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Flashbacks und anhaltende Wahrnehmungsstörungen nach Einnahme von serotonergen Halluzinogenen

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Abstract

Serotonerge Halluzinogene wie LSD und Psilocybin besitzen kein abhängigkeitserzeugendes Potenzial und zeigen eine niedrige Toxizität. Sie stehen jedoch im Verdacht, das Auftreten von Störungsbildern begünstigen zu können, die die akute Wirkung der Substanz überdauern oder erst verzögert auftreten. Zu diesen zählt vor allem die Gruppe der Flashbacks und der anhaltenden Wahrnehmungsstörung nach Einnahme von Halluzinogenen (HPPD), die in internationalen Klassifikationssystemen operationalisiert wird. In diesem Artikel konzeptuelle, klinische und epidemiologische Aspekte dieser Phänomene dargestellt, um einen Beitrag zur Einschätzung des Risikopotenzials dieser Substanzen geben zu können.

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... Vor diesem Hintergrund werden in der wissenschaftlichen Literatur primär drei psychedelikainduzierte Störungsbilder diskutiert: (1) die Auslösung einer Angstbzw. Panikstörung, (2) die Erstmanifestation oder Exazerbation einer psychotischen Erkrankung und (3) anhaltende Wahrnehmungsstörungen (Hallucinogen Persisting Perception Disorder, DSM-V), die vorübergehend oder persistierend auftreten können (Majić et al. 2016). Bei allen drei Störungsbildern handelt es sich um sehr seltene und häufig transitorische Phänomene, deren Pathomechanismus im Zusammenhang mit der Einnahme von Psychedelika aufgrund mangelnder Daten oder uneindeutiger Ergebnisse noch nicht aufgeklärt werden konnte. ...
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Psychedelika (klassische bzw. serotonerge Halluzinogene) sind psychoaktive Substanzen, welche Wahrnehmung, Affekte sowie eine Reihe kognitiver Prozesse intensiv verändern können. Die Mehrheit ihrer Vertreter gilt als physiologisch sicher und nicht addiktiv. Ihre Geschichte reicht bis in prähistorische Zeit zurück. Mit der Entdeckung der Wirkstoffe Meskalin, Lysergsäurediethylamid (LSD), Dimethyltryptamin (DMT) und Psilocybin begann sowohl ihre wissenschaftliche Erforschung als auch die Verbreitung ihres nicht medizinischen Gebrauchs. Psychedelika stellen eine pharmakologisch, psychometrisch und tierexperimentell abgrenzbare Substanzklasse dar, die zunehmend im Interesse der medizinischen Grundlagen- und Therapieforschung steht. Dieses Kapitel strebt hinsichtlich der relevanten Wissensgebiete einen ausgewogenen Kurzüberblick über die Substanzklasse und ihre wichtigsten Vertreter an, wobei dem historisch komplexen Wirkgefüge zwischen Medizin- und Sozialgeschichte der Substanzklasse ein Schwerpunkt gewidmet ist.
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Anxiety and depression are some of the most common psychiatric symptoms of patients suffering with life-threatening diseases, often associated with a low quality of life and a poor overall prognosis. 5-HT2A-receptor agonists (serotonergic hallucinogens, ‘psychedelics’) like lysergic acid diethylamide (LSD) and psilocybin were first investigated as therapeutic agents in the 1960s. Recently, after a long hiatus period of regulatory obstacles, interest in the clinical use of these substances has resumed. The current article provides a systematic review of studies investigating psychedelics in the treatment of symptoms of existential distress in life-threatening diseases across different periods of research, highlighting how underlying concepts have developed over time. A systematic search for clinical trials from 1960 to 2017 revealed 11 eligible clinical trials involving a total number of N = 445 participants, of which 7 trials investigated the use of lysergic acid diethylamide (LSD) (N = 323), 3 trials investigated the use of psilocybin (N = 92), and one trial investigated the use of dipropyltryptamine (DPT) (N = 30). The 4 more recent randomized controlled trials (RCTs) (N = 104) showed a significantly higher methodological quality than studies carried out in the 1960s and 1970s. Evidence supports that patients with life threatening diseases associated with symptoms of depression and anxiety benefit from the anxiolytic and antidepressant properties of serotonergic hallucinogens. Some studies anecdotally reported improvements in patients´ quality of life and reduced fear of death. Moreover, low rates of side effects were reported in studies that adhered to safety guidelines. Further studies are needed to determine how these results can be transferred into clinical practice.
