Hallucinogen persisting perception disorder: what do we know after 50 years?
'Flashbacks' following use of hallucinogenic drugs have been reported for decades; they are recognized in DSM-IV as 'Hallucinogen Persisting Perception Disorder (Flashbacks)', or HPPD. We located and analyzed 20 quantitative studies between 1955 and 2001 examining this phenomenon. However, many of these studies were performed before operational criteria for HPPD were published in DSM-III-R, so they are difficult to interpret in the light of current diagnostic criteria. Overall, current knowledge of HPPD remains very limited. In particular (1) the term 'flashbacks' is defined in so many ways that it is essentially valueless; (2) most studies provide too little information to judge how many cases could meet DSM-IV criteria for HPPD; and consequently (3) information about risk factors for HPPD, possible etiologic mechanisms, and potential treatment modalities must be interpreted with great caution. At present, HPPD appears to be a genuine but uncommon disorder, sometimes persisting for months or years after hallucinogen use and causing substantial morbidity. It is reported most commonly after illicit LSD use, but less commonly with LSD administered in research or treatment settings, or with use of other types of hallucinogens. There are case reports, but no randomized controlled trials, of successful treatment with neuroleptics, anticonvulsants, benzodiazepines, and clonidine. Although it may be difficult to collect large samples of HPPD cases, further studies are critically needed to augment the meager data presently available regarding the prevalence, etiology, and treatment of HPPD.
Halpern
John H
JH
Harvard Medical School, Biological Psychiatry Laboratory, Alcohol and Drug Abuse Research Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478-9106, USA. john_halpern@hms.harvard.edu
Pope
Harrison G
HG
D002986:Clinical Trials as Topic; D006213:Hallucinogens / Q000009:adverse effects*; D006801:Humans; D008238:Lysergic Acid Diethylamide / Q000009:adverse effects; D016239:MEDLINE; D010468:Perceptual Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy
D006213:Hallucinogens; D008238:Lysergic Acid Diethylamide