Litjens Ruud P W, Brunt Tibor M, Alderliefste Gerard-Jan, Westerink Remco H S
Neurotoxicology Research Group, Toxicology Division, Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, P.O. Box 80177 NL-3508 TD Utrecht, The Netherlands; Drug Monitoring, Netherlands Institute of Mental Health and Addiction, P.O. Box 725, NL-3500 AS Utrecht, The Netherlands.
Drug Monitoring, Netherlands Institute of Mental Health and Addiction, P.O. Box 725, NL-3500 AS Utrecht, The Netherlands.
Eur Neuropsychopharmacol. 2014 Aug;24(8):1309-23. doi: 10.1016/j.euroneuro.2014.05.008. Epub 2014 May 20.
Hallucinogen persisting perception disorder (HPPD) is a drug-induced condition associated with inaccurate visual representations. Since the underlying mechanism(s) are largely unknown, this review aims to uncover aspects underlying its etiology. Available evidence on HPPD and drug-related altered visual processing was reviewed and the majority of HPPD cases were attributed to drugs with agonistic effects on serotonergic 5-HT₂A receptors. Moreover, we present 31 new HPPD cases that link HPPD to the use of ecstasy (MDMA), which is known to reverse serotonin reuptake and acts as agonist on 5-HT₂A receptors. The available evidence suggests that HPPD symptoms may be a result from a misbalance of inhibitory-excitatory activity in low-level visual processing and GABA-releasing inhibitory interneurons may be involved. However, high co-morbidities with anxiety, attention problems and derealization symptoms add complexity to the etiology of HPPD. Also, other perceptual disorders that show similarity to HPPD cannot be ruled out in presentations to clinical treatment. Taken together, evidence is still sparse, though low-level visual processing may play an important role. A novel finding of this review study, evidenced by our new cases, is that ecstasy (MDMA) use may also induce symptoms of HPPD.
致幻剂持续性感知障碍（HPPD）是一种与视觉表征不准确相关的药物诱发病症。由于其潜在机制大多未知，本综述旨在揭示其病因背后的各个方面。我们回顾了关于HPPD和药物相关视觉加工改变的现有证据，大多数HPPD病例归因于对血清素能5-HT₂A受体有激动作用的药物。此外，我们呈现了31例新的HPPD病例，这些病例将HPPD与摇头丸（MDMA）的使用联系起来，已知摇头丸可逆转血清素再摄取并作为5-HT₂A受体的激动剂。现有证据表明，HPPD症状可能是低水平视觉加工中抑制性 - 兴奋性活动失衡的结果，且可能涉及释放GABA的抑制性中间神经元。然而，与焦虑、注意力问题和现实解体症状的高共病率增加了HPPD病因的复杂性。此外，在临床治疗中不能排除其他与HPPD相似的感知障碍。综上所述，尽管低水平视觉加工可能起重要作用，但证据仍然稀少。本综述研究的一个新发现，由我们的新病例证明，是使用摇头丸（MDMA）也可能诱发HPPD症状。