Article
Zusammenfassung Hintergrund Der Einsatz von serotonergen Halluzinogenen (Psychedelika) wie Lysergsäure-Diethylamid (LSD) und Psilocybin und Entaktogenen wie 3,4-Methylendioxymethamphetamin (MDMA) im Rahmen von Psychotherapie ist in den letzten Jahren wieder zunehmend ins Licht des wissenschaftlichen Interesses gerückt. Die vorliegende Arbeit fasst die aktuelle Evidenz zur substanzunterstützten Psychotherapie mit serotonergen Psychoaktiva zusammen. Methode Eine selektive Literaturrecherche erfolgte in PubMed und der Cochrane Library, wobei nach Studien gesucht wurde, in denen der Einsatz von serotonergen Psychoaktiva in der Psychotherapie seit 2000 untersucht wurde. Ergebnisse Es fanden sich Studien für die folgenden Behandlungsindikationen: Alkoholabhängigkeit (LSD und Psilocybin), Nikotinabhängigkeit (Psilocybin), Behandlung von Angst und Depression bei lebensbedrohlicher körperlicher Erkrankung (LSD und Psilocybin), Zwangsstörungen (Psilocybin), therapieresistente Major Depression (Psilocybin) und posttraumatische Belastungsstörung (MDMA). Diskussion Abhängigkeitserkrankungen, posttraumatische Belastungsstörung sowie Angst und Depression bei lebensbedrohlicher körperlicher Erkrankung stellen derzeit die am besten evaluierten Indikationen für die substanzunterstützte Psychotherapie mit serotonergen Psychoaktiva dar. Bisher zeigten sich Hinweise für eine Wirksamkeit bei relativ guter Verträglichkeit. Weitere Studien sind erforderlich, um einzuschätzen, ob diese Substanzen in Zukunft in der Behandlung bestimmter therapieresistenter psychischer Erkrankungen eine Option darstellen können.
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Psychedelics (serotonergic hallucinogens) are powerful psychoactive substances that alter perception and mood and affect numerous cognitive processes. They are generally considered physiologically safe and do not lead to dependence or addiction. Their origin predates written history, and they were employed by early cultures in many sociocultural and ritual contexts. After the virtually contemporaneous discovery of (5R,8R)-(+)-lysergic acid-N,N-diethylamide (LSD)-25 and the identification of serotonin in the brain, early research focused intensively on the possibility that LSD and other psychedelics had a serotonergic basis for their action. Today there is a consensus that psychedelics are agonists or partial agonists at brain serotonin 5-hydroxytryptamine 2A receptors, with particular importance on those expressed on apical dendrites of neocortical pyramidal cells in layer V. Several useful rodent models have been developed over the years to help unravel the neurochemical correlates of serotonin 5-hydroxytryptamine 2A receptor activation in the brain, and a variety of imaging techniques have been employed to identify key brain areas that are directly affected by psychedelics. Recent and exciting developments in the field have occurred in clinical research, where several double-blind placebo-controlled phase 2 studies of psilocybin-assisted psychotherapy in patients with cancer-related psychosocial distress have demonstrated unprecedented positive relief of anxiety and depression. Two small pilot studies of psilocybinassisted psychotherapy also have shown positive benefit in treating both alcohol and nicotine addiction. Recently, blood oxygen level–dependent functional magnetic resonance imaging and magnetoencephalography have been employed for in vivo brain imaging in humans after administration of a psychedelic, and results indicate that intravenously administered psilocybin and LSD produce decreases in oscillatory power in areas of the brain’s default mode network. © 2016 by The American Society for Pharmacology and Experimental Therapeutics.
