LSD interruption (HPPD) in the professional literature. Reasons for this intriguing, benign, reversible and apparently harmless side effect are proposed.
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Clinical characteristics of individuals with schizophrenia and hallucinogen persisting Perception Disorder: a preliminary investigation.
Journal of dual diagnosis, 2014Co-Authors: Shaul Lev-ran, Daniel Feingold, Alma Frenkel, Arturo G. LernerAbstract:Objective: An unusual side effect of hallucinogen use is the appearance of hallucinogen persisting Perception Disorder (HPPD). Despite high rates of prior hallucinogen use among individuals with schizophrenia, there are insufficient data on the clinical characteristics of individuals with co-occurring schizophrenia and HPPD. Methods: Twenty-six hospitalized patients with schizophrenia and prior LSD use (12 with HPPD and 14 without HPPD) were recruited. Participants were clinically assessed using validated tools, and details regarding hospitalizations were retrieved from their medical records. Those patients who also had HPPD completed a questionnaire addressing HPPD-associated perceptual disturbances. Results: Participants were mostly male (n = 22, 84.6%) and had an average age of 32.3 (SD = 7.67). Nearly half (n = 12, 46.2%) met criteria for HPPD. No significant differences were found in sociodemographic and clinical characteristics (including response to antipsychotic medications and adverse effects) be...
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Synthetic Cannabis Substances (SPS) Use and Hallucinogen Persisting Perception Disorder (HPPD): Two Case Reports.
The Israel journal of psychiatry and related sciences, 2014Co-Authors: Arturo G. Lerner, Craig Goodman, Oren Bor, Shaul Lev-ranAbstract:Hallucinogen Persistent Perceptual Disorder (HPPD) is a clinical syndrome characterized by the recurrence of distressing perceptual disturbances which previously emerged during primary hallucinogen intoxication, in the absence of recent use. Here we present two patients who developed HPPD following use of Synthetic Cannabis Substances (SCS), with no prior history of natural-occurring or synthetic hallucinogen use. Both cases had a prior history of cannabis dependence and current tobacco dependence. In both cases patients reported the presence of visual disturbances when smoking SCS and staring at stationary and moving objects. Both patients discontinued SCS use abruptly after suffering from a panic attack under the influence of SCS. Despite cessation of SCS, both patients continued to suffer from HPPD which was accompanied by significant anxiety. Following clonazepam treatment, both subjects reported significant improvement in symptoms and remained with a residual focal visual disturbance which was not accompanied by significant anxiety. To the best of our knowledge these are the first reports of HPPD following SCS use. In light of the increasing use of SCS, clinical psychiatrists should be aware of these perceptual side effects.
John H. Halpern - One of the best experts on this subject based on the ideXlab platform.
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A Review of Hallucinogen Persisting Perception Disorder (HPPD) and an Exploratory Study of Subjects Claiming Symptoms of HPPD.
Current topics in behavioral neurosciences, 2018Co-Authors: John H. Halpern, Arturo G. Lerner, Torsten PassieAbstract:Hallucinogen persisting Perception Disorder (HPPD) is rarely encountered in clinical settings. It is described as a re-experiencing of some perceptual distortions induced while intoxicated and suggested to subsequently cause functional impairment or anxiety. Two forms exist: Type 1, which are brief “flashbacks,” and Type 2 claimed to be chronic, waxing, and waning over months to years. A review of HPPD is presented. In addition, data from a comprehensive survey of 20 subjects reporting Type-2 HPPD-like symptoms are presented and evaluated. Dissociative Symptoms are consistently associated with HPPD. Results of the survey suggest that HPPD is in most cases due to a subtle over-activation of predominantly neural visual pathways that worsens anxiety after ingestion of arousal-altering drugs, including non-hallucinogenic substances. Individual or family histories of anxiety and pre-drug use complaints of tinnitus, eye floaters, and concentration problems may predict vulnerability for HPPD. Future research should take a broader outlook as many perceptual symptoms reported were not first experienced while intoxicated and are partially associated with pre-existing psychiatric comorbidity.
