Hallucinogen-Induced Persisting Perception Disorder: A Case Report.

Hallucinogen-persisting perception disorder (HPPD) causes persistent visual distortions, most commonly after lysergic acid diethylamide (LSD) use. A 28-year-old Caucasian male with a history of polysubstance use, including LSD and cannabis, developed classic HPPD symptoms seven months after stopping LSD. Diagnosis required ruling out other causes through laboratory and imaging tests. His symptoms did not improve with antipsychotics, indicating they were not solely due to mental illness. While alpha-2 adrenergic drugs like clonidine and benzodiazepines are considered first-line treatment, the patient showed improvement with lamotrigine, which is the gold standard for treating perceptual disturbances in time and space.

Study at a glance

Abstract

Hallucinogen-persisting perception disorder (HPPD), also known as acute hallucinogen-induced psychosis or informally known as "flashbacks," is an unusual condition experienced by patients due to the use of different hallucinogenic substances. Hallucinogen-persisting perception disorder causes many symptoms, predominantly persistent visual perception distortion instead of intermittent distortion. Although different hallucinogens could cause HPPD, lysergic acid diethylamide (LSD) and LSD-like properties seem to be the most common hallucinogens causing the symptoms. In our case report, the patient is a 28-year-old Caucasian male with a long psychiatric and social history of polysubstance use using LSD and cannabis. He started experiencing many of the classic symptoms of HPPD seven months after stopping LSD. The diagnosis is suspected by ruling out all other possible underlying causes with the help of several laboratory and imaging tests. Despite having an extensive psychiatric history of illnesses, the patient's symptoms failed to improve with antipsychotics, confirming that the symptoms were not only due to mental illness. Although supposedly the first-line treatment for HPPD is the use of alpha-2 adrenergic drugs such as clonidine and benzodiazepines, we started to witness improvement in patient's symptoms with the use of lamotrigine, which is the gold standard in treating perceptual disturbance in time and space.