The “Endless Trip” among the NPS Users: Psychopathology and Psychopharmacology in the Hallucinogen-Persisting Perception Disorder. A Systematic Review

Abstract

Hallucinogen-persisting perception disorder (HPPD) is a syndrome characterized by prolonged or reoccurring perceptual symptoms, reminiscent of acute hallucinogen effects. HPPD was associated with a broader range of LSD (lysergic acid diethylamide)-like substances, cannabis, methylenedioxymethamphetamine (MDMA), psilocybin, mescaline, and psychostimulants. The recent emergence of novel psychoactive substances (NPS) posed a critical concern regarding the new onset of psychiatric symptoms/syndromes, including cases of HPPD. Symptomatology mainly comprises visual disorders (i.e., geometric pseudo-hallucinations, haloes, flashes of colors/lights, motion-perception deficits, afterimages, micropsia, more acute awareness of floaters, etc.), even though depressive symptoms and thought disorders may be comorbidly present. Although HPPD was first described in 1954, it was just established as a fully syndrome in 2000, with the revised fourth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). HPPD neural substrates, risk factors, and aetiopathogenesys still largely remain unknown and under investigation, and many questions about its pharmacological targets remain unanswered too. A critical mini review on psychopathological bases, etiological hypothesis, and psychopharmacological approaches toward HPPD, including the association with some novel substances, are provided here, by means of a literature search on PubMed/Medline, Google Scholar, and Scopus databases without time restrictions, by using a specific set of keywords. Pharmacological and clinical issues are considered, and practical psychopharmacological recommendations and clinical guidelines are suggested.

Designer drugs: mechanism of action and adverse effects

“…Byproducts and impurities can pose such risks as septum perforation when insufflated or necrotic ulcers and infections when injected (Lafferty et al 2016;Parks et al 2015). Hallucinogen-persisting perception disorder has been associated with psychedelics, cannabinoids, and psychostimulants, manifesting in prolonged or reoccurring perceptual symptoms (Ikeda et al 2005;Orsolini et al 2017;. The neurological and psychological changes that are associated with designer drugs can impair safe driving, and driving under the influence can severely jeopardize traffic safety (Adamowicz and Lechowicz 2015;Maas et al 2015;Musshoff et al 2014).…”

Psykedeliske stoffer i behandling av angst, depresjon og avhengighet

“…Hallusinogenpersistent persepsjonsforstyrrelse (Hallucinogen Persisting Perception Disorder, HPPD) er en tilstand som har vaert hovedsakelig assosiert med rekreasjonsbruk av LSD (17). Tilstanden kjennetegnes av at akutte persepsjoner gjenoppleves lenge etter akutt påvirkning av stoffet.…”

“…Tilstanden har ukjent utbredelse, men den regnes som sjelden. Studier av tilstanden har metodologiske svakheter og baserer seg mye på kasusrapporter (17), og den har ikke blitt sett i de moderne studiene på feltet (8)(9)(10)(11)(12)(13)(14)(15)(16). En amerikansk studie med 130 000 deltagere, hvor 13,4 % oppga aktuelt og/eller tidligere bruk av psykedelika (LSD, psilocybin eller meskalin), viste ingen sammenheng mellom bruk og psykiske vansker (18).…”

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

“…A vast list of psychoactive substances has been identified and linked with the development of this condition, including Magic Mushrooms (psilocybin) [ 21 ] and muscimol ( Amanita muscaria (L.) Lam.) [ 22 ]; San Pedro cactus and Peyote (mescaline) [ 16 , 23 ]; ketamine [ 24 ]; dextromethorphan [ 25 ]; MDMA and MDA [ 26 ]; and cannabis and synthetic cannabinoids [ 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. This condition has also been associated with the consumption of Ayahuasca, Datura stramonium L., Salvia divinorum Epling & Játiva, and Tabernanthe iboga (L.) Nutt., which contains ibogaine [ 17 , 18 ].…”