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Рассказать вам о психическом расстройстве под названием hppd ( Длительное расстройство восприятия, вызванное галлюциногенами)
Resolution without treatment
It’s very common to have the symptoms go away without any treatment. Here’s an example:
Case 1
26-year-old male
Five year history of cannabis use
Also reported LSD use
During which there was macropsia, micropsia, pelopsia, and teleopsia.
Symptoms reminiscent of Alice in Wonderland Syndrome (AIWS)
Single LSD experience led him to stop all drug use
The experience lasted longer than usual and included some anxiety
Two days post-LSD
Noticed the return of visual effects
Including the AIWS-like effects
He became preoccupied with the symptoms and distressed by them, feeling intimidated and disheartened.
One year later
The visual disturbances completely disappeared.
Case is unique since it lacked typical HPPD symptoms and had AIWS-like symptoms
Treatments
There are no clear guidelines for treatment.
Non-drug options include stress reduction and engaging in things that’ll leave you less focused on the symptoms. Psychotherapy has sometimes been helpful, as has the use of tinted glasses.
Medication
Reports of success exist with benzodiazepines (often clonazepam), clonidine, naltrexone, lamotrigine, levetiracetam, and SSRIs.
Benzodiazepines seem to be helpful for a large portion of people, though they typically just reduce the symptoms and make them more manageable. It’s possible they’re reducing the symptoms due to an impact on anxiety, but they could also be helpful through a direct effect on visual processing.
There’s a more variable response to SSRIs. Evidence suggests that if people can get through the adjustment period, they may often be useful. But they clearly don’t work for everyone and they sometimes increase the symptoms, especially during the adjustment period.
Antipsychotics, although once proposed as a treatment, have generally been found to be ineffective or to have a negative impact. For example, risperidone has had negative effects in many people.
Clonazepam case series
14 patients with HPPD and anxiety
All believed LSD was the cause of their symptoms
They had complained of HPPD for at least three weeks
Clonazepam was proposed at 2 mg/d
Based on their comorbid anxiety and prior reports of success
Clonazepam was given for two months and then gradually discontinued
Results
Significant reductions in visual disturbances
Significant reductions in anxious mood, tension, and insomnia.
The benefits were maintained after clonazepam was stopped.
Combo of tolcapone and carbidopa/levodopa (Sinemet)
20 patients
A significant beneficial response was seen in a third of patients, with little response in the rest.
This was only an open-label trial and placebo can’t be ruled out.
The benefit could potentially come from affecting sensory gating mechanisms.
Naltrexone cases
1
24-year-old male
History of LSD use
Reported flashes of color, visual distortions, trails of images, and positive afterimages.
Episodes lasted a few minutes and caused distress and impairment.
Accompanied by dysphoric mood and suicidal thoughts.
2 months of unsuccessful benzodiazepine and antidepressant treatment
Treatment
Naltrexone at 25 mg/d for two days, followed by 50 mg/d
Significant reduction in frequency and duration of flashbacks within two weeks, along with reduced suicidal thoughts.
Full remission within 2 months of therapy.
Remission remained months later after discontinuation of treatment.
2
22-year-old male
History of LSD and ecstasy use
Reported geometric hallucinations, false perception of movement, positive afterimages, and body image distortion.
Severe enough to cause substantial stress and anxiety.
One month of unsuccessful benzodiazepine treatment
Treatment
25 mg of naltrexone for 2 days followed by 50 mg/d
Significant improvement in flashbacks and anxiety within 2 weeks.
Therapy discontinued after 2 months and improvement remained for months after.
Case reports
Case 1
26-year-old male
Five year history of cannabis use
Daily without any HPPD symptoms
Concomitant tobacco use
Two years prior to evaluation
Was using synthetic cannabinoids instead of cannabis on a near-daily basis.
Tobacco use as well
Under influence of synthetic cannabinoids
Reported visual disturbances
Halos, color intensification, visual snow, positive afterimages, illusions of movement, and trailing.
Considered benign and comfortable.
Occurred sporadically during two years of consumption.
One eventual episode
Severe panic attack from synthetic cannabinoids, causing him to abruptly discontinue use.
Panic attack included visual disturbances, described as a “horrific trip.”
48-hours post-panic attack
Reexperienced visual disturbances with anxiety
Continued to report visual disturbances and anxiety
Psychiatric examination
Reported visual disturbances similar to those caused by synthetic cannabinoids
Almost daily episodes of symptoms lasting for a second to a few minutes.
