HPPD

Generell information

HPPD är förkortningen för "Hallucinogen Persisting Perception Disorder" och kan översättas till Posthallucinatorisk perceptionsstörning. Det är en störning av synintrycken orsakad av hallucinogener vars natur är såpass plågsam att man fått ett handikapp i sitt dagliga leverne. Det kan beskrivas som en form av en visuell störning, man kan säga att det är en synlig form av tinnitus. "Synbrus" istället för öronpip.

Symptomen kan men måste inte vara något av följande:

  • Vibrationer eller andningar av väggar och dylikt
  • Föremål som "hoppar" ur sin plats
  • Saker verkar bli "in/ut zoomade" i synfältet
  • Ett konstant flimmer i synfältet
  • Färghallucinationer vid mörker

Problemen behöver inte vara hela livet ut. Personer har blivit av med sina besvär, men det har tagit många månader, ibland många år. Avhållsamhet från hallucinogena droger är ett måste. Ibland kan antiepileptiska läkemedel och benzodiazepiner lindra symptomen[1].

Halpern et al. skriver i sin metastudie från 2016 att HPPD-diagnoserna tenderat att inkludera fenomen som i den klassiska litteraturen kallats flashbacks samt visuella störningar. Författarna delar därför upp HPPD i två klasser. Klass 1 som är flashback-liknande och Klass 2. När det gäller klass två så anges följande om läkemedel för behandling:

For those claiming Type 2 HPPD, improvements have been reported with sunglasses (Abraham 1983) and psychotherapy (Abraham et al.1996). With Type 2 HPPD, antipsychotic drugs worsened some symptoms (Abraham and Mamen 1996; Morehead 1997, Lerner et al. 2002; Goldman et al. 2007). SSRIs worsened 4 cases documented by Markel et al. (1994), but other clinicians report improvements (Young 1997; Aldurra and Crayton 2001). Anti-seizure drugs and clonidine were also used with some success (Alarcon et al. 1982; Lerner et al. 2000). It is not easy to determine how best to treat HPPD given this literature. The widely variable, partially contradictory findings may require us to speculate on placebo effects, idiosyncratic neurochemistry, and spontaneous recovery, or perhaps more simply, an inadequately defined HPPD.
— Halpern et al. (2016)[2]

Prevalens

HPPD kan uppkomma efter att ha brukat psykedelia så lite som en enda gång. Troligtvis är vissa individer känsligare än andra. Men det är vanligare bland personer som använt stora doser med hög frekvens. En del upplever att små begynnande tecken på visuella synstörningar blivit bestående efter ytterligare trippar. Kombinationer med alkohol och stimulanter har också visat sig förvärra symptomen[3][4].

Mycket information om prevalensen av HPPD saknas, främst för att skadan är sällsynt förekommande[5].

The incidence of HPPD is unknown, although it is thought to be very uncommon given the relatively few cases reported out of the millions of hallucinogen doses consumed since the 1960s (Halpern and Pope, 2003) Although the term ‘flashback’ is sometimes used interchangeably with HPPD, the former term is often used to describe any brief perceptual effects reminiscent of acute hallucinogen effects but occurring beyond acute hallucinogen use, usually in the absence of clinical distress or impairment (Lerner et al., 2002). Indeed, many illicit hallucinogen users report some brief visual abnormalities occurring after acute hallucinogen effects, but only for a small minority of users are these effects troubling or impairing enough to be considered clinically significant or warrant the diagnosis of HPPD (Lerner et al., 2002; Baggott, et al., 2006). Many illicit users regard such sub-clinical effects as benign and pleasurable (Strassman 1984; Lerner,et al., 2002; Frecska and Luna, 2006). Importantly, the incidence of HPPD or other perceptual abnormalities appears to be much lower in therapeutic or research contexts with careful screening and preparation than in the context of illicit recreational use, which may include the confounds of polydrug use and unscreened psychiatric disorders (Cohen, 1960; McGlothlin and Arnold, 1971; Strassman 1984; Halpern and Pope, 2003).
— Johnson et al. (2008)[6]
Interestingly, Type 2 HPPD was never clearly reported during the 1960s when millions of Americans took LSD on a regular basis with less knowledge about hallucinogens and more resultant complications. HPPD was not described in the comprehensive retrospective surveys of LSD use in psychotherapy in approximately 10,000 patients during the 1950–1960s (Cohen 1960; Malleson 1971; Passie 1997).
— Halpern et al. (2016)[2]

En studie från 2010 visade att runt 4% av LSD-brukarna som svarade på ett webbformulär upplevde effekter som skulle kunna klassas som HPPD:

We used an online questionnaire to document the symptoms and relationship to drug use of unusual visual phenomena in hallucinogen users. 16,192 individuals viewed the information sheet and 2679 were included in the study. Of these, 224 reported having unrelated diagnoses associated with unusual visual experiences and were excluded from main analyses. Most (60.6%) of the remaining 2455 participants reported having experienced drug-free visual experiences that resembled hallucinogen effects. Probability of experiencing constant or near-constant symptoms was predicted by greater past exposure to specific hallucinogens, including lysergic acid diethylamide (LSD). Although symptoms were common, few (104, or 4.2% of the sample) found them distressing or impairing enough to consider seeking treatment.
— Bagott et al. (2010)[7]

Även andra formulär och fallbeskrivningar indikerar att problemet verkar vara mer associerat med LSD än andra psykedeliska droger.

