Hallucinogen persisting perception disorder

From Wikipedia, the free encyclopedia
Jump to navigation Jump to search
Hallucinogen persisting perception disorder
Red-blue-noise.gif
HPPD noise simulation, often referred to as visual snow
SpecialtyPsychiatry

Hallucinogen persisting perception disorder (HPPD) is a chronic and non-psychotic disorder in which a person experiences apparent lasting or persistent visual hallucinations or perceptual distortions after a previous hallucinogenic drug experience, usually lacking the same feelings of intoxication or mental alteration experienced while on the drug. The hallucinations and perceptual changes themselves are usually not intense or impairing and consist of visual snow, trails and after images (palinopsia), light fractals on flat surfaces, intensified colors, or other psychedelic visuals. People who have never previously taken drugs have also reported some visual anomalies associated with HPPD (such as floaters and visual snow).[1][2]

HPPD is a DSM-5 diagnosis with diagnostic code 292.89 (F16.983).[3] For the diagnosis to be made, other psychological, psychiatric, or neurological conditions must be ruled out and it must cause distress in everyday life.[3] 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 among both hallucinogen users and psychiatrists and is often misdiagnosed as a substance-induced psychosis.

History[edit]

In 1898, the English writer and intellectual Havelock Ellis reported a heightened sensitivity to "the more delicate phenomena of light and shade and color" for a prolonged period of time after consuming the psychedelic drug mescaline. This may have been one of the first recorded cases of what would later be called "HPPD".[4] However, mild residual effects or "afterglows" from these types of drugs are not necessarily unusual nor indicative of what can be classified as a disorder like HPPD since distress to the individual is usually a requirement for diagnosis.[3]

Symptoms[edit]

"Halos" are a often described symptom of HPPD

Typical symptoms of the disorder include: halos or auras surrounding objects, trails following objects in motion, difficulty distinguishing between colors, apparent shifts in the hue of a given item, the illusion of movement in a static setting, visual snow, distortions in the dimensions of a perceived object, intensified hypnagogic & hypnopompic hallucinations, and a heightened awareness of floaters. The visual alterations experienced by those with HPPD are not homogeneous and there appear to be individual differences in both the number and intensity of symptoms.[citation needed]

Visual aberrations can occur periodically in healthy individuals – e.g. afterimages after staring at a light, noticing floaters inside the eye, or seeing specks of light in a darkened room. However, in people with HPPD, symptoms are typically persistent enough that the individual cannot ignore them.[citation needed]

There is some uncertainty about to what degree visual snow constitutes a true HPPD symptom. There are many individuals who have never used a drug which could have caused the onset, but yet experience the same grainy vision reported by HPPD sufferers. There are a few potential reasons for this, the most obvious of which being the theory that the drug usage may exaggerate the intensity of visual snow.

Visual Snow with additional geometric hallucinations

Another theory is that instead, there may be no change in the severity or magnitude of the visual snow, but perhaps the drug usage opens sensory pathways that result in the individual becoming more aware of any visual disturbances that may have simply not been noticed before the incidence of substance use. As for root cause of visual snow, some theories suggest that it is the result of thermal noise in the visual cortex or in the 'Optic Pathway' as eye tests for individuals who experience visual snow often reveal that physically, the eye is perfectly normal, and in many cases the individual still maintains 20/20 vision.[5]

HPPD usually has a visual manifestation. Drugs affecting the auditory sense, like diisopropyltryptamine (DiPT), may produce auditory disturbances, though there are few known cases. Some hallucinogenic substances can produce temporary tinnitus-like symptoms as a side effect.

