Hallucinogen Persisting Perception Disorder: Etiology, Clinical Features, and Therapeutic Perspectives

Abstract

Hallucinogen Persisting Perception Disorder (HPPD) is a rare, and therefore, poorly understood condition linked to hallucinogenic drugs consumption. The prevalence of this disorder is low; the condition is more often diagnosed in individuals with a history of previous psychological issues or substance misuse, but it can arise in anyone, even after a single exposure to triggering drugs. The aims of the present study are to review all the original studies about HPPD in order to evaluate the following: (1) the possible suggested etiologies; (2) the possible hallucinogens involved in HPPD induction; (3) the clinical features of both HPPD I and II; (4) the possible psychiatric comorbidities; and (5) the available and potential therapeutic strategies. We searched PubMed to identify original studies about psychedelics and Hallucinogen Persisting Perception Disorder (HPPD). Our research yielded a total of 45 papers, which have been analyzed and tabled to provide readers with the most updated and comprehensive literature review about the clinical features and treatment options for HPPD.

New/emerging psychoactive substances and associated psychopathological consequences

“…A florid/acute/transient psychosis; relapse/worsening of a pre-existing psychosis and bipolar disorder (Oluwabusi et al, 2012;Ustundag et al, 2015); and the persistent psychotic disorder 'spiceophrenia' (Papanti et al, 2013;Schifano et al, 2016) have all been described. With synthetic cannabinoids, similar to what being described for a range of remaining NPS (Schifano et al, 2015), the total or partial recurrence of perceptual disturbances that appeared during previous hallucinogenic intoxications, typically known as Hallucinogen-Persisting Perception Disorder (HPPD), may occur (Martinotti et al, 2018). The intoxication/acute toxic effects of SCs appear to be more akin to those experienced with sympathomimetic/stimulant drug use (Naviglio et al, 2015;Wood and Dargan, 2012).…”

Visual snow syndrome

“…25 VS and HPPD indeed share some clinical aspects, mostly characterized by the possibility of the latter to manifest with visual static, palinopsia, flashes, and other types of visual dysperceptions. 5,25,26 Recent literature seems to suggest that HPPD can be distinguished into 2 main entities. In type 2 HPPD, the visual symptoms are constant or nearly constant, 27 consistent with the group of participants from our cohort.…”

Visual snow syndrome after start of citalopram—novel insights into underlying pathophysiology

“…Thus, in subjects with an increased vulnerability, VSS might also be triggered by minor changes in serotonergic transmission due to SSRI, like in our case. Further evidence for the important role of serotonergic transmission derives from the at least partial effectiveness of lamotrigine in both conditions [10][11][12], as lamotrigine also has an inhibitory function on 5HT 2a -receptors [13].…”