Diagnos

Följande kriterier måste uppfyllas för att diagnostiseras som HPPD:

The essential feature of Hallucinogen Persisting Perception Disorder (Flashbacks) is the transient recurrence of disturbances in perception that are reminiscent of those experienced during one or more earlier Hallucinogen Intoxications. The person must have had no recent Hallucinogen Intoxication and must show no current drug toxicity (Criterion A). This reexperiencing of perceptual symptoms causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion B). The symptoms are not due to a general medical condition (e.g., anatomical lesions and infections of the brain or visual epilepsies) and are not better accounted for by another mental disorder (e.g., delirium, dementia, or Schizo- phrenia) or by hypnopompic hallucinations (Criterion C). The perceptual disturbances may include geometric forms, peripheral-field images' flashes of color, intensified colors, trailing images (images left suspended in the path of a moving object as seen in stroboscopic photography), perceptions of entire objects, afterimages (a same-colored or complementary-colored shadow of an object remaining after removal of the object), halos around objects, macropsia, and micropsia. The abnormal perceptions that are associated with Hallucinogen Persisting Perception Disorder occur episodically and may be self-induced (e.g., by thinking about them) or triggered by entry into a dark environment, various drugs, anxiety or fatigue, or other stressors.

The episodes usually abate after several months but can last longer. Reality testing remains intact (i.e., the person recognizes that the perception is a drug effect and does not represent external reality). In contrast, if the person has a delusional interpretation concerning the etiology of the perceptual disturbance, the appropriate diagnosis would be Psychotic Disorder Not Otherwise Specified.

Diagnostic Critera:

A. The reexperiencing, following cessation of use of a hallucinogen, of one or more of the perceptual symptoms that were experienced while intoxicated with the hallucinogen (e.g.. geometric hallucinations, false perceptions of movement in the peripheral visual fields, flashes of color, intensified colors, trails of images of moving objects, positive afterimages, halos around objects, macropsia, and micropsia).

B. The symptoms in Criterion A cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The symptoms are not due to a general medical condition (e.g., anatomical lesions and infections of the brain. visual epilepsies) and are not better accounted for by an- other mental disorder (e.g., delirium, dementia, schizophrenia) or hypnopompic hallucinations.
— American Psychiatric Association[8]

To strictly meet these criteria, an individual must display several attributes. First, hallucinogen use must precede the syndrome; if an individual has pre-existing perceptual symptoms that persist and/or evolve after hallucinogen intoxication, a diagnosis of HPPD is not justified. Moreover, DSM-IV suggests in its text that HPPD persists ‘‘long after the use of hallucinogens has stopped’’ (p. 313). Thus, symptoms lasting only days after hallucinogen ingestion are presumably insufficient to represent HPPD.

Second, the word ‘reexperiencing’ in criterion A, together with the requirement for ‘distress or impair-ment’ in criterion B, suggests that perceptual phenom-ena should be sufficiently striking to be outside the range of normal experience. Simply seeing bright spots in front of one’s eyes upon entering a dark room, for example, probably should not qualify for the diagnosis of HPPD.

Third, as indicated in criterion C, alternative etiolo-gies for unusual perceptual experiences must be on-sidered before diagnosing HPPD. DSM-IV cites visual epilepsies, migraine, delirium, dementia, schizophrenia, and hypnopompic hallucinations as specific disorders to rule out. Less clear in DSM-IV is whether to exclude acute intoxication with other drugs that might cause visual disturbances. On the one hand, DSM-IV specifies that ‘‘the person must. . . show no current drug toxi-city. . .’’ (p. 233), but the same text specifies that the abnormal perceptions may be ‘‘triggered’’ by ‘‘various drugs’’ (p. 233). Despite these somewhat contradictory statements, prudence dictates withholding the diagnosis of HPPD in cases where current or prior use of a drug may be causing or contributing to aberrant perceptual experiences. Other conditions to be ruled out before diagnosing HPPD should be posttraumatic stress dis-order (PTSD) and depersonalization and derealization associated with severe anxiety and depression. Finally, one must exclude other hallucinogen-induced disorders recognized by DSM-IV, such as hallucinogen-induced psychotic, mood, or anxiety disorders
— Halpern, 2002[5]

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Externa länkar:

  1. Clonazepam treatment of lysergic acid diethylamide-induced hallucinogen persisting perception disorder with anxiety features (Lerner, 2003)
  2. 2,0 2,1 A Review of Hallucinogen Persisting Perception Disorder (HPPD) and an Exploratory Study of Subjects Claiming Symptoms of HPPD (Halpern et al. ,2016)
  3. Batzer, W., Ditzler, T., Brown, C., 1999. LSD use and flashbacks in alcoholic patients. J. Addict. Dis. 18, 5-63
  4. Strassman, R.J., 1984. Adverse reactions to psychedelic drugs: a review of the literature. J. Nerv. Ment. Dis. 172, 577-595.
  5. 5,0 5,1 Hallucinogen persisting Perception disorder: what do we know after 50 years? (Halpern, 2002)
  6. Human hallucinogen research: guidelines for safety (Johnson et al. , 2008)
  7. Abnormal visual experiences in individuals with histories of hallucinogen use: a Web-based questionnaire (Bagott et al. , 2010)
  8. Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (American Psychiatric Association, 2000) (DSM-IV-TR)

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Wikipedia: Hallucinogen persisting perception disorder

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