According to a 2016 review, there are two theorized subtypes of the condition.[3] Type 1 HPPD is where people experience random, brief flashbacks.[3] Type 2 HPPD entails experiencing persistent changes to vision, which may vary in intensity.[3] This model has faced scrutiny however due to "flashbacks" often being considered a separate affliction and not always a perceptual one.[6]

Cause[edit]

HPPD is not related to psychosis due to the fact those affected by the disorder can easily distinguish their visual disturbances from reality.[7] A vast list of psychoactive substances has been identified and linked with the development of this condition, including lysergamides like LSD and LSA, tryptamines like psilocybin and DMT, phenethylamines like 2C-B, MDMA, MDA and mescaline.[8][9] Dissociatives such as ketamine and dextromethorphan as well as cannabis and synthetic cannabinoids, salvia divinorum, datura and iboga are also known to trigger HPPD.[9] LSD seems to be the substance with the most reported cases of HPPD, 81 of 95 studies found LSD to be the substance that caused HPPD[10]

It is, therefore, clear that HPPD is not strictly associated with psychedelic consumption, but a number of hallucinogen-inducing substances may be correlated with its arising.[9] The dosage and how frequent one uses these substances doesn't seem to matter in the development of this condition since there's several reports in the litterature were people have gotten it after a single use.[9] Which strongly indicate that there is a genetic predisposition to this condition. It also seems that combining rectreational or medical drugs that act on the 5HT2-a receptors, like SSRI's, drastically increases the risk of developing it because of the drug-drug interaction.[11]

The exact pathophysiologic mechanism underlying HPPD is poorly understood. The primary neurobiological hypothesis is that persistent hallucinations are the result of chronic disinhibition of visual processors and subsequent dysfunction in the central nervous system following consumption of hallucinogens.[12][13] Chronic disinhibition may occur from destruction and/or dysfunction of cortical serotonergic inhibitory interneurons involving the inhibitory neurotransmitter, gamma-aminobutyric acid (GABA).[14][15][16][17] This ultimately can cause disruption of the normal neurological mechanisms that are responsible for filtration of unnecessary stimuli in the brain. 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 HPPD.[18]

Treatment[edit]

As of January 2022 there is no officially recognized cure or therapy for HPPD. The rate of spontaneous remission is very high with up to 50% of cases within a few months.[19]

Those affected with HPPD are heavily advised to discontinue all recreational drug uses also including legal stimulants like caffeine, taurine and nicotine, as many of them are thought to increase symptoms in the short term.[citation needed]

Antipsychotics such as aripiprazole or risperidone intended to treat mental disorders like schizophrenia should only be taken in careful consultation with a psychiatrist experienced in HPPD. The success rate of antipsychotics as a treatment method for HPPD is still debated. Two young men with HPPD and schizophrenia as a comorbidity experienced a remission of visual perceptual disturbance during a 6-month follow-up observation under treatment with risperidone.[10] There has been been a case study in 2013 where oral risperidone was also successful for treating HPPD.[20]In other cases risperidone has shown no effect on HPPD[10] or where it had a paradoxical effect and lead to permanent symptom exacerbation.[21]

Reports exist that various drugs provide partial or even complete remission.

  • Lamotrigine an anticonvulsant is the most popular medication for HPPD treatment. In the case of a 36-year-old man who suffered from HPPD for 18-years, the complex visual perception disorders largely resolved within 12 months after initiation of treatment with lamotrigine. In an another case a 33-year-old woman developed HPPD after abusing LSD for a year long at the age of 18. She reported afterimages, perception of movement in her peripheral visual fields, blurring of small patterns, halo effects, and macro- and micropsia. Previous treatment with antidepressants and risperidone failed to ameliorate these symptoms. Upon commencing drug therapy with lamotrigine, these complex visual disturbances receded almost completely. Lamotrigine is considered a possible treatment option for HPPD. Lamotrigine is generally well tolerated with a relative lack of adverse effects.[19]
  • Clonidine an antihypertensive that a pilot study of eight patients suggested could help significantly alleviate "LSD-related flashbacks."[22]
  • In a case study of two subjects suffering from synthetic cannabis-induced HPPD the symptoms significant improvement with Clonazepam treatment.[23] In a 2003 study 16 people with LSD-induced HPPD reported a significant relief and the presence of only mild symptomatology during clonazepam administration.[24]

