Neven Arjen, Blom Jan Dirk
From Parnassia Psychiatric Institute (Drs. Neven and Blom), The Hague, the Netherlands.
Fivoor (Dr. Neven), The Hague, the Netherlands.
Harv Rev Psychiatry. 2025 Sep 1;33(5):264-275. doi: 10.1097/HRP.0000000000000439. Epub 2025 Sep 9.
After participating in this CME activity, the psychiatrist should be better able to: Define hallucinogen persisting perception disorder (HPPD) and describe its diagnostic criteria and subtypes. Evaluate pharmacological and nonpharmacological interventions, including evidence-based and supportive approaches. Hallucinogen persisting perception disorder (HPPD) is characterized by perceptual phenomena that either linger after substance-use cessation or recur as reperceptions or flashbacks. These symptoms may be either mild and transient or long-lasting and severely burdening. Since evidence for pharmacological treatment of HPPD is unclear, we seek to provide treatment advice based on a systematic review of existing medication studies. Our search yielded 31 studies with 87 participants treated for HPPD with different types of medication. Three observational studies reported substantial symptom reduction for regimens with clonidine, clonazepam, and levetiracetam. The other 28 studies, which consist of case reports and small case series, found largely similar results for benzodiazepines, antiepileptics, antidepressants, and alpha agonists. Of those who received these pharmacological treatments, 28% showed full recovery and 61% partial recovery within a year. When HPPD was triggered by lysergic acid diethylamide, benzodiazepines were ineffective. Notably, several studies described HPPD symptom aggravation upon treatment with the antipsychotic agent risperidone. Although not statistically significant, our analysis suggests that HPPD can be treated to good effect with the aforementioned groups of medicines. On the basis of our findings, we provide a list of practice-based treatment methods and make suggestions for further research. In particular, epidemiological studies are needed to investigate the natural course of HPPD. Likewise, randomized controlled pharmacological studies are necessary to evaluate the efficacy of medications in different, well-defined HPPD subgroups.
参与本继续医学教育活动后，精神科医生应更有能力：定义致幻剂持续性感知障碍（HPPD）并描述其诊断标准和亚型。评估药物和非药物干预措施，包括循证方法和支持性方法。致幻剂持续性感知障碍（HPPD）的特征是在停止使用物质后仍持续存在或作为再次感知或闪回而复发的感知现象。这些症状可能轻微且短暂，也可能持久且严重影响生活。由于针对HPPD的药物治疗证据尚不明确，我们旨在通过对现有药物研究的系统综述提供治疗建议。我们的检索共得到31项研究，其中87名参与者接受了不同类型药物治疗HPPD。三项观察性研究报告称，可乐定、氯硝西泮和左乙拉西坦治疗方案能显著减轻症状。另外28项研究（包括病例报告和小病例系列）发现，苯二氮䓬类药物、抗癫痫药物、抗抑郁药物和α激动剂的效果大致相似。在接受这些药物治疗的患者中，28%在一年内完全康复，61%部分康复。当HPPD由麦角酸二乙胺引发时，苯二氮䓬类药物无效。值得注意的是，几项研究描述了使用抗精神病药物利培酮治疗时HPPD症状加重的情况。尽管无统计学意义，但我们的分析表明，上述几类药物可有效治疗HPPD。基于我们的研究结果，我们提供了一系列基于实践的治疗方法，并对进一步研究提出建议。特别是，需要进行流行病学研究以调查HPPD的自然病程。同样，有必要开展随机对照药物研究，以评估药物在不同的、明确界定的HPPD亚组中的疗效。
