The female patient, now 33 years old and an architect by profession, reported the recreational use of up to 30 doses of lysergic acid diethylamide (LSD ‘tabs’) during a 1-year stay in the USA at the age of 18. It is important to note that in contrast to classical psychotic disorders, patients with HPPD recognize the unreal nature of their visual disturbances which qualifies them as pseudohallucinations. At variance with DSM-IV-R, ICD-10 recognizes hallucinogen-induced visual disturbances as lasting only seconds to minutes. Furthermore, these episodes may persist for years. Such experiences may take the form of various geometric shapes, objects in the peripheral visual fields, flashes of different colours, enhanced colour intensity, trailing and stroboscopic perception of moving objects, after images, halos and macro- and micropsia. However, the Diagnostic and Statistical Manual of Mental Disorders, fourth revised edition (DSM-IV-R), classifies these phenomena under the term ‘hallucinogen persisting perception disorder (HPPD)’ – defined as a long-lasting condition characterized by spontaneous recurrence of visual disturbances reminiscent of acute hallucinogen intoxication. In the International Classification of Diseases, 10th revision (ICD-10), such hallucinogen-induced echo psychoses are listed under F16.70. įlashbacks, echo phenomena and other psychotic manifestations typically occur after drug-free periods of varying lengths. Between 5% and 50% of hallucinogen users are reported to have experienced at least one flashback. Ever since the first description, reports about the incidence of post-toxic flashbacks show a wide variation. ![]() Moreover, a consistent etiological model to explain these effects has yet to be proposed. However, the clinical relevance of the long-term psychological sequelae which include so-called flashbacks remains unclear.
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