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Hallucinogens: An update
Current Psychiatry Reports, 2003Co-Authors: John H. HalpernAbstract:Research of hallucinogen abuse rarely extends beyond epidemiology and observed pathology. Even less research has been completed on the special circumstances surrounding the religious use of hallucinogens or on potential therapeutic applications. Rather than offer another basic review on the well-known hazards of illicit hallucinogen use, this paper provides an overview and practice recommendations on compounds the clinician may be less familiar with, such as the botanical plant Salvia divinorum , the drug 3,4-methylenedioxymethamphetamine (“ecstasy”) and synthetic hallucinogen analogs. The often-warned, but rarely occurring, hazard of hallucinogen persisting Perception Disorder (“flashbacks”) is also reviewed with treatment recommendations provided. The current status of clinical research with the hallucinogens is presented, with case vignettes suggesting hallucinogens may have anti-addictive applications. The special circumstances surrounding the religious, nondrug use of hallucinogens as sacred sacraments in the US and elsewhere are also presented. It is hoped that the reader will gain a more nuanced understanding of how these physiologically nonaddictive drugs may offer legitimate benefits in modern society. By appreciating that such benefits may one day be borne out by careful, methodologically sound research, clinicians should be better armed in raising the topic of hallucinogen use and abuse with their patients.
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Hallucinogens: An update
Current Psychiatry Reports, 2003Co-Authors: John H. HalpernAbstract:Research of hallucinogen abuse rarely extends beyond epidemiology and observed pathology. Even less research has been completed on the special circumstances surrounding the religious use of hallucinogens or on potential therapeutic applications. Rather than offer another basic review on the well-known hazards of illicit hallucinogen use, this paper provides an overview and practice recommendations on compounds the clinician may be less familiar with, such as the botanical plant Salvia divinorum , the drug 3,4-methylenedioxymethamphetamine (“ecstasy”) and synthetic hallucinogen analogs. The often-warned, but rarely occurring, hazard of hallucinogen persisting Perception Disorder (“flashbacks”) is also reviewed with treatment recommendations provided. The current status of clinical research with the hallucinogens is presented, with case vignettes suggesting hallucinogens may have anti-addictive applications. The special circumstances surrounding the religious, nondrug use of hallucinogens as sacred sacraments in the US and elsewhere are also presented. It is hoped that the reader will gain a more nuanced understanding of how these physiologically nonaddictive drugs may offer legitimate benefits in modern society. By appreciating that such benefits may one day be borne out by careful, methodologically sound research, clinicians should be better armed in raising the topic of hallucinogen use and abuse with their patients.
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Hallucinogen persisting Perception Disorder: what do we know after 50 years?
Drug and alcohol dependence, 2003Co-Authors: John H. Halpern, Harrison G. PopeAbstract:'Flashbacks' following use of hallucinogenic drugs have been reported for decades; they are recognized in DSM-IV as 'Hallucinogen Persisting Perception Disorder (Flashbacks)', or HPPD. We located and analyzed 20 quantitative studies between 1955 and 2001 examining this phenomenon. However, many of these studies were performed before operational criteria for HPPD were published in DSM-III-R, so they are difficult to interpret in the light of current diagnostic criteria. Overall, current knowledge of HPPD remains very limited. In particular (1) the term 'flashbacks' is defined in so many ways that it is essentially valueless; (2) most studies provide too little information to judge how many cases could meet DSM-IV criteria for HPPD; and consequently (3) information about risk factors for HPPD, possible etiologic mechanisms, and potential treatment modalities must be interpreted with great caution. At present, HPPD appears to be a genuine but uncommon Disorder, sometimes persisting for months or years after hallucinogen use and causing substantial morbidity. It is reported most commonly after illicit LSD use, but less commonly with LSD administered in research or treatment settings, or with use of other types of hallucinogens. There are case reports, but no randomized controlled trials, of successful treatment with neuroleptics, anticonvulsants, benzodiazepines, and clonidine. Although it may be difficult to collect large samples of HPPD cases, further studies are critically needed to augment the meager data presently available regarding the prevalence, etiology, and treatment of HPPD.
Henry David Abraham - One of the best experts on this subject based on the ideXlab platform.