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Hallucinogen persisting perception disorder (HPPD) is a drug-induced condition associated with inaccurate visual representations. Since the underlying mechanism(s) are largely unknown, this review aims to uncover aspects underlying its etiology. Available evidence on HPPD and drug-related altered visual processing was reviewed and the majority of HPPD cases were attributed to drugs with agonistic effects on serotonergic 5-HT2A receptors. Moreover, we present 31 new HPPD cases that link HPPD to the use of ecstasy (MDMA), which is known to reverse serotonin reuptake and acts as agonist on 5-HT2A receptors. The available evidence suggests that HPPD symptoms may be a result from a misbalance of inhibitory-excitatory activity in low-level visual processing and GABA-releasing inhibitory interneurons may be involved. However, high co-morbidities with anxiety, attention problems and derealization symptoms add complexity to the etiology of HPPD. Also, other perceptual disorders that show similarity to HPPD cannot be ruled out in presentations to clinical treatment. Taken together, evidence is still sparse, though low-level visual processing may play an important role. A novel finding of this review study, evidenced by our new cases, is that ecstasy (MDMA) use may also induce symptoms of HPPD.
Article
Patients with 'visual snow' report continuous tiny dots in the entire visual field similar to the noise of an analogue television. As they frequently have migraine as a comorbidity with ophthalmological, neurological and radiological studies being normal, they are offered various diagnoses, including persistent migraine aura, post-hallucinogen flashback, or psychogenic disorder. Our aim was to study patients with 'visual snow' to characterize the phenotype. A three-step approach was followed: (i) a chart review of patients referred to us identified 22 patients with 'visual snow'. Fifteen had additional visual symptoms, and 20 patients had comorbid migraine, five with aura; (ii) to identify systematically additional visual symptoms, an internet survey (n = 275) of self-assessed 'visual snow' subjects done by Eye On Vision Foundation was analysed. In two random samples from 235 complete data sets, the same eight additional visual symptoms were present in >33% of patients: palinopsia (trailing and afterimages), entoptic phenomena (floaters, blue field entoptic phenomenon, spontaneous photopsia, self-light of the eye), photophobia, and nyctalopia (impaired night vision); and (iii) a prospective semi-structured telephone interview in a further 142 patients identified 78 (41 female) with confirmed 'visual snow' and normal ophthalmological exams. Of these, 72 had at least three of the additional visual symptoms from step (ii). One-quarter of patients had 'visual snow' as long as they could remember, whereas for the others the mean age of onset was 21 ± 9 years. Thirty-two patients had constant visual symptoms, whereas the remainder experienced either progressive or stepwise worsening. Headache was the most frequent symptom associated with the beginning or a worsening of the visual disturbance (36%), whereas migraine aura (seven patients) and consumption of illicit drugs (five, no hallucinogens) were rare. Migraine (59%), migraine with aura (27%), anxiety and depression were common comorbidities over time. Eight patients had first degree relatives with visual snow. Clinical investigations were not contributory. Only a few treatment trials have been successful in individual patients. Our data suggest that 'visual snow' is a unique visual disturbance clinically distinct from migraine aura that can be disabling for patients. Migraine is a common concomitant although standard migraine treatments are often unhelpful. 'Visual snow' should be considered a distinct disorder and systematic studies of its clinical features, biology and treatment responses need to be commenced to begin to understand what has been an almost completely ignored problem.
