Schizophrenia and hallucinogen persisting perception disorder: A clinical investigation.

BACKGROUND AND OBJECTIVES: We compared characteristics of schizophrenia patients with prior LSD use who developed hallucinogen persisting perception disorder (SCH+HPPD) with those who did not (SCH-HPPD). METHODS: Data were collected for 37 subjects in the SCH+HPPD group and 43 subjects in the SCH-HPPD group. RESULTS: Socio-demographics and positive symptom scores were similar between groups. Individuals in the SCHIZO+HPPD group scored lower on general psychopathology and negative symptoms scores. DISCUSSION AND CONCLUSIONS: Individuals with schizophrenia and HPPD present with less severe psychopathology, despite persistent perceptual disturbances. SCIENTIFIC SIGNIFICANCE: Our findings highlight the importance of further research into this subset of patients.

Flashbacks and HPPD: A Clinical-oriented Concise Review.

A unique characteristic of LSD, LSD-like and substances with hallucinogenic properties is the recurrence of some or all the hallucinogenic symptoms which had appeared during the intoxication after the immediate effects of the substance had worn off. This recurring syndrome, mainly visual, is not clearly understood. The terms Flashback and Hallucinogen Persisting Perception Disorder (HPPD) have been used interchangeably in the professional literature. We have observed at least two different recurrent syndromes, the first Flashback Type we refer to as HPPD I, a generally short-term, non-distressing, benign and reversible state accompanied by a pleasant affect. In contrast, the second HPPD Type we refer to as HPPD II, a generally long-term, distressing, pervasive, either slowly reversible or irreversible, non-benign state accompanied by an unpleasant affect. HPPD I and II appear to be part of a broad spectrum of non-psychopathological and psychopathological states reported by hallucinogen users. HPPD I and II may be clinically characterized by prodromal symptoms, onset, content of visual imagery, precipitators, frequency, duration and intensity of perceptual recurrences, severity, course, differential diagnosis, accompanying mood and affect, insight and remission. Pharmacological therapy with or without preceding or following co-occurring psychiatric disorders have been shown to ameliorate this syndrome. A large variety of medications may be utilized to alleviate this condition, but with differential results suggesting several subtypes. The purpose of this manuscript is to provide a clinical-oriented, comprehensive and concise review to treating psychiatrists.

LSD Flashbacks - The Appearance of New Visual Imagery Not Experienced During Initial Intoxication: Two Case Reports.

A side effect associated with the use of synthetic hallucinogens such as lysergic acid diethylamide-(LSD) is the partial or total recurrence of perceptual disturbances which previously appeared during intoxication, despite absence of recent use. These are commonly referred to as "flashbacks" or Hallucinogen Persisting Perception Disorder (HPPD). Here we present two cases of patients with a prior history of LSD use who turned to psychiatric consultation following brief episodes of HPPD. Surprisingly, in both cases new visual imagery appeared during episodes of flashbacks which was not experienced during primary LSD use. Both subjects reported the ability to discern between LSD-associated visual disturbances and new visual imagery. This phenomenon did not cause functional impairment and in both cases caused gradual concern due to its persistence. Both patients refused medical treatment and continued psychiatric follow-up. At one year follow-up both patients reported almost complete spontaneous remission. To the best of our knowledge these are the first reported cases of LSD-related benign flashbacks in which new imagery is experienced. Reasons for this reversible and apparently harmless side effect are proposed. Conclusions from case reports should be taken with caution.

Responsibility of the therapist for the patients' actions (Tarasoff Rules): position of the psychiatrists.

BACKGROUND AND AIMS: Patient confidentiality and the therapists responsibility to society may present a challenge in the therapeutic relationship between the psychiatrist and the patient. We examined the attitudes of Israeli psychiatrists concerning the duty to warn and protect according to the Tarasoff Rule. METHODS: Questionnaires to examine psychiatrists opinions concerning the implementation of the Tarasoff Rule in Israel were sent to senior psychiatrists involved in forensic psychiatry for anonymous completion. RESULTS: 108 (64%) questionnaires were returned. 61 (57%) replied that they encountered similar situations. CONCLUSIONS: Thorough understanding of the Tarasoff Rule, clarification of the patients potential dangerousness, and timely deliberation of the issues will assist the therapist. Investigation of the medical consensus of senior physicians, as performed in our study, is also a point of reference for formulating an opinion.

Benign and time-limited visual disturbances (flashbacks) in recent abstinent high-potency heavy cannabis smokers: a case series study.

Eight high-potency heavy cannabis smokers who fulfilled DSM-IV-TR criteria for cannabis dependence sought treatment for outpatient detoxification. During routine psychiatric interview they reported the presence of visual disturbances when intoxicated and no prior history of LSD use. They all communicated the persistence of visual disturbances after ceasing cannabis use. Seven categories of visual disturbances were described when staring at stationary and moving objects: visual distortions, distorted perception of distance, illusions of movement of stationary and moving objects, color intensification of objects,dimmed color, dimensional distortion and blending of patterns and objects. Patients reported having 2-5 different categories of flashbacks up to 3-6 months after cessation of cannabis use. The described phenomena may be interpreted as a time-limited benign side effect of high-potency cannabis use in some individuals. A combination of vulnerability and use of large amounts of high potency cannabis seem to contribute to the appearance of this condition. Conclusions from uncontrolled case series should be taken with appropriate caution.

Clonazepam treatment of lysergic acid diethylamide-induced hallucinogen persisting perception disorder with anxiety features.

An unique and intriguing characteristic of lysergic acid diethylamide (LSD) and LSD-like substances is the recurrence of some of the symptoms which appear during the intoxication, in the absence of recent intake of hallucinogens. Hallucinogen persisting perception disorder (HPPD) is a condition in which the re-experiencing of one or more perceptual symptoms causes significant distress or impairment in social, occupational or other important areas of functioning and may be extremely debilitating. Benzodiazepines are one of the recommended agents for the treatment of HPPD but it is unclear which of them may be more helpful. The goal of our investigation was to assess the efficacy of clonazepam in the treatment of LSD-induced HPPD. Sixteen patients fulfilled entrance criteria. All complained of HPPD with anxiety features for at least 3 months and were drug free at least 3 months. They received clonazepam 2 mg/day for 2 months. Follow-up was continued for 6 months. They were weekly evaluated during the 2 months of clonazepam administration and monthly during the follow-up period using the Clinical Global Impression Scale, a Self-report Scale and Hamilton Anxiety Rating Scale. Patients reported a significant relief and the presence of only mild symptomatology during the clonazepam administration. This improvement was clearly sustained and persisted during a 6-month follow-up period. This study suggests that high potency benzodiazepines like clonazepam, which has serotonergic properties, may be more effective than low-potency benzodiazepines in the treatment of some patients with LSD-induced HPPD.

Risperidone-associated, benign transient visual disturbances in schizophrenic patients with a past history of LSD abuse.

Two schizophrenic patients, who had a prior history of LSD abuse and who had previously developed EPS with classic antipsychotics, were successfully treated with risperidone. They both reported short episodes of transient visual disturbances, which appeared immediately after starting treatment with risperidone. This imagery resembled visual disturbances previously experienced as "flashbacks" related to prior LSD consumption. Risperidone administration was continued and the visual disturbances gradually wore off. During a six-month follow-up period, there was no recurrence of visual disturbances. This phenomenon may be interpreted as a benign, short-term and self-limiting side effect which does not contraindicate the use of risperidone or interfere with treatment. Conclusions based on two case reports should be taken with appropriate caution.