BackgroundHallucinogen persisting perception disorder (HPPD) is characterized by the re-emergence of perceptual symptoms experienced during acute hallucinogen intoxication following drug cessation. The underlying pathophysiology is poorly understood. We report the clinical characteristics and investigation findings of a series of HPPD cases with a literature review of previous case reports. We draw parallels between the features of HPPD and Visual Snow Syndrome (VSS).MethodsRetrospective case series of 13 patients referred from neuro-ophthalmologists. Literature review with 24 HPPD case reports were identified through database search using the terms “hallucinogenic persisting perception disorder” OR “hallucinogen persisting perception disorder.”ResultsLysergic acid diethylamide (LSD), 3,4-Methyl enedioxy methamphetamine (MDMA) and cannabinoid use was common. Cannabinoids and MDMA were mostly used in association with classical hallucinogens. The most frequent symptoms in our patients were visual snow, floaters, palinopsia, photophobia and nyctalopia. In the literature other symptoms included visual hallucinations altered motion perception, palinopsia, tracers and color enhancement. Ophthalmic and neurologic investigations were mostly normal. The majority of patients had ongoing symptoms. Two of our patients fully recovered—one after treatment with benzodiazepine and one without treatment. Twenty-five percent of cases from the literature fully recovered.ConclusionsHPPD presents with heterogeneous visual phenomena on a background of previous classic and non-classic hallucinogen use. Ophthalmic investigations are typically normal. The symptoms of HPPD in our case series overlap with the typical features of Visual Snow Syndrome (VSS). Patients presenting with VSS should be screened for past recreational drug use. The DSM-5 description of HPPD does not include visual snow, nyctalopia, photophobia or floaters. A revision of the diagnostic criteria to include these symptoms may better reflect the typical clinical phenotype. Increased awareness of HPPD as a secondary cause of VSS can avoid extensive investigations. Controlled trials comparing primary and secondary VSS patients are needed to understand the pathophysiology better and optimize treatment for HPPD.

This article describes the successful treatment of a 16-year-old female presenting with chronic posttraumatic stress disorder (PTSD) related to alleged childhood sexual abuse using traumafocused cognitive behavioral therapy (TF-CBT). Treatment was delivered by a graduate student who learned the treatment through the completion of an online training course and was supervised by a licensed clinical psychologist. Both the student and the supervisor had extensive training and experience in the delivery of cognitive behavioral therapy (CBT) interventions for adolescents. Several challenges were encountered, most notably the reemergence of legal proceedings related to the alleged abuse during the course of treatment. Treatment implications are discussed, including the need to tailor manualized treatments for particular clients and the utility of online training courses. Overall, this case study adds to the limited literature on the treatment of chronic PTSD in adolescents and provides support for the transportability of TF-CBT to practice settings, as well as the dissemination potential of an online course.Keywords posttraumatic stress disorder, trauma-focused cognitive behavioral therapy, dissemination Theoretical and Research Basis for TreatmentPosttraumatic stress disorder (PTSD) is a psychiatric disorder that develops after being exposed to a traumatic event (either directly or indirectly) in which death, serious injury, or sexual violence was threatened or occurred. It is characterized by reexperiencing symptoms, avoidance behaviors, negative alterations in mood and thoughts, and increased arousal (American Psychiatric Association, 2013). Chronic PTSD affects both children and adults and has been associated with long-term changes in brain structure and function, as well as increased risk for suicide, substance abuse, and health problems (Brown, 2005). A recent national survey of adolescents aged 13 through 17 years found a lifetime prevalence rate of 4.7% using the Diagnostic and Statistical

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Adolescents and young adults (youth), ages 13 to 24 years, represented 21% of the 39,782 HIV infections reported during 2016 in the United Stated, with a disproportionate prevalence in ethnic, minority youth (Centers for Disease Control and Prevention, 2017). Antiretroviral therapy (ART) has been recommended for all people living with HIV infection (PLWH; U.S. Department of Health and Human Services, 2017). However, youth living with HIV (YLWH) face substantial difficulties with ART adherence, in comparison to adult counterparts, resulting in poor health outcomes such as treatment failure and risk of sexual transmission to seronegative partners (Wong, Zucker, Fernandes, & Cennimo, 2016; Wood, Lowenthal, Lee, Ratcliffe, & Dowshen, 2017). Adherence research is an important component of effective HIV treatment and care, but to date, there is a paucity of evidence describing targeted behavioral interventions for YLWH (Shaw & Amico, 2016), including studies designed to examine the influence of technology on adherence behavior (Navarra et al., 2017). Guided by the PRECEDE PROCEDE model of health education and promotion (Green & Kreuter, 1991), the aims of our pilot study were to (a) test the feasibility and acceptability of