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The Psychopharmacology of Hallucinogens
Neuropsychopharmacology, 1996Co-Authors: Henry David Abraham, Andrew M Aldridge, Prashant GogiaAbstract:Hallucinogenic drugs have been inhaled, ingested, worshipped, and reviled since prehistory. With the purification and synthesis of bontanical preparations and the ensuing discovery of chemically unique agents, hope was raised regarding their therapeutic potential, but this hope has been clouded by an epidemic of abuse and an inventory of adverse effects. This review examines aspects of that controversy, including the history of hallucinogens, epidemiology of current hallucinogen abuse, the association of LSD use with prolonged psychoses and hallucinogen persisting Perception Disorder, and the efforts to demonstrate the drug's therapeutic efficacy. Human subject ramifications in hallucinogen experimentation are discussed. Future lines of research are suggested in human, animal, and tissue culture paradigms.
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LSD-like panic from risperidone in post-LSD visual Disorder
Journal of Clinical Psychopharmacology, 1996Co-Authors: Henry David Abraham, Anitra MamenAbstract:Risperidone, a novel antipsychotic agent, is an antagonist of postsynaptic serotonin-2 and dopamine D2 receptors. In certain individuals, the hallucinogenic drug lysergic acid diethylamide (LSD) is associated with apparently lifelong continuous visual disturbances, characterized in DSM-IV as hallucinogen-persisting Perception Disorder (HPPD). Because the hallucinogenic mechanism of LSD is known to act in part at postsynaptic serotonin-2 receptors, it is noteworthy that three HPPD patients treated with risperidone reported an exacerbation of LSD-like panic and visual symptoms. We conclude that HPPD may be a relative contraindication for the use of risperidone
Domenico De Berardis - One of the best experts on this subject based on the ideXlab platform.
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The "Endless Trip" among the NPS Users: Psychopathology and Psychopharmacology in the Hallucinogen-Persisting Perception Disorder. A Systematic Review.
Frontiers in psychiatry, 2017Co-Authors: Laura Orsolini, Domenico De Berardis, Gabriele Duccio Papanti, Amira Guirguis, John Corkery, Fabrizio SchifanoAbstract:Hallucinogen-persisting Perception Disorder (HPPD) is a syndrome characterized by prolonged or reoccurring perceptual symptoms, reminiscent of acute hallucinogen effects. HPPD was associated with a broader range of LSD (lysergic acid diethylamide)-like substances, cannabis, methylenedioxymethamphetamine (MDMA), psilocybin, mescaline, and psychostimulants. The recent emergence of novel psychoactive substances (NPS) posed a critical concern regarding the new onset of psychiatric symptoms/syndromes, including cases of HPPD. Symptomatology mainly comprises visual Disorders (i.e., geometric pseudo-hallucinations, haloes, flashes of colors/lights, motion-Perception deficits, afterimages, micropsia, more acute awareness of floaters, etc.), even though depressive symptoms and thought Disorders may be comorbidly present. Although HPPD was first described in 1954, it was just established as a fully syndrome in 2000, with the revised fourth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). HPPD neural substrates, risk factors, and aetiopathogenesys still largely remain unknown and under investigation, and many questions about its pharmacological targets remain unanswered too. A critical mini review on psychopathological bases, etiological hypothesis, and psychopharmacological approaches toward HPPD, including the association with some novel substances, are provided here, by means of a literature search on PubMed/Medline, Google Scholar, and Scopus databases without time restrictions, by using a specific set of keywords. Pharmacological and clinical issues are considered, and practical psychopharmacological recommendations and clinical guidelines are suggested.
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The “Endless Trip”: Psychopathology and psychopharmacology in the Hallucinogen Persisting Perception Disorder (HPPD)
European Psychiatry, 2016Co-Authors: Laura Orsolini, Alessandro Valchera, Duccio Papanti, R. Vecchiotti, Domenico De BerardisAbstract:Introduction Hallucinogen Persisting Perception Disorder (HPPD) is a syndrome characterized by prolonged or reoccurring perceptual symptoms, reminiscent of acute hallucinogen effects. HPPD was associated with a broader range of LSD (lysergic acid diethylamide)-like substances, including cannabis, MDMA (methylenedioxymethamphetamine), psilocybin, mescaline and other psychostimulants. Symptomatology mainly comprises visual Disorders (i.e., geometric pseudo-hallucinations, halos, flashes of colours/lights, motion-Perception deficits, afterimages, micropsy, more acute awareness of floaters, etc.), even though depressive symptoms and thought Disorders may be comorbidly present. Objective Although HPPD was firstly described in 1954, it was definitely established as a syndrome in 2000 with the revised forth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). However, neuronal substrate, risk factors, aetiology and pathogenesis of HPPD remains still unknown and under investigation. Furthermore, there are still open questions about its pharmacological targets. Aims A critical review on psychopathological bases, etiological hypothesis and psychopharmacological approaches towards HPPD was here provided. Methods A systematic literature search on PubMed/Medline, GoogleScholar and Scopus databases without time restrictions, by using a specific set of keywords was here carried out. In addition, a case report was here described. Results and conclusions Pharmacological and clinical issues are here considered and practical psychopharmacological recommendations and clinical guidelines here suggested.