Article
Hintergrund Alkohol- und substanzmittelassoziierte Störungen (ASUD) gehören zur häufigsten Komorbidität bei schizophrenen und affektiven Störungsbildern und haben einen signifikanten negativen Einfluss auf deren Verlauf und Prognose. In der vorliegenden Studie wurden in einer multizentrischen Querschnittserhebung an 9 baden-württembergischen Krankenhäusern für Psychiatrie und Psychotherapie Patienten mit einer Diagnose aus der ICD-10-Kategorie F2 oder F3 bezüglich eines Substanzmittelkonsums untersucht. Ziel dieser Arbeit ist es, Prävalenz und Charakteristika der ASUD an einer deutschen Stichprobe zu erheben und anhand der Ergebnisse den aktuellen Forschungsstand zu den theoretischen Konzepten der Komorbidität von Sucht und F2-/F3-Diagnosen zu diskutieren. Methode Soziodemographische und krankheitsrelevante Daten wurden bei 50 konsekutiv aufgenommenen Patienten pro Zentrum mit einer verkürzten Version des EuropASI erhoben, die Aussagen zum aktuellen Drogenkonsum wurden mit einem Urin-Drogenscreening objektiviert. Neben korrelativen Analysen dienten Regressionsanalysen zur Untersuchung prädiktiver Variablen für einen Substanzkonsum. Ergebnisse Die Stichprobe umfasste 448 Patienten, Doppeldiagnosen aus den ICD-Klassifikationen F2x und F1x wiesen 169 Patienten (37,7%) und mit den Klassifikationen F3x und F1x 144 Patienten (32,1%) auf. 64 Patienten (14,3%) hatten eine F2-Diagnose und 71 Patienten (15,8%) eine F3-Diagnose jeweils ohne ASUD. Neben Alkohol (n = 268) und Tabak (n = 325) wurden verordnete und nichtverordnete Hypnotika/Tranquilizer (n = 214), Cannabis (n = 156), Psychostimulanzien (n = 96), Opiate (n = 71) und Halluzinogene (n = 36) konsumiert. Die häufigste Kombination und längste Einnahmedauer umfassen anamnestisch und aktuell Tabak, Alkohol, Hypnotika/Tranquilizer, Cannabis und Psychostimulanzien vor allem bei Männern mit schizophrenen Störungen. Hinsichtlich der Motivation vor Erstkonsum standen allgemeine psychische Anpassungsstörungen (51%), Peer-Einflüsse (42%) und unspezifische affektive Symptome im Vordergrund. Patienten mit schizophrenen und affektiven Erkrankungen mit komorbidem ASUD leiden signifikant häufiger unter substanzmittelassoziierten Störungen im familiären Umfeld und suizidaler Gefährdung als Patienten ohne Substanzmissbrauch. Schlussfolgerung Die im Querschnitt erfassten hohen Prävalenzwerte und die Bedeutung des Konsums von Nikotin, Alkohol sowie von Cannabis und Psychostimulanzien bei Patienten mit F2- und F3-Diagnosen erfordern effektivere präventive und störungsspezifische therapeutische Maßnamen.
Article
A 33-year-old female patient developed a hallucinogen-persisting perception disorder (HPPD) after lysergic acid diethylamide (LSD) abuse for a year at the age of 18. Specifically, she reported after images, 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. Based on its hypothesized neuroprotective and mood-stabilizing effects, the antiepileptic lamotrigine may offer a promising new approach in the treatment of HPPD.
Article
The catechol-O-methyltransferase (COMT) Val(108/158)Met polymorphism of the dopamine system is essential for prefrontal cortex processing capacity and efficiency. In addition, dopaminergic neurotransmission is also associated with the sensory gating phenomenon protecting the cerebral cortex from information overload. It is however unclear if COMT genotype as a predictor of prefrontal efficiency modulates sensory gating on the level of the auditory cortex, i.e. the gating of the auditory evoked P50 and N100 components. P50 and N100 gating and COMT Val(108/158)Met genotype were determined in 282 healthy subjects of German descent carefully screened for psychiatric or neurological disorders. A significant effect of the COMT genotype was observed for N100 gating (F=4.510, df=2, p=0.012) but not for P50 gating (F=0.376, df=2, p=0.687). Contrast analysis showed that Met/Met individuals had poorer N100 gating compared to Val/Met (F=-12.931, p=0.003) and the Val/Val individuals (F=-11.056, p=0.057). The results indicate that a high prefrontal efficiency as suggested by the COMT Met/Met genotype is associated with to a poor sensory gating of the N100 component. This would fit in a model where a high prefrontal processing capacity allows a pronounced afferent input of sensory information from the auditory cortex as reflected by a poor sensory gating. The more pronounced prefrontal contribution to the N100 compared to the P50 component may explain the exclusive genotype association with the N100 sensory gating. This preliminary model should be replicated and validated in future investigations.
