(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (AG) Class of 2022, Baylor College of Medicine, Houston, Texas
Subject
Hallucinations
Description
Summary: 1. Hallucinogen persistent perception disorder a. disorder precipitated by the use of prior hallucinogens b. causes persistent positive visual disturbance similar to the person's first experience with the hallucinogen c. can't be attributed to active drug use or any other neurologic or psychiatric condition 2. Symptoms a. Visual Hallucinations i. No stimulus b. Illusions i. Has a stimulus c. Palinopsia i. A repeating image ii. changes in size either bigger (macropsia) or smaller (micropsia) iii. changes in shape and color iv. floaters or flashing lights or jagged lines v. can look exactly like migraine. d. Possible feelings of depersonalization or disconnection from their environment.
Transcript
So today we're going to be talking about hallucinogen persisting perception disorder (HPPD) and it is what it sounds like. It is a disorder precipitated by the use of prior hallucinogens. It's persisting because it doesn't go away - it's not transient. And it causes persistent positive visual disturbance and so they're very similar to what the person experienced when they first took the hallucinogen. And what's interesting about HPPD is the hallucinogen use is often remote in time - it was years ago. LSD of course was the prototype but any of the hallucinogenic agents, magic mushrooms, peyote - all of these hallucinogenic agents can cause HPPD years after the exposure. And so they have visual hallucinations. And as you know, a hallucination means there's no stimulus. It can also cause illusions where there is a stimulus. So the visual hallucinations can be geometric figures, circles, they can be formed hallucinations or unformed hallucinations. They can take the form of palinopsia which is a repeating image. Palin- means repeat so they might see the trailing form of illusory palinopsia where they see their hand moving across. They might have repeating images over and over again - the regular kind of palinopsia. They might have changes in size either bigger (macropsia) or smaller (micropsia). They can have changes in shape and color, they might see floaters or flashing lights or jagged lines. It can look exactly like migraine. The perceptual deficits might be accompanied by feelings of depersonalization or disconnection from their environment similar to the hallucinogenic experience. It can't be attributed to active drug use or any other neurologic or psychiatric condition. And so hallucinogen persisting perception disorder is a disorder created by the remote use of hallucinogens that results in downstream persisting perception disorders that are often visual hallucinations, illusions, and palinopsias and you should be able to make the diagnosis and there is no other test. It's strictly these diagnostic criteria.