Severe enough episodes to cause anxiety, distress, and impaired social/occupational functioning.
Placed on clonazepam at 0.25 mg BID and then 1 mg BID
During two weeks post-examination
Two additional but milder panic attacks with visual disturbances
Then the panic attacks ended, but visual changes remained
Symptoms dramatically started to improve, initially with episodes becoming more benign and less distressing.
Clonazepam continued for 5 weeks and then withdrawn.
Even after clonazepam ended, continued improvement occurred.
Reduced frequency of perceptual issues and anxiety.
6-month evaluation
Nearly complete end to symptoms
Only thing that persisted was trailing
Case 2
24-year-old male
Three year history of daily cannabis use
A year prior to evaluation
Replaced cannabis with synthetic cannabinoids (SC)
Reported visual disturbances during SC use
Considered them “amusingly entertaining” and would occur when viewing stationary and moving objects.
Stationary objects: Halos, visual snow, positive afterimages, and dimensional distortion.
Moving objects: Illusions of movement, black moving spots with eyes open and closed (speckles/dots in peripheral field), and trailing.
One eventual use
Severe panic attack under the influence, thought it was a heart attack.
Ended up in ED, where diazepam was given.
Day after panic attack
Another panic attack including visual imagery similar to under SC influence.
Then continued to report visual phenomena and anxiety.
Episodes occurred daily and lasted from a second to a few minutes.
Panic attack was distressing enough to lead to immediate cessation of SC use.
Visual problems caused significant distress, anxiety, and infringed upon social and occupational functioning.
Withdrawal from SC treated with clonazepam
Episodes became more benign and less distressing.
Dramatically started to improve, even after clonazepam suspension.
Reduced frequency eventually
By end of six months
Almost no visual disturbances
Only non-distressing black moving spots in visual field.
Case 3
48-year-old male
Presented with distressing visual experiences
Variable severity
Present for over 20 years
Examples of visual effects
Red objects have a green shimmer around them like with 3D glasses
Altered sense of distance
Alteration of his own reflection
Any patterns on objects appear to move constantly
Words moving while reading text
Vehicles have trails/stretching while driving past
Difficulty in focusing vision
Symptoms not always present, but when they were, they significantly impaired functioning.
Had trouble crossing the road and had to dim the lights.
Associated the symptoms with LSD use 25 years prior.
LSD was taken alongside cannabis and alcohol.
Even felt, at times, the drug put him “in a coma” and he was “dreaming all of this.”
Tied back to a single use of LSD with cannabis and alcohol
Symptoms began immediately the next day
He had taken LSD 15 times prior to the trigger experience
Consistently reported depersonalization and his visual distortions caused enough stress to make him suicidal.
Low mood, decreased concentration, anxiety, and an inability to cope.
Over a period of 25 years, received these diagnoses:
LSD-induced depersonalization syndrome, depersonalization-derealization syndrome, LSD induced simple schizophrenia, depressive disorders, and anxiety disorders.
Treatment
1 mg of clonazepam four times daily
Eventually also given escitalopram (switched to reboxetine) for a depressive episode
Result
These were gone 3 months later: geometric hallucinations, false perception of movement in peripheral fields, flashes of colour, intensified colours, trails of images of moving objects, positive after images, macropsia, micropsia
Remained at a lower intensity and frequency: halos around objects
Case 4
Took LSD for the first time at 17
Had used cannabis and alcohol as well
Began taking LSD every other month, 1-2 blotters of unknown dose
At the end of his first year of use
One specific trip left him suddenly with severe abnormal visual disturbances.
Disturbances
Small intensely colored, flickering, geometric shapes within entire visual field
Intermittent trailing
After images from objects he had just seen
Reading was impaired
Symptoms aggravated by
Mental stress, lack of sleep, and use of caffeine.
He tried to alleviate symptoms by using more LSD, which was ineffective.
LSD use continued for 6 more years, followed by 5 years of abstinence, and then returning to use of LSD once per month.
Alcohol, cannabis, and cocaine use were present during adult life.
He eventually became strictly abstinent, but visual problems remained.
Three months of clonidine was unhelpful.
Treatment
7 months of lamotrigine at 200 mg/d
Led to steady improvement of perception issues
Afterimages totally went away
Color-intensive flickering became fainter, less bright, and more transparent.