Article
Despite longstanding reports of prolonged or reoccurring perceptual changes in a subset of hallucinogen users, very little is known about Hallucinogen Persisting Perception Disorder and related visual abnormalities in hallucinogen users. We used an online questionnaire to document the symptoms and relationship to drug use of unusual visual phenomena in hallucinogen users. 16,192 individuals viewed the information sheet and 2679 were included in the study. Of these, 224 reported having unrelated diagnoses associated with unusual visual experiences and were excluded from main analyses. Most (60.6%) of the remaining 2455 participants reported having experienced drug-free visual experiences that resembled hallucinogen effects. Probability of experiencing constant or near-constant symptoms was predicted by greater past exposure to specific hallucinogens, including lysergic acid diethylamide (LSD). Although symptoms were common, few (104, or 4.2% of the sample) found them distressing or impairing enough to consider seeking treatment. Visual changes in hallucinogen users may be more common than previously suspected and are worthy of further study.
Article
Nutt and colleagues' 'rational' scale to assess the harms of commonly used drugs was based on ratings by a panel of experts. This survey aimed to assess drug users' views of the harms of drugs using the same scale. As users' drug choices are not solely based on harms, we additionally assessed perceived benefits. The survey was hosted at http://www.nationaldrugsurvey.org. UK residents reported their experience of 20 commonly used substances; those with direct experience of a substance rated its physical, dependence-related and social harms as well as benefits. A total of 1501 users completed the survey. There was no correlation between the classification of the 20 drugs under the Misuse of Drugs Act and ranking of harms by users. Despite being unclassified substances, alcohol, solvents and tobacco were rated within the top ten most harmful drugs. There was a remarkably high correlation (r = 0.896) overall between rankings by users' and by experts. Ecstasy, cannabis and LSD were ranked highest by users on both acute and chronic benefits. These findings imply that users are relatively well informed about the harms associated with the drugs they use. They also suggest that the current UK legal classification system is not acting to inform users of the harms of psychoactive substances.
Article
Lysergic acid diethylamide (LSD) was synthesized in 1938 and its psychoactive effects discovered in 1943. It was used during the 1950s and 1960s as an experimental drug in psychiatric research for producing so-called "experimental psychosis" by altering neurotransmitter system and in psychotherapeutic procedures ("psycholytic" and "psychedelic" therapy). From the mid 1960s, it became an illegal drug of abuse with widespread use that continues today. With the entry of new methods of research and better study oversight, scientific interest in LSD has resumed for brain research and experimental treatments. Due to the lack of any comprehensive review since the 1950s and the widely dispersed experimental literature, the present review focuses on all aspects of the pharmacology and psychopharmacology of LSD. A thorough search of the experimental literature regarding the pharmacology of LSD was performed and the extracted results are given in this review. (Psycho-) pharmacological research on LSD was extensive and produced nearly 10,000 scientific papers. The pharmacology of LSD is complex and its mechanisms of action are still not completely understood. LSD is physiologically well tolerated and psychological reactions can be controlled in a medically supervised setting, but complications may easily result from uncontrolled use by layman. Actually there is new interest in LSD as an experimental tool for elucidating neural mechanisms of (states of) consciousness and there are recently discovered treatment options with LSD in cluster headache and with the terminally ill.
Article
Recurrent hallucinations appeared in an 11-year-old boy during 5 days following ketamine anaesthesia. Previous anaesthesia with ketamine and adequate diazepam supplementation did not produce any such effect. The phenomenon of delayed recurring hallucinations is a rare but dangerous side-effect of ketamine, not unlike LSD flashbacks. The described case lends support to previous reports on the value of diazepam in the prevention of post-ketamine perceptual abnormalities.