Current research[edit]

The Australian Macquarie University is currently researching how HPPD affects the brain using Magnetic Resonance Imaging (fMRI) and Magnetoencephalography (MEG) studies to precisely measure the spatial and temporal activities of the visual pathways, which will be used to compare with control participants who are free from visual hallucinations.[25] Australians affected by HPPD and interested in participating can apply as probands.[26]

Prevalence[edit]

Estimates in the 1960s and 1970s were around 1 in 20 for intermittent HPPD among regular users of hallucinogens. In a 2010 study of psychedelic users, 23.9% reported constant HPPD-like effects, however only 4.2% considered seeking treatment due to the severity.[27] It is not clear how common chronic HPPD may be, but one estimate in the 1990s was that 1 in 50,000 regular users might have chronic hallucinations.[3]

Society and culture[edit]

In the second episode of the first season of the 2014 series True Detective ("Seeing Things"), primary character Rustin Cohle (Matthew McConaughey) is depicted as having symptoms similar to HPPD such as light tracers as a result of "neurological damage" from substance use.[28]

American journalist Andrew Callaghan, former host of the internet series All Gas No Brakes and current host of Channel 5, revealed during a 2021 interview with Vice News that he has a HPPD diagnosis as a result of excessive psilocybin use at a young age. Describing his symptoms, he noted that he experiences persistent visual snow and palinopsia.[29]

References[edit]

