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On Perception and Consciousness in HPPD: A Systematic Review

Hallucinogen-persisting perception disorder (HPPD) features as a diagnostic category in the DSM-5, ICD-11, and other major classifications, but our knowledge of the phenomenology of the perceptual symptoms involved and the changes in consciousness during the characteristic “flashbacks” is limited. W...

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Autores principales: Vis, Pieter J., Goudriaan, Anneke E., ter Meulen, Bastiaan C., Blom, Jan Dirk
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8385145/
https://www.ncbi.nlm.nih.gov/pubmed/34456666
http://dx.doi.org/10.3389/fnins.2021.675768
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author Vis, Pieter J.
Goudriaan, Anneke E.
ter Meulen, Bastiaan C.
Blom, Jan Dirk
author_facet Vis, Pieter J.
Goudriaan, Anneke E.
ter Meulen, Bastiaan C.
Blom, Jan Dirk
author_sort Vis, Pieter J.
collection PubMed
description Hallucinogen-persisting perception disorder (HPPD) features as a diagnostic category in the DSM-5, ICD-11, and other major classifications, but our knowledge of the phenomenology of the perceptual symptoms involved and the changes in consciousness during the characteristic “flashbacks” is limited. We systematically evaluated original case reports and case series on HPPD to define its phenomenology, associated (psycho)pathology, and course. Our search of PubMed and Embase yielded 66 relevant publications that described 97 people who, together, experienced 64 unique symptoms of HPPD. Of these, 76% concerned symptoms characteristic of Alice in Wonderland syndrome, over 50% non-visual symptoms, and 38% perceptual symptoms not clearly linked to prior intoxication states. This is in contrast with the DSM-5 diagnostic criteria for HPPD. Even though less than half of the patients showed a protracted disease course of over a year, a third achieved remission. However, in patients with co-occurring depression (with or without anxiety) HPPD symptoms persisted longer and treatment outcomes were more often negative. Thus, unlike the acute stages of psychedelic drug intoxication, which may be accompanied by altered states of consciousness, HPPD is rather characterized by changes in the content of consciousness and an attentional shift from exogenous to endogenous phenomena. Since HPPD is a more encompassing nosological entity than suggested in the DSM-5, we recommend expanding its diagnostic criteria. In addition, we make recommendations for clinical practice and future research.
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spelling pubmed-83851452021-08-26 On Perception and Consciousness in HPPD: A Systematic Review Vis, Pieter J. Goudriaan, Anneke E. ter Meulen, Bastiaan C. Blom, Jan Dirk Front Neurosci Neuroscience Hallucinogen-persisting perception disorder (HPPD) features as a diagnostic category in the DSM-5, ICD-11, and other major classifications, but our knowledge of the phenomenology of the perceptual symptoms involved and the changes in consciousness during the characteristic “flashbacks” is limited. We systematically evaluated original case reports and case series on HPPD to define its phenomenology, associated (psycho)pathology, and course. Our search of PubMed and Embase yielded 66 relevant publications that described 97 people who, together, experienced 64 unique symptoms of HPPD. Of these, 76% concerned symptoms characteristic of Alice in Wonderland syndrome, over 50% non-visual symptoms, and 38% perceptual symptoms not clearly linked to prior intoxication states. This is in contrast with the DSM-5 diagnostic criteria for HPPD. Even though less than half of the patients showed a protracted disease course of over a year, a third achieved remission. However, in patients with co-occurring depression (with or without anxiety) HPPD symptoms persisted longer and treatment outcomes were more often negative. Thus, unlike the acute stages of psychedelic drug intoxication, which may be accompanied by altered states of consciousness, HPPD is rather characterized by changes in the content of consciousness and an attentional shift from exogenous to endogenous phenomena. Since HPPD is a more encompassing nosological entity than suggested in the DSM-5, we recommend expanding its diagnostic criteria. In addition, we make recommendations for clinical practice and future research. Frontiers Media S.A. 2021-08-11 /pmc/articles/PMC8385145/ /pubmed/34456666 http://dx.doi.org/10.3389/fnins.2021.675768 Text en Copyright © 2021 Vis, Goudriaan, ter Meulen and Blom. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neuroscience
Vis, Pieter J.
Goudriaan, Anneke E.
ter Meulen, Bastiaan C.
Blom, Jan Dirk
On Perception and Consciousness in HPPD: A Systematic Review
title On Perception and Consciousness in HPPD: A Systematic Review
title_full On Perception and Consciousness in HPPD: A Systematic Review
title_fullStr On Perception and Consciousness in HPPD: A Systematic Review
title_full_unstemmed On Perception and Consciousness in HPPD: A Systematic Review
title_short On Perception and Consciousness in HPPD: A Systematic Review
title_sort on perception and consciousness in hppd: a systematic review
topic Neuroscience
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8385145/
https://www.ncbi.nlm.nih.gov/pubmed/34456666
http://dx.doi.org/10.3389/fnins.2021.675768
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