Article
WHILE SCIENTISTS may debate the appropriate use of hallucinogens, history records our unceasing urge to cope with dreary reality or dread with the aid of magic, drugs, drama, festival rites, and (with biological regularity) through dreams. The need to transcend limits also finds a voice in utopian ideologies-be they of the inner world, of this, or the next; the promise of omnipotent mastery is always either implicit or readily inferred. Thus whether it is the proletarian masses, or youth mesmerized by mellow yellow banana, or the princes of the land of genital primacy, or the meek-each is promised the inheritance of what probably will be a rather crowded earth. Given the prevalence of these motives it is not surprising that drugs play a role not only in the behavior of individuals but also in social and ideological processes. With the appropriate motives and occasion
Article
One hundred twenty-three persons with a history of LSD use were studied for the presence of the LSD flashback phenomenon and compared with 40 control subjects. A syndrome emerged that included ten distance visual disturbances. It had lasted for five years in half of the population, was treatable with benzodiazepines, exacerbated by phenothiazines, and precipitated by 19 different stimuli, most commonly emergence into a dark environment. Sensitivity to LSD as determined by flashbacks appears to divide the study sample into three discrete subgroups. There may be a genetic basis to LSD sensitivity.
Article
We studied whether patients hospitalized for LSD psychosis are clinically separable from acute schizophrenics. The family histories, manifest symptoms, premorbid adjustment, and profiles on an extensive test battery were analyzed for 52 LSD psychotics and 29 matched first-break schizophrenics. The LSD patients did not differ from schizophrenics in incidence of psychosis or suicide among the parents. However, the rate of parental alcoholism for LSD psychotics far exceeded that for schizophrenics and the general population. The two groups were distinguished on some clinical features but were equivalent in premorbid adjustment, on most cognitive measures when initially hospitalized or reassessed three to five years later, and in number of subsequent rehospitalizations. Thus, in most respects the LSD psychotics were fundamentally similar to schizophrenics in geneaology, phenomenology, and course of illness. The findings supported a model of LSD psychosis as a drug-induced schizophreniform reaction in persons vulnerable to both substance abuse and psychosis.
Article
Two adolescents with a long history of abuse of lysergic acid diethylamide (LSD) and symptoms consistent with major depressive disorder, on initiation of antidepressant therapy with selective serotonin reuptake inhibitor agents, had the new onset or worsening of LSD flashback syndrome. The similarity in neuroreceptor physiology for both LSD and serotonin suggests that the LSD flashback syndrome may be induced by these drugs in patients with a history of LSD abuse.
Article
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.
Article
Hallucinogen persisting perceptual disorder (HPPD) may follow the ingestion of LSD or other hallucinogens in a subset of users. It is characterized by chronic, intermittent or constant visual hallucinations of many sorts persisting beyond the period of acute drug effects. We studied 44 LSD-induced HPPD subjects and 88 matched controls to search for spectral and evoked potential differences using quantitative EEG (qEEG). HPPD subjects demonstrated faster alpha frequency and shorter VER (visual evoked response) latency, consistent with prior animal and human data on response to acute LSD administration which suggest LSD-induced cortical disinhibition. AER (auditory evoked response) latency was prolonged consistent with a differential LSD effect upon visual and auditory systems. The exploratory T-statistic significance probability mapping (T-SPM) technique demonstrated HPPD-control differences mostly involving temporal and left parietal scalp regions, confirmed by a split-half analysis. Significant variables were all derived from the long latency flash VER and click AER. None were derived from spectral analyzed EEG data. Canonical correlation between SPM-derived measures and variables reflecting disease severity was highly significant. A between-group stepwise discriminant analysis based upon a full set of qEEG measures demonstrated 87% prospective classification success by jackknifing and 88% success in a separate split-half analysis.
Article
We collected and reviewed studies in which neuropsychological tests were administered to users of LSD or other hallucinogens. Interpretation of the studies is limited by various confounding variables, such as subjects' premorbid cognitive and personality function and prior use of other substances. At present, the literature tentatively suggests that there are few, if any, long-term neuropsychological deficits attributable to hallucinogen use. To better resolve this issue, however, it will be important to study larger samples of chronic, frequent hallucinogen users who have not often used other types of drugs.
