This tension resulted in months of delay in seeking treatment, and therefore significantly prolonged the PAEs, making it a potentially significant factor for clinicians to consider. “Ego death” in the western psychedelic subculture is at times a highly regarded aspiration, interpretively adopted from other spiritual traditions 34 and popularized with relation to psychedelics by figures such as Timothy Leary 35. Notably, Dr. A was specifically advised by the leaders to not seek psychiatric treatment as her experience was conceived of as a necessary feature of an intended purification process, rather than as an adverse effect. Within such narratives, the interruption of a purification or incomplete purification is sometimes considered a major harm or error 24. After she stopped working with the leaders her concerns included worries about the consequences of ending a purification process, sudden disorientation, feeling foolish, and subsequently fear that the delay in seeking medical treatment would affect her prognosis for recovery.
Data availability
This latent period may last from minutes, hours, or days up to years, and re-emerge as either HPPD I or II with or without any recognized or perceived precipitator 17,19. Episodes of HPPD I and II may appear spontaneously or they may be triggered by identified and non-identified precipitators 18. With regards to this point, neither HPPD I nor HPPD II can really be considered as persisting in a narrow sense of the word. Additionally, their differential diagnosis can only be proposed in terms of prognosis rather than clinical presentation. (2) Statistical analyses comparing the HPPD group with the two control groups, after adjusting for alpha levels, found no significant differences. Given the small sample size, alcoholism the appropriateness of using standard inferential statistics is debatable, as they may not reliably identify differences unless the effect sizes are large.
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From her initial positive experiences with psilocybin, she concluded that psychedelics not only had therapeutic potential but also might induce a global change in consciousness towards political and societal betterment 22. Osterhold (2023) observed that such idealizations may frame psychedelic use as part of a high stakes mission that proliferates use and obscures harms 23. After the sixth and final retreat Dr. A’s symptoms continued to intensify and were sufficiently impairing that she took leave from seeing patients. She turned to the leaders for support, who provided individualized guidance and energy healing for additional financial cost ($5000, in addition to the $25,000 payment for the training program). They advised her specifically to not seek psychiatric intervention or medication as it could impair the process of “rebirth” following her “ego death” and would prolong her symptoms.
Comparison between HPPD group and psychedelic-using control group
Therefore, additional research is needed to further explore the neuropsychological implications of HPPD. (1) Evaluation against norm-referenced data from standardized tests revealed that the cognitive performance of the HPPD group was, mostly, within the normal range. However, closer examination on the subject level revealed that five individuals within the HPPD group exhibited below-average performance in the Rey-Osterrieth Complex Figure (ROCF) recall trial.
We report a list of the main literature-reported visual disturbances in Table 2. DSM-5 diagnoses applied by her treating clinicians included unspecified mood hppd symptoms disorder with manic features and hallucinogen use not meeting criteria for use disorder. Her work-up for organic causes was negative, encompassing serum chemistries, complete blood count, ethanol, thyroid screening, folate, vitamin B12 level, urine drug screen, urinalysis, and head computerized tomography scan. During her first week of inpatient admission, she was prescribed brief trials of medications, which she frequently declined due to concern about side effects, including quetiapine, valproate, gabapentin, hydroxyzine, mirtazapine, and clonazepam. Given her disinclination to psychiatric medications and the severity of her distress, her treatment team recommended a course of electroconvulsive therapy (ECT). She completed seven ECT treatments (See Table 1), with her symptoms improving rapidly following her second treatment.
Management of HPPD1 3
These medications may also be helpful when visual disturbances are accompanied by co-occurring mood swings and mood disorders. She experienced numerous symptoms suggestive of a trauma reaction including recurrent involuntary intrusive flashbacks of her challenging experiences, avoidance behaviors related to integration, numerous negative alterations in cognition and mood, and highly elevated levels of arousal. Because of the degree of distress that intense and prolonged CEs can produce, they may meet criteria for exposure in PTSD. For example, Davies (1979) describes a patient who after ingesting LSD experienced multiple hours of hallucinatory rape and subsequently exhibited symptoms of a severe trauma response, despite being aware after the fact that the experience was hallucinatory 44.
- Notably, Dr. A was specifically advised by the leaders to not seek psychiatric treatment as her experience was conceived of as a necessary feature of an intended purification process, rather than as an adverse effect.
- Agomelatine, given its peculiar function on neurotrophic factors 74, could have some benefits on the syndrome, although no data are available until now.
- Amelioration following long-term administration of SSRIs was attributed to the down-regulation of 5-HT2 receptors, providing more evidence to corroborate the serotonergic mechanisms underlying this condition.
- More research is needed to understand the changes in the brain that cause HPPD symptoms.
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Her confidence in the leaders declined as her symptoms persisted and, despite their objections, she began to seek guidance from medical professionals. She briefly trialed psychotropic medications as described earlier, but largely continued to prioritize the leaders’ guidance. With HPPD a person experiences ongoing visual disturbances, flashbacks, and other persistent symptoms after hallucinogenic drug use.