Reading capacity improved greatly, which provided great relief.
He described this as having a “dirty screen” in front of his eyes, which was present for 18 years, and was slowly beginning to clear.
Also provided general improvement in overall mental well-being.
Case 5
18-year-old male
Hospitalized for perceptual impairment and dysphoric mood that was present for 8 months.
Family history of psychiatric problems
Had regularly used cannabis, at least some each week.
Perceptual distortions began after using psilocybin in the form of Psilocybe semilanceata
Reexperienced psilocybin-like effects the following day when using cannabis.
Also derealization and depersonalization, as well as difficulty distinguishing distortions from reality.
These problems became a daily issue, worsening in the dark.
Distressful and upleasant
Eventually stopped cannabis two months later
Symptoms initially improved post-cannabis cessation, but increased again 6 months post-cessation.
Treatment
Amisulpride at 100 mg
Replaced amisulpride (due to sedation) with Olanzapine at 5 mg
Olanzapine exacerbated the symptoms
Olanzapine replaced with Risperidone with 2 mg
Risperidone continued with addition of sertraline at 150 mg
To deal with persistent dysphoric mood and recurrence of anxiety-like symptoms
Combo of risperidone and sertraline led to decrease of daily episodes of perception difficulties and depressive symptoms.
HPPD disappeared after 6 months of treatment.
He also became more active in social settings.
Case 6
30-year-old male
Presented to ED after surviving two subsequent suicide attempts.
History of depression and bipolar disorder
History of trauma
Witnessed friends and relatives murdered during Kosovo War as a child.
No recent alcohol/drug use, but a distant history of cannabis use.
HPPD appeared after using cannabis
Vivid & saturated color, macro/micropsia, and seeing things in motion as moving faster than reality.
Derealization and dissociation
Distortions were continuous, but he could sometimes distract himself with concentration on schoolwork.
Responses to treatment
Good historical response to SSRIs
Negative response in the form of worsened visual symptoms with risperidone
6 months of lamotrigine at 200 mg/d followed by 6 months at 100 mg/d
Reported total resolution of macropsia and micropsia.
Significant improvement in motion and light perception.
He ultimately committed suicide.
Case 7
38-year-old female
Had panic attacks for 17 years
Took LSD, leading to a severely “bad trip,” about 17 years prior
She was disoriented, believed the world was collapsing, and thought she was going insane.
No further LSD use, but she reported persistent phenomena.
Flashbacks on a near-daily basis for 9 months post-experience.
For 8 years post-LSD
Panic attacks precipitated by flashbacks similar to first LSD trip.
Anxiety attacks lasted for 30 seconds to 1 minute.
History of cannabis, alcohol, cocaine, and MDMA use.
Treatment
Risperidone 0.5 mg/d
Significant reduction in frequency and intensity of panic attacks and perceptual disturbances within 3-4 weeks.
Case 8
33-year-old female
Used LSD up to 30 times around the age of 18
Also took cannabis, ecstasy, psilocybin, and ketamine.
2-3 weeks after last LSD session
Persistent visual disturbances developed
They were “flashback” episodes described as similar to LSD effects.
Afterimages, perception of motion in periphery, flickering, halo effects, macropsia, micropsia, and bright spots of light across visual field.
No visual changes with eyes closed.
Symptoms persisted for 13 years
Led to her having trouble focusing properly with her eyes.
She became suicidal and depressed as a result.
Had some trouble distinguishing between normal and abnormal perceptions.
Attempted treatment
Sertraline, citalopram, and fluoxetine relieved depression but not HPPD.
Risperidone was also ineffective.
Treatment
Lamotrigine was initiated and given for over 12 months.
6 months of 200 mg, followed by 100 mg
Abnormal sense perception of “levitation” was alleviated
All macropsia and micropsia disappeared
Reduction in afterimages, halos, and the bright spots.
SSRI addition didn’t change anything
Actually made derealization and depersonalization worse.
Stress was connected to worsening of symptoms.
What to do if you have symptoms
You should stop using drugs, especially cannabis and psychedelics, if you have HPPD symptoms.
Visiting a physician is wise if the symptoms cause impairment or distress. It’s good to rule out other potential causes and to receive an accurate diagnosis.
With a diagnosis, you may benefit from medication as well as stress reduction and psychotherapy. |
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