Hallucinogens and related dis... Health Article

Diagnosis

Although not all experts agree, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), which presents guidelines used by the American Psychiatric Association for diagnosisof mental disorders, recognizes two hallucinogen-related disorders: hallucinogen dependence and hallucinogen abuse. Hallucinogen dependence is the continued use of hallucinogens even when the substances cause the affected individual significant problems, or when the individual knows of adverse effects (memory impairment while intoxicated, anxiety attacks, flashbacks), but continues to use the substances anyway. "Craving" hallucinogens after not using them for a period of time has been reported. Hallucinogen abuse is repeated use of hallucinogens even after they have caused the user impairment that undermines his or her ability to fulfill obligations at work, school, or home, but the use is usually not as frequent as it is among dependent users. In addition to these two disorders, the American Psychiatric Association recognizes eight hallucinogen-induced disorders. These are:

• hallucinogen intoxication
• hallucinogen persistent perception disorder (flashbacks)
• hallucinogen intoxication delirium
• hallucinogen-induced psychotic disorder with delusions
• hallucinogen-induced psychotic disorder with hallucinations
• hallucinogen-induced mood disorder
• hallucinogen-induced anxiety disorder
• hallucinogen-related disorder not otherwise specified

Hallucinogen dependence and abuse are normally diagnosed from reports by the patient or person accompanying the patient of use of a hallucinogenic drug. Active hallucinations and accompanying physical symptoms can confirm the diagnosis, but do not have to be present. Routine drug screening does not detect LSD in the blood or urine, although specialized laboratory methods can detect the drug. Hallucinogen dependence differs from other drug dependence in that there are no withdrawal symptoms when the drug is stopped, and the extent of tolerance, (needing a higher and higher dose to achieve the same effect) appears minimal.

Hallucinogen intoxication is diagnosed based on psychological changes, perceptual changes, and physical symptoms that are typical of hallucinogen use. These changes must not be caused by a general medical condition, other substance abuse, or another mental disorder.

Hallucinogen persisting perception disorder, better known as flashbacks, occur after hallucinogen use followed by a period of lucidity. Flashbacks may occur weeks or months after the drug was used, and may occur after a single use or many uses.

To be diagnosed as a psychiatric disorder, flashbacks must cause significant distress or interfere with daily life activities. They can come on suddenly with no warning, or be triggered by specific environments. Flashbacks may include emotional symptoms, seeing colors, geometric forms, or, most commonly, persistence of trails of light across the visual field. They may last for months. Flashbacks are most strongly associated with LSD.

Hallucinogen intoxication delirium is rare unless the hallucinogen is contaminated by another drug or chemical such as strychnine. In hallucinogen intoxication, the patient is still grounded in reality and recognizes that the experiences of altered perception are due to using a hallucinogen. In hallucinogen intoxication delirium, the patient is no longer grounded in reality. Hallucinogen-induced psychotic disorders are similar in that the patient loses touch with reality. Psychotic states can occur immediately after using the drug, or days or months later.

Hallucinogen-induced mood disorder and hallucinogen-induced anxiety disorder are somewhat controversial, as hallucinogen use may uncover latent or pre-existing anxiety or mood disorders rather than being the cause of them. However, it does appear that MDMA use can cause major depression.

Treatments

Acute treatment is aimed at preventing the patient from harming himself or anyone else. Since most people experiencing hallucinogen intoxication remain in touch with reality, "talking down" or offering reassurance and support that emphasizes that the bad trip, anxiety, panic attack, or paranoia will pass as the drug wears off is often helpful. Patients are kept in a calm, pleasant, but lighted environment, and are encouraged to move around while being helped to remain oriented to reality. Occasionally, drugs such as lorazepamare given for anxiety. Complications in treatment occur when the hallucinogen has been contaminated with other street drugs or chemicals. The greatest life-threatening risk is associated with MDMA. Users may develop dangerously high body temperatures. Reducing the patient's temperature is an essential acute treatment.

Treatment for long-term effects of hallucinogen use involve long-term psychotherapyafter drug use has stopped. Many people find 12-step programs or group support helpful. In addition, underlying psychiatric disorders must be addressed.

Prognosis

Because hallucinogens are not physically addictive, many people are able to stop using these drugs successfully. However, users may be haunted by chronic problems such as flashbacks or mood and anxiety disorders either brought about or worsened by use of hallucinogens. It is difficult to predict who will have long-term complications and who will not.