Article
A pilot open study was conducted in order to evaluate the efficacy of clonidine in the treatment of LSD-induced hallucinogen persisting perception disorder (HPPD). Eight patients fulfilled entrance criteria. All complained of HPPD for at least 3 months and were drug free at least 3 months. They received fixed low doses of clonidine, 0.025 mg, three times a day for 2 months. They were evaluated by the Clinical Global Impression Scale (CGI) and a self-report scale on the severity of symptoms (graded 0-5). Patients scored an average of 5.25 (SD = 0.46) on the CGI and 4 on the self-report scale at baseline, indicating marked psychopathology. One patient dropped out at week 3 and a second patient dropped out at week 5. Of the six patients remaining at the end of 2 months, the average CGI score was 2.5 (SD = 0.55) and the self-report scale score was 2, indicating mild symptomatology. LSD-related flashbacks associated with excessive sympathetic nervous activity may be alleviated with clonidine in some patients.
Article
LSD use in certain individuals may result in chronic visual hallucinations, a DSM-IV syndrome known as hallucinogen persisting perception disorder (HPPD). We studied 38 HPPD subjects with a mean of 9.7 years of persistent visual hallucinations and 33 control subjects. Measures of local and medium distance EEG spectral coherence were calculated from all subjects. Coherence, a measure of spectral similarity over time, may estimate cortical coupling. In the eyes-open state in HPPD subjects, widespread reduction of coherence was noted. However, upon eye closure, the occipital region demonstrated augmented regional coherence over many frequencies but with reduced coherence of the occipital region to more distant regions. This occipital coherence increase correlated with previously reported shortened occipital visual evoked potential latency for HPPD subjects. We speculate from coherence and known clinical and psychophysical data that, in HPPD, there is widespread cortical inhibition in the eyes-opened state, but localized and isolated occipital disinhibition upon eye closure, a state known to facilitate hallucinatory experiences. An analogy is drawn to findings in the interictal and ictal epileptic focus. In HPPD, we speculate that occipital EEG hypersynchrony resulting from increased regional coherence, when coupled with relative isolation of visual cortex, especially upon eye closure, facilitates hallucinations and illusions.
Article
One unique characteristic of lysergic acid diethylamide (LSD) and LSD-like substances is the recurrence of some of the symptoms which appeared during the intoxication after the immediate effect of the hallucinogen has worn off. This recurring syndrome, mainly visual, has not been clearly understood, appreciated or distinguished from other clinical entities by clinicians. The terms Flashback and Hallucinogen Persisting Perception Disorder (HPPD) are used interchangeably in the professional literature. Flashback is a usually short-term, non-distressing, spontaneous, recurrent, reversible and benign condition accompanied by a pleasant affect. In contrast, HPPD is a generally long-term, distressing, spontaneous, recurrent, pervasive, either slowly reversible or irreversible, non-benign condition accompanied by an unpleasant dysphoric affect. Flashback and HPPD appear to be part of a vast and broad spectrum of non-psychopathological and psychopathological states reported by hallucinogen users. Pharmacological agents such as clonidine, perphenazine and clonazepan have been shown to ameliorate this syndrome in some of the individuals seeking treatment.
Article
'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.
Article
Actually, guidelines for treatment of substance-related disorders were written under the overall control of the DG-Sucht e. V. and the DGPPN e. V. This appears within the framework of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaft (AWMF). The leading objective of these guidelines is the description of the current scientifically proven and evidence-based medicine in addiction to derive recommendations to therapy. In this context, the guideline for treatment of cocaine-, amphetamine-, ecstasy-, and halluzinogen-related disorders is introduced.
Article
The recurrence of flashbacks without acute or chronic hallucinogen consumption has been recognized in the DSM IV criteria as the hallucinogen persisting perception disorder (HPPD). Perceptual disturbances may last for 5 years or more and represent a real psychosocial distress. We reported here a case of a 18-year-old young man presenting HPPD after a mixed intoxication with psylocibin and cannabis. This report shows symptomatic recurrences persisting more than 8 months. Various differential diagnoses were evoked and our therapeutic strategies were described.