  1. ^ Zobor, Ditta; Strasser, Torsten; Zobor, Gergely; Schober, Franziska; Messias, Andre; Strauss, Olaf; Batra, Anil; Zrenner, Eberhart (April 2015). "Ophthalmological assessment of cannabis-induced persisting perception disorder: Is there a direct retinal effect?". Documenta Ophthalmologica. 130 (2): 121–130. doi:10.1007/s10633-015-9481-2. PMID 25612939. S2CID 9684212.
  2. ^ Krebs, Teri S.; Johansen, Pål-Ørjan (19 August 2013). "Psychedelics and Mental Health: A Population Study". PLOS ONE. 8 (8): e63972. Bibcode:2013PLoSO...863972K. doi:10.1371/journal.pone.0063972. PMC 3747247. PMID 23976938.
  3. ^ a b c d e f g Halpern, John H.; Lerner, Arturo G.; Passie, Torsten (2016). "A Review of Hallucinogen Persisting Perception Disorder (HPPD) and an Exploratory Study of Subjects Claiming Symptoms of HPPD". Behavioral Neurobiology of Psychedelic Drugs. Current Topics in Behavioral Neurosciences. 36. pp. 333–360. doi:10.1007/7854_2016_457. ISBN 978-3-662-55878-2. PMID 27822679.
  4. ^ Hanson, Dirk (29 April 2013). "When the Trip Never Ends". Dana Foundation.
  5. ^ Baylor, D A; Matthews, G; Yau, K W (1 December 1980). "Two components of electrical dark noise in toad retinal rod outer segments". The Journal of Physiology. 309 (1): 591–621. doi:10.1113/jphysiol.1980.sp013529. PMC 1274605. PMID 6788941.
  6. ^ Halpern, J (1 March 2003). "Hallucinogen persisting perception disorder: what do we know after 50 years?". Drug and Alcohol Dependence. 69 (2): 109–119. doi:10.1016/S0376-8716(02)00306-X. PMID 12609692.
  7. ^ Bogenschutz, Michael P.; Ross, Stephen (2016). "Therapeutic Applications of Classic Hallucinogens". Behavioral Neurobiology of Psychedelic Drugs. Current Topics in Behavioral Neurosciences. 36. pp. 361–391. doi:10.1007/7854_2016_464. ISBN 978-3-662-55878-2. PMID 28512684.
  8. ^ Majić, Tomislav; Schmidt, Timo T.; Hermle, Leo (2016), von Heyden, Maximilian; Jungaberle, Henrik; Majić, Tomislav (eds.), "Flashbacks und anhaltende Wahrnehmungsstörungen nach Einnahme von serotonergen Halluzinogenen", Handbuch Psychoaktive Substanzen, Springer Reference Psychologie (in German), Berlin, Heidelberg: Springer, pp. 1–13, doi:10.1007/978-3-642-55214-4_63-1, ISBN 978-3-642-55214-4, retrieved 2022-01-09
  9. ^ a b c d Martinotti, Giovanni; Santacroce, Rita; Pettorruso, Mauro; Montemitro, Chiara; Spano, Maria Chiara; Lorusso, Marco; di Giannantonio, Massimo; Lerner, Arturo G. (16 March 2018). "Hallucinogen Persisting Perception Disorder: Etiology, Clinical Features, and Therapeutic Perspectives". Brain Sciences. 8 (3): 47. doi:10.3390/brainsci8030047. PMC 5870365. PMID 29547576.
  10. ^ a b c Hermle, L.; Ruchsow, M.; Täschner, K. L. (September 2015). "Halluzinogen-induzierte Persistierende Wahrnehmungsstörung (HPPD) und Flashback-Phänomene – Differenzialdiagnose und Erklärungsmodelle". Fortschritte der Neurologie · Psychiatrie. 83 (9): 506–515. doi:10.1055/s-0035-1553717. PMID 26421858.
  11. ^ Hosanagar, Avinash; Cusimano, Joseph; Radhakrishnan, Rajiv (23 February 2021). "Therapeutic Potential of Psychedelics in Treatment of Psychiatric Disorders, Part 2: Review of the Evidence". The Journal of Clinical Psychiatry. 82 (3). doi:10.4088/JCP.20ac13787. S2CID 233974724.
  12. ^ Abraham, Henry David; Aldridge, Andrew M. (October 1993). "Adverse consequences of lysergic acid diethylamide". Addiction. 88 (10): 1327–1334. doi:10.1111/j.1360-0443.1993.tb02018.x. PMID 8251869.
  13. ^ Lerner, Arturo G; Rudinski, Dmitri; Bor, Oren; Goodman, Craig (2014). "Flashbacks and HPPD: A Clinical-oriented Concise Review" (PDF). The Israel Journal of Psychiatry and Related Sciences. 51 (4): 296–301. PMID 25841228.
  14. ^ Abraham, Henry David; Duffy, Frank Hopkins (7 October 1996). "Stable quantitative EEG difference in post-LSD visual disorder by split-half analysis: evidence for disinhibition". Psychiatry Research: Neuroimaging. 67 (3): 173–187. doi:10.1016/0925-4927(96)02833-8. PMID 8912957. S2CID 7587687.
