Рассказать вам о психическом расстройстве под названием hppd ( Длительное расстройство восприятия, вызванное галлюциногенами)

• Название: Рассказать вам о психическом расстройстве под названием hppd ( Длительное расстройство восприятия, вызванное галлюциногенами)
• Дата: 17.02.2019
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Hallucinogen Persisting Perception Disorder (HPPD)

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Hallucinogen Persisting Perception Disorder (HPPD) is a disorder characterized by visual phenomena that appear following drug use. Under DSM-5 criteria, an HPPD diagnosis requires the visual changes be distressing or impairing. There are people who have the same or similar symptoms without distress.

While “hallucinogen” is in the name and psychedelics are the most frequently implicated drugs, other drugs (e.g. cannabis and MDMA) have been associated with the condition.

It often occurs in people with no preexisting psychological issues. Though a personal or familial background of psychiatric issues could be a risk factor.

HPPD is distinct from psychosis. The majority of people understand their symptoms aren’t part of reality. We can therefore treat it as a perceptual issue, albeit one frequently found in people with comorbid psychiatric problems.

A large portion of cases spontaneously resolve within a year. In some situations, the symptoms can persist for years and decades.

DSM-5 Criteria

All of the criteria must be met for a diagnosis.

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  The reexperiencing, following cessation of use of a hallucinogen, of one or more of the perceptual symptoms that were experienced while intoxicated with the hallucinogen (e.g., geometric hallucinations, false perceptions of movement in the peripheral visual fields, flashes of color, intensified colors, trails of images of moving objects, positive afterimages, halos around objects, macropsia, and micropsia)
  
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  The symptoms in Criterion A cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  
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  The symptoms are not due to a general medical condition (e.g., anatomical lesions and infections of the brain, and visual epilepsies) and are not better accounted for by another mental disorder (e.g., delirium, dementia, and Schizophrenia) or hypnopompic hallucinations.
  

There are some difficulties that appear when trying to provide a diagnosis. Similar symptoms can be caused by psychosis, brain tumor, and seizure disorders.

It occurs in relatively few people, so we have a lack of good information to go on. Most of the information is coming from individual case reports, some case series, and some open-label treatment trials.

As the definition of HPPD/flashbacks has changed over time, it’s difficult to use some of the older info to inform our current understanding of HPPD.

Since there’s a lot of variation in the symptoms, triggers, and causal drugs, it’s also possible that not all cases can actually be grouped in the same exact disorder.

Onset

For some, the symptoms appear immediately after a drug experience. In other cases, the symptoms arise days later. There are also cases where people report their symptoms arose many weeks or months after drug use, but it’s harder to point to the drug as the cause.

Some people only encounter HPPD after extensive drug use, frequently with psychedelics and other substances. But it can appear after minimal drug use.

What It’s Not

Eye floaters have a basis in the eye and occur in many people with no relevant drug use history. They’re not the same as HPPD, but the disorder can lead to noticing them more.

Simple visual changes like seeing bright spots in a dark room or having a temporary visual disturbance after viewing a bright light also frequently occur without HPPD.

“Flashbacks” are more complicated. The term has historically been used in so many ways as to become practically meaningless without an accompanying definition whenever it’s mentioned.

It’s sometimes used to discuss experiences that are very psychedelic-like, both in visual effects and psychological changes. These cases seem to be rare.

When I use the term, it’s to refer to transient and intermittent appearances of symptoms that don’t necessarily cause distress and go beyond the visual component.

Common symptoms

Visual snow, trailing, halos, positive afterimages, altered color intensity, perceived movement of objects, micropsia, and macropsia.

The intensity of the effects varies. Those with HPPD generally have pretty intense effects, while others may have relatively mild distortions that don’t lead to a diagnosis.

An example of HPPD’s presentation can be found in a survey involving 19 people:

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  19/19 reported visual snow, though some only had the symptom during the nighttime.
  
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  Drugs they had taken
  
  • 
    LSD (12), psilocybin (4), MDMA (1), cannabis (1), 2C-I (1), combo of amphetamines/opioids/SSRIs (1)
    
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  They all reported anxiety or panic while on the drug they believed was responsible.
  
  • 
    Most said it was “marked” or “extreme” anxiety.
    
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  Onset
  
  • 
    12/19 reported symptoms within 24 hours.
    
  • 
    7/19 reported symptoms one week to months later.
    
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  All reported symptoms that didn’t match their drug experience.
  
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  Common symptoms
  
  • 
    Head pressure, ghosted afterimage of text, stationary object swaying or moving, trails, halos, auras, floaters, concentration difficulties, daytime visual snow, and nighttime visual snow.
    
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  What makes it worse?
  
  • 
    Cannabis was the most common trigger, followed by alcohol.
    
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  What improves the symptoms?
  
  • 
    Sedative/hypnotics drugs ranked highest, followed by alcohol.
    

Here’s another case series from the Netherlands:

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  All involved at least 2 different visual phenomena that had occurred with at least 1 episode per week.
  
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  Symptoms
  
  • 
    Visual snow, afterimages, flashes, illusory movement, and increased observation of floaters.
    
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  Those who were investigated by ophthalmologists and neurologists didn’t show any abnormalities.
  
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  Many reported other symptoms
  
  • 
    45% had sensations in the head of pressure, clicks, dryness, or a “shrinking brain.”
    
  • 
    39% had derealization
    
  • 
    32% has depersonalization
    
  • 
    71% had anxiety or panic before/following the use of drugs
    
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  Some experienced symptoms after a single use, but others only experienced symptoms after extensive drug use.
  

Categories

Flashbacks

These are short-lived periods of hallucinogen-like activity that often occur without distress. Flashbacks tend to occur rarely and the frequency fades over time.

