182 Hallucinogen Persisting Perception Disorder (Flashbacks) (292.89)

DSM-IV-TR criteria

A. The re-experiencing, 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 another mental disorder (e.g., delirium, dementia, Schizophrenia) or hypnopompic hallucinations.

Associated features

Major depression and panic disorders and frequented associated features of HPPD.

Child vs. adult presentation

Gender and cultural differences in presentation

Epidemiology

• Episodes of self induced abnormal perceptions are associated with HPPD. These episodes can occur simply by thinking about them or can be triggered by stressors such as entry into a dark environment, various drugs, and anxiety or fatigue. These episodes will usually stop or be less frequently occurring after several months. The individual must be able to recognize that the perception is a drug effect and does not represent external reality. A diagnosis of Psychotic Disorder Not Otherwise Specified would be needed if the individual has a delusional interpretation concerning the etiology of the perceptual disturbance.
• Uncommon, although prevalence rates are higher in larger populations, the amount of people who take hallucinogens and those who suffer from HPPD have no correlation.

Etiology

No one is completely sure what causes HPPD, although there have been many theories. Many believe that the excessive use of hallucinogen causing drugs do not develop HPPD.

Empirically supported treatment

HPPD can often times mimic side affects of a stroke, brain tumor, or any other neurological disorder. Antidepressant drugs can sometimes help but there is no certain cure or treatment for HPPD. Psychotherapy helps to reduce anxiety or to help one cope with the hallucinations, but unfortunately there is nothing to take away the actual hallucinations. Benzodiazepines such as Valium or Xanax can help to reduce haullucinations as well as the anticonvulsant drug Clonazepam/Klonopin.

DSM-V Proposed Changes: Adding “Hallucinogen-Use Disorder”

DSM-V Criteria for Hallucinogen-Use Disorder:

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 (or more) of the following, occurring within a 12-month period:

1. recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)

2. recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)

3. continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

4. tolerance, as defined by either of the following:

• a need for markedly increased amounts of the substance to achieve intoxication or desired effect
• markedly diminished effect with continued use of the same amount of the substance

(Note: Tolerance is not counted for those taking medications under medical supervision such as analgesics, antidepressants, ant-anxiety medications or beta-blockers.)

5. withdrawal, as manifested by either of the following:

• the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)
• the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
• (Note: Withdrawal is not counted for those taking medications under medical supervision such as analgesics, antidepressants, anti-anxiety medications or beta-blockers.)

6. the substance is often taken in larger amounts or over a longer period than was intended

7. there is a persistent desire or unsuccessful efforts to cut down or control substance use

8. a great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects

9. important social, occupational, or recreational activities are given up or reduced because of substance use

10. the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance

11. Craving or a strong desire or urge to use a specific substance.

Severity specifiers:

• Moderate: 2-3 criteria positive
• Severe: 4 or more criteria positive

Specify if:

• With Physiological Dependence: evidence of tolerance or withdrawal (i.e., either Item 4 or 5 is present)
• Without Physiological Dependence: no evidence of tolerance or withdrawal (i.e., neither Item 4 nor 5 is present)

Course specifiers (see text for definitions):

• Early Full Remission
• Early Partial Remission
• Sustained Full Remission
• Sustained Partial Remission
• On Agonist Therapy
• In a Controlled Environment