Hallucinogens disorder

Glassification of Substance-Related Disorders. The DSM-IV classification system (1) divides substance-related disorders into two categories (/) substance use disorders, ie, abuse and dependence and (2) substance-induced disorders, intoxication, withdrawal, delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. The different classes of substances addressed herein are alcohol, amphetamines, caffeine, caimabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics or anxiolytics, polysubstance, and others. On the basis of their significant socioeconomic impact, alcohol, nicotine, cocaine, and opioids have been selected for discussion herein. 

Table 6-4. DSM-IV-TR diagnostic criteria for hallucinogen persisting perception disorder...

Patients seen for flashbacks are treated with oral diazepam (15—30 mg/day for adults) if symptoms of anxiety are severe (Rumack 1987). Neuroleptics, especially haloperidol, have been implicated in a transient increase in visual flashbacks and are not recommended (Moskowitz 1971 Strassman 1984). Risperidone and selective serotonin reuptake inhibitors may also worsen symptoms of hallucinogen persisting perception disorder (Halpern and Pope 2003). The patient needs assurance of the self-limiting nature of the phenomenon and its decreasing frequency of reoccurrence with time. The patient should be reminded that any future use of hallucinogens or marijuana may precipitate similar symptoms (Strassman 1984). 

Halpern JH, Pope HG Jr Hallucinogen persisting perception disorder what do we know after 30 years Drug Alcohol Depend 69 109—119, 2003 Halpern JH, Pope HG Jr, Sherwood AR, et al Residual neuropsychological effects of illicit 3,4-methylenedioxymethamphetamine (MDMA) in individuals with minimal exposure to other drugs. Drug Alcohol Depend 7 149-152, 2004 Hatrick JA, Dewhurst K Delayed psychosis due to LSD. Lancet 2 742-744, 1970... 

HPPD hallucinogen persisting perception disorder MF.l.AS mitochondrial myopathy, encephalopathy, lactic... 

See Chap. 68, Substance-Related Disorders Overview and Depressants, Stimulants, and Hallucinogens, authored by Paul L. Doering and Lisa Boothby, and Chap. 69, Substance-Related Disorders Alcohol, Nicotine, and Caffeine, authored by Paul L. Doering, W. Klugh Kennedy, and Lisa A. Boothby, for a more detailed discussion of the topic. 

Hallucinogen-persisting perception disorder Hallucinogen-persisting perception disorder (HPPD), commonly called flashbacks, are phenomena where the person reexperiences aspects of the hallucinogenic trip long after it has ended. This is reported by approximately 15% of LSD users. 

The transmethylation hypothesis depended on the psychosis of mescaline as an example of how methylated compounds similar in structure to the monoamine neurotransmitters could be psychotogenic, and demonstrated how methionine, the precursor of the methyl donor S-adenosylmethionine, could exacerbate the psychotic symptoms of schizophrenia in patients. This theory was fed by studies of the now notorious pink spot, an amine found in paper chromatography of urine extracts from schizophrenics and thought to be 3,4-dimethoxyphenylethylamine (i.e., O-methylated dopamine). Subsequent studies eventually identified this as another compound or compounds, primarily of dietary origin. Another methylated derivative erroneously proposed to be found in higher quantities in schizophrenia was dimethyltryptamine. This compound is similar in structure to LSD, the hallucinogenic nature of which was the key to the serotonin deficiency hypothesis, which proposed that the known antagonism of serotonin (5-HT) by LSD indicated that psychotic disorders such as schizophrenia may result from a hypofunction of 5-HT. 

Morehead, D. (1997) Exacerbation of hallucinogen-persisting perception disorder with risperidone. ] Clin Psychopharm 17 327-328. 

In the late nineteenth and twentieth centuries, hallucinogenic substances were viewed as possible tools for understanding and treating psychiatric and other mental disorders. Tribal medicine men, or shamans, have always maintained it was an effective medicine to treat a number of ailments including alcoholism. However, peyote did not really catch on as a drug to be explored in the recreational arena until 1953 when the English novelist Aldous Huxley (1894-1963) wrote The Doors of Perception where he recounted his experiences with the peyote. 

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