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Ford H, Fraser CL, Solly E, Clough M, Fielding J, White O, Van Der Walt A. Hallucinogenic Persisting Perception Disorder: A Case Series and Review of the Literature. Front Neurol 2022; 13:878609. [PMID: 35599738 PMCID: PMC9120359 DOI: 10.3389/fneur.2022.878609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Hallucinogen persisting perception disorder (HPPD) is characterized by the re-emergence of perceptual symptoms experienced during acute hallucinogen intoxication following drug cessation. The underlying pathophysiology is poorly understood. We report the clinical characteristics and investigation findings of a series of HPPD cases with a literature review of previous case reports. We draw parallels between the features of HPPD and Visual Snow Syndrome (VSS). Methods Retrospective case series of 13 patients referred from neuro-ophthalmologists. Literature review with 24 HPPD case reports were identified through database search using the terms “hallucinogenic persisting perception disorder” OR “hallucinogen persisting perception disorder.” Results Lysergic acid diethylamide (LSD), 3,4-Methyl enedioxy methamphetamine (MDMA) and cannabinoid use was common. Cannabinoids and MDMA were mostly used in association with classical hallucinogens. The most frequent symptoms in our patients were visual snow, floaters, palinopsia, photophobia and nyctalopia. In the literature other symptoms included visual hallucinations altered motion perception, palinopsia, tracers and color enhancement. Ophthalmic and neurologic investigations were mostly normal. The majority of patients had ongoing symptoms. Two of our patients fully recovered—one after treatment with benzodiazepine and one without treatment. Twenty-five percent of cases from the literature fully recovered. Conclusions HPPD presents with heterogeneous visual phenomena on a background of previous classic and non-classic hallucinogen use. Ophthalmic investigations are typically normal. The symptoms of HPPD in our case series overlap with the typical features of Visual Snow Syndrome (VSS). Patients presenting with VSS should be screened for past recreational drug use. The DSM-5 description of HPPD does not include visual snow, nyctalopia, photophobia or floaters. A revision of the diagnostic criteria to include these symptoms may better reflect the typical clinical phenotype. Increased awareness of HPPD as a secondary cause of VSS can avoid extensive investigations. Controlled trials comparing primary and secondary VSS patients are needed to understand the pathophysiology better and optimize treatment for HPPD.
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Affiliation(s)
- Hannah Ford
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Clare L. Fraser
- Faculty of Health and Medicine, Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Emma Solly
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Meaghan Clough
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Joanne Fielding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Owen White
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Anneke Van Der Walt
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Neuro-Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
- *Correspondence: Anneke Van Der Walt
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Doyle MA, Ling S, Lui LM, Fragnelli P, Teopiz KM, Ho R, Di Vincenzo JD, Rosenblat JD, Gillissie ES, Nogo D, Ceban F, Jawad MY, McIntyre RS. Hallucinogen persisting perceptual disorder: a scoping review covering frequency, risk factors, prevention and treatment. Expert Opin Drug Saf 2022; 21:733-743. [DOI: 10.1080/14740338.2022.2063273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Marcus A. Doyle
- Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada
- Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Susan Ling
- Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, ON, Canada
| | - Leanna M.W. Lui
- Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, ON, Canada
| | - Paul Fragnelli
- Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada
| | | | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Joshua D. Di Vincenzo
- Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, ON, Canada
- CRTCE, Braxia Health
| | - Joshua D. Rosenblat
- Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- CRTCE, Braxia Health
| | | | - Danica Nogo
- Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada
| | - Felicia Ceban
- Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | | | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, ON, Canada
- CRTCE, Braxia Health
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Orsolini L, Papanti GD, De Berardis D, Guirguis A, Corkery JM, Schifano F. The "Endless Trip" among the NPS Users: Psychopathology and Psychopharmacology in the Hallucinogen-Persisting Perception Disorder. A Systematic Review. Front Psychiatry 2017; 8:240. [PMID: 29209235 PMCID: PMC5701998 DOI: 10.3389/fpsyt.2017.00240] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/03/2017] [Indexed: 12/21/2022] Open
Abstract
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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Affiliation(s)
- Laura Orsolini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.,Neomesia Mental Health, Villa Jolanda Hospital, Jesi, Italy.,Polyedra, Teramo, Italy
| | - Gabriele Duccio Papanti
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Domenico De Berardis
- Polyedra, Teramo, Italy.,NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", Teramo, Italy.,Department of Neuroscience, Imaging and Clinical Science, Chair of Psychiatry, University "G. D'Annunzio", Chieti, Italy
| | - Amira Guirguis
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - John Martin Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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