Hallucinogen persisting perception disorder: what do we know after 50 years?
This meta-analysis (2003, s=20) reviews the findings concerning the Hallucinogen Persisting Perception Disorder (HPPD, or flashbacks) diagnosis. It discusses the difficulty of applying its diagnostic criteria reliably in light of the ambiguous definition of a 'flashback' which shares similarities with symptoms of PTSD. Results conclude that the prevalence of strict HPPD in response to illicit hallucinogen use is probably very low, although the aetiology and treatment of this disorder are understudied.
Abstract
Introduction
Flashbacks’ following use of hallucinogenic drugs have been reported for decades; they are recognized in DSM-IV as ‘Hallucinogen Persisting Perception Disorder (Flashbacks)’, or HPPD.
Methods
We located and analyzed 20 quantitative studies between 1955 and 2001 examining this phenomenon. However, many of these studies were performed before operational criteria for HPPD were published in DSM-III-R, so they are difficult to interpret in the light of current diagnostic criteria.
Results
Overall, current knowledge of HPPD remains very limited. In particular (1) the term ‘flashbacks’ is defined in so many ways that it is essentially valueless; (2) most studies provide too little information to judge how many cases could meet DSM-IV criteria for HPPD; and consequently (3) information about risk factors for HPPD, possible etiologic mechanisms, and potential treatment modalities must be interpreted with great caution. At present, HPPD appears to be a genuine but uncommon disorder, sometimes persisting for months or years after hallucinogen use and causing substantial morbidity. It is reported most commonly after illicit LSD use, but less commonly with LSD administered in research or treatment settings, or with use of other types of hallucinogens. There are case reports, but no randomized controlled trials, of successful treatment with neuroleptics, anticonvulsants, benzodiazepines, and clonidine.
Discussion
Although it may be difficult to collect large samples of HPPD cases, further studies are critically needed to augment the meager data presently available regarding the prevalence, etiology, and treatment of HPPD.
Research Summary of 'Hallucinogen persisting perception disorder: what do we know after 50 years?'
Introduction
Reports of 'flashbacks' after hallucinogen use have appeared in the scientific and popular literature for many decades. Standardised diagnostic criteria were not available until the publication of DSM-III-R in 1986 and were slightly revised in DSM-IV as Hallucinogen Persisting Perception Disorder (HPPD). DSM-IV requires re-experiencing perceptual symptoms that occurred during intoxication, clinically significant distress or impairment, and exclusion of medical or other psychiatric causes. Halpern and Pope set out to review quantitative studies of post-hallucinogen perceptual disturbances to determine what is reliably known about HPPD. Specifically, they aimed to locate studies reporting groups of cases, assess how well these reports map onto modern DSM-IV criteria, and summarise evidence on epidemiology, aetiology, and treatment.
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Study Details
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Halpern, J. (2003). Hallucinogen persisting perception disorder: what do we know after 50 years?. Drug and Alcohol Dependence, 69(2), 109-119. https://doi.org/10.1016/S0376-8716(02)00306-X
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