  15. ^ Abraham, Henry David; Hopkins Duffy, Frank (1 October 2001). "EEG coherence in post-LSD visual hallucinations". Psychiatry Research: Neuroimaging. 107 (3): 151–163. doi:10.1016/S0925-4927(01)00098-1. PMID 11566431. S2CID 14509310.
  16. ^ Garratt, Jennifer C.; Alreja, Meenakshi; Aghajanian, George K. (1993). "LSD has high efficacy relative to serotonin in enhancing the cationic current Ih: Intracellular studies in rat facial motoneurons". Synapse. 13 (2): 123–134. doi:10.1002/syn.890130205. PMID 8446921. S2CID 9496153.
  17. ^ Sanders-Bush, E.; Burris, K. D.; Knoth, K. (1 September 1988). "Lysergic acid diethylamide and 2,5-dimethoxy-4-methylamphetamine are partial agonists at serotonin receptors linked to phosphoinositide hydrolysis". Journal of Pharmacology and Experimental Therapeutics. 246 (3): 924–928. PMID 2843634.
  18. ^ Schankin, Christoph J.; Maniyar, Farooq H.; Sprenger, Till; Chou, Denise E.; Eller, Michael; Goadsby, Peter J. (2014). "The Relation Between Migraine, Typical Migraine Aura and "Visual Snow"". Headache: The Journal of Head and Face Pain. 54 (6): 957–966. doi:10.1111/head.12378. PMID 24816400. S2CID 4164884.
  19. ^ a b Hermle, Leo; Simon, Melanie; Ruchsow, Martin; Geppert, Martin (October 2012). "Hallucinogen-persisting perception disorder". Therapeutic Advances in Psychopharmacology. 2 (5): 199–205. doi:10.1177/2045125312451270. PMC 3736944. PMID 23983976.
  20. ^ Subramanian, N.; Doran, M. (March 2014). "Improvement of hallucinogen persisting perception disorder (HPPD) with oral risperidone: case report". Irish Journal of Psychological Medicine. 31 (1): 47–49. doi:10.1017/ipm.2013.59. PMID 30189471. S2CID 52170294.
  21. ^ Abraham, Henry David; Mamen, Anitra (June 1996). "LSD-Like Panic From Risperidone in Post-LSD Visual Disorder". Journal of Clinical Psychopharmacology. 16 (3): 238–241. doi:10.1097/00004714-199606000-00008. PMID 8784656.
  22. ^ Lerner, A. G.; Gelkopf, M.; Oyffe, I.; Finkel, B.; Katz, S.; Sigal, M.; Weizman, A. (January 2000). "LSD-induced hallucinogen persisting perception disorder treatment with clonidine: an open pilot study". International Clinical Psychopharmacology. 15 (1): 35–37. doi:10.1097/00004850-200015010-00005. PMID 10836284. S2CID 10871755.
  23. ^ Lerner, Arturo G; Goodman, Craig; Bor, Oren; Lev-Ran, Shaul (2014). "Synthetic Cannabis Substances (SPS) Use and Hallucinogen Persisting Perception Disorder (HPPD): Two Case Reports" (PDF). The Israel Journal of Psychiatry and Related Sciences. 51 (4): 277–280. PMID 25841224.
  24. ^ Lerner, Arturo G.; Gelkopf, Marc; Skladman, Irena; Rudinski, Dmitri; Nachshon, Hanna; Bleich, Avi (March 2003). "Clonazepam treatment of lysergic acid diethylamide-induced hallucinogen persisting perception disorder with anxiety features". International Clinical Psychopharmacology. 18 (2): 101–105. doi:10.1097/00004850-200303000-00007. PMID 12598822. S2CID 24924089.
  25. ^ "Hallucinogen Persisting Perception Disorder (HPPD) Protocol: Multimodal Neuroimaging to uncover neurobiological pathogenesis". Macquarie University. Retrieved 2022-01-06.[unreliable source?]
  26. ^ https://www.hppdonline.com/topic/8929-groundbreaking-study-happening-now-please-participate/
  27. ^ Baggott, M. J.; Coyle, J. R.; Erowid, E.; Erowid, F.; Robertson, L. C. (1 March 2011). "Abnormal visual experiences in individuals with histories of hallucinogen use: A web-based questionnaire". Drug and Alcohol Dependence. 114 (1): 61–67. doi:10.1016/j.drugalcdep.2010.09.006. PMID 21035275.
  28. ^ Fukunaga, Cary Joji; Cuddy, Carol; Pizzolatto, Nic; McConaughey, Matthew; Harrelson, Woody; Monaghan, Michelle; Potts, Michael, Arkapaw, Adam; Hall, Alex; Burnett, T-Bone; HBO Entertainment; Home Box Office (2016). True detective. Season 1, Season 1. OCLC 964500128.[non-primary source needed]
  29. ^ Documenting America's Underbelly - ALL GAS NO BRAKES (video). Vice. January 21, 2021. 20:48-21:49 minutes in. Archived from the original on 2021-12-13. Retrieved January 24, 2021.

External links[edit]

Classification
External resources