Laura Orsolini - One of the best experts on this subject based on the ideXlab platform.
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The "Endless Trip" among the NPS Users: Psychopathology and Psychopharmacology in the Hallucinogen-Persisting Perception Disorder. A Systematic Review.
Frontiers in psychiatry, 2017Co-Authors: Laura Orsolini, Domenico De Berardis, Gabriele Duccio Papanti, Amira Guirguis, John Corkery, Fabrizio SchifanoAbstract:Hallucinogen-persisting Perception Disorder (HPPD) is a syndrome characterized by prolonged or reoccurring perceptual symptoms, reminiscent of acute hallucinogen effects. HPPD was associated with a broader range of LSD (lysergic acid diethylamide)-like substances, cannabis, methylenedioxymethamphetamine (MDMA), psilocybin, mescaline, and psychostimulants. The recent emergence of novel psychoactive substances (NPS) posed a critical concern regarding the new onset of psychiatric symptoms/syndromes, including cases of HPPD. Symptomatology mainly comprises visual Disorders (i.e., geometric pseudo-hallucinations, haloes, flashes of colors/lights, motion-Perception deficits, afterimages, micropsia, more acute awareness of floaters, etc.), even though depressive symptoms and thought Disorders may be comorbidly present. Although HPPD was first described in 1954, it was just established as a fully syndrome in 2000, with the revised fourth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). HPPD neural substrates, risk factors, and aetiopathogenesys still largely remain unknown and under investigation, and many questions about its pharmacological targets remain unanswered too. A critical mini review on psychopathological bases, etiological hypothesis, and psychopharmacological approaches toward HPPD, including the association with some novel substances, are provided here, by means of a literature search on PubMed/Medline, Google Scholar, and Scopus databases without time restrictions, by using a specific set of keywords. Pharmacological and clinical issues are considered, and practical psychopharmacological recommendations and clinical guidelines are suggested.
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The “Endless Trip”: Psychopathology and psychopharmacology in the Hallucinogen Persisting Perception Disorder (HPPD)
European Psychiatry, 2016Co-Authors: Laura Orsolini, Alessandro Valchera, Duccio Papanti, R. Vecchiotti, Domenico De BerardisAbstract:Introduction Hallucinogen Persisting Perception Disorder (HPPD) is a syndrome characterized by prolonged or reoccurring perceptual symptoms, reminiscent of acute hallucinogen effects. HPPD was associated with a broader range of LSD (lysergic acid diethylamide)-like substances, including cannabis, MDMA (methylenedioxymethamphetamine), psilocybin, mescaline and other psychostimulants. Symptomatology mainly comprises visual Disorders (i.e., geometric pseudo-hallucinations, halos, flashes of colours/lights, motion-Perception deficits, afterimages, micropsy, more acute awareness of floaters, etc.), even though depressive symptoms and thought Disorders may be comorbidly present. Objective Although HPPD was firstly described in 1954, it was definitely established as a syndrome in 2000 with the revised forth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). However, neuronal substrate, risk factors, aetiology and pathogenesis of HPPD remains still unknown and under investigation. Furthermore, there are still open questions about its pharmacological targets. Aims A critical review on psychopathological bases, etiological hypothesis and psychopharmacological approaches towards HPPD was here provided. Methods A systematic literature search on PubMed/Medline, GoogleScholar and Scopus databases without time restrictions, by using a specific set of keywords was here carried out. In addition, a case report was here described. Results and conclusions Pharmacological and clinical issues are here considered and practical psychopharmacological recommendations and clinical guidelines here suggested.