Flashbacks may only last seconds or minutes. Some people enjoy flashbacks, viewing them as a “free trip” or a moment of nostalgic psychedelia.

HPPD Intermittent

Individuals with this form experience HPPD in the form of episodes. They may have no or only minor persistent symptoms, such as visual snow.

The condition is characterized by brevity and intermittency.

Distress is a part of the diagnosis and potentially impairment.

HPPD Ongoing

Visual phenomena are always present, though the intensity may vary. An episodic nature can still exist, with the effects increasing in response to triggers.

Most common drugs

LSD is the most common substance in the published papers. Other drugs include cannabis, MDMA, psilocin, and other psychedelics.

Some anecdotal reports suggest phenethylamines like those from the 2C series and NBOMe series might trigger HPPD at a greater rate. This may not come across in the literature due to relatively use rates and shorter use histories.

Whether or not those substances actually cause HPPD more often isn’t known.

The most we know is that all psychedelics appear to come with some potential to trigger the disorder.

Similarities to other conditions

There might be a similar mechanism to what is seen in visual snow, tinnitus, and migraine aura. Although the presentation of those conditions is different from HPPD.

Review of studies

A review of the major case series involving persistent psychedelic-related visual changes from 1950 onward is available. There are some severe limitations with it due to varying definitions of flashbacks and too little information in many cases to determine whether someone had HPPD.

The reports showed a widely variable prevalence of HPPD, ranging from 0% among hundreds of people to 33% or 77% in other groups.

1 – 1955

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  8 psychiatric patients were treated with weekly doses of LSD
  
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  They showed temporary auditory and visual changes, sometimes accompanied by mood swings, changes in body image, and regression to childish behavior.
  
• 
  Generally the symptoms resolved within a day, but one patient reported symptoms for 3 weeks.
  

2 – 1965

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  Review of 34 LSD-related psychiatric admissions
  
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  11 reported “spontaneous return of perceptual distortions or feelings of depersonalization similar to those experienced under the influence of LSD.”
  
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  At least 8 of the patients were psychotic prior to LSD use.
  

3 – 1969

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  31 subjects from the drug using community of Haight-Ashbury
  
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  8 reported flashbacks
  
  • 
    1 had never used hallucinogens
    
  • 
    6 were diagnosed with other psychiatric disorders
    

4 – 1970

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  20 hallucinogen users were recruited via an ad
  
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  11 reported having “recurrences of trip phenomena” lasting up to 3 months
  
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  All were active cannabis users and most were active amphetamine users.
  

5 – 1971

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  431 US Air Force recruits who acknowledged illicit drug use
  
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  94 reported flashbacks
  
  • 
    10 had them from non-hallucinogens
    
    • 
      5 from cannabis
      
    • 
      5 from amphetamine or barbiturates
      
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  Some of the answers may have been given in order to avoid entering the Vietnam War.
  

6 – 1971

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  Follow-up interviews of 247 people who received LSD as part of psychotherapy or research protocols.
  
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  5 reported “major perceptual changes” suggestive of possible HPPD.
  

7 – 1972/1976

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  2001 soldiers entering or leaving the Vietnam War
  
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  95 reported flashbacks
  
  • 
    1 had not used any drugs
    
  • 
    26 had never used a hallucinogen
    

8 – 1974

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  44 college students with a history of hallucinogen use
  
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  22 reported episodes of flashbacks
  
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  Depression, paranoia, and anxiety or tension were reported among some as well.
  
  • 
    Those symptoms were listed as typical flashback effects.
    

9 – 1976

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  91 young drug users admitted to a Norwegian hospital
  
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  65 had a history of hallucinogen use
  
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  50 reported flashbacks
  
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    2 reported them specifically after cannabis use exclusively
    
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  By 1.5 to 4 year follow-ups
  
  • 
    35/50 still reported flashbacks
    

10 – 1974/1977

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  235 people who admitted to using LSD
  
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  28% reported flashbacks
  
  • 
    36% found these experiences were “disruptive to their normal behavior”
    
  • 
    16% stated they sought clinical treatment
    

11 – 1978

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  63 psychedelic drug users, mainly college students
  
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  34 reported flashbacks
  
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  20 reported “perceptual illusions” as a feature of their flashbacks
  
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  Other symptoms
  
  • 
    Depersonalization, anxiety, tension, panic, disorientation, confusion, union with the world
    
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  22/63 said their flashbacks could be triggered by cannabis or alcohol
  

12 – 1983

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  280 Army soldiers interviewed prior to administrative discharge
  
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  179 admitted to using hallucinogens
  
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  Of 207 heavy drug users, 146 reported flashbacks
  
  • 
    109 reported simple visual experiences
    
  • 
    98 reported trails
    
  • 
    76 reported “re-trips”
    
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  8 reported flashbacks with no hallucinogen history
  
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  All six deemed to have “severe” flashbacks also displayed symptoms of “severe psychopathology” other than active psychosis.
  

13 – 1983

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  55 LSD users recruited via advertisement at an emergency psychiatric service
  
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  Documented 16 types of visual disturbances
  
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  Some popular triggers included dark environment (16%) and intention (14%)
  
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  1 was eventually found to have temporal lobe epilepsy
  
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  8 were found to have concomitant anxiety or panic
  
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  3 had major affective disorders
  
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  7 had “temporoparietal abnormalities”
  

Contents[hide]

• 
  1 History
  
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  2 Prevalence
  
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  3 Risk factors
  
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  4 Triggers
  
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  5 Possible mechanisms
  
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  6 Resolution without treatment
  
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  7 Treatments
  
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  8 What to do if you have symptoms
  
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  9 References