- Last edited on March 29, 2021
Other Hallucinogen (LSD, MDMA) Intoxication
Primer
Other Hallucinogen Intoxication occurs when there is a clinically significant problematic physiological, behavioural or psychological change that develops during, or shortly after ingestion of a hallucinogen. Depending on the specific hallucinogen, the episode of intoxication can last from minutes, to hours, or longer.[1]
Epidemiology
- The prevalence of other hallucinogen intoxication (not phencyclidine or PCP-like substances) can be roughly estimated by the prevalence of use.
- In the United States, about 1.8% of individuals age 12 years or older report using hallucinogens in the past year.
- About 7.1% of adults age 18 to 25 using hallucinogens in the past year.[2]
Prognosis
- The perceptual disturbances and impaired judgment from hallucinogen intoxication can result in injuries or fatalities.
- This includes car crashes, fights, or unintentional self injury (e.g. - attempting to “fly” from high places)
- Environmental factors, the “set and setting”, personality structure, expectations of the individual using the hallucinogen modulate the nature of and severity of hallucinogen intoxication.[3]
- Other hallucinogen intoxication may lead to increased the risk for suicidality, although suicide is rare among users of hallucinogens.[4]
DSM-5 Diagnostic Criteria
Criterion A
Recent use of a hallucinogen (other than phencyclidine).
Criterion B
Clinically significant problematic behavioural or psychological changes (e.g. - marked anxiety or depression, ideas of reference, fear of “losing one’s mind,” paranoid ideation, impaired judgment) that developed during, or shortly after, hallucinogen use.
Criterion C
Perceptual changes occurring in a state of full wakefulness and alertness (e.g. - subjective intensification of perceptions, depersonalization, derealization, illusions, hallucinations, synesthesias) that developed during, or shortly after, hallucinogen use.
Criterion D
At least 2
of the following signs developing during, or shortly after, hallucinogen use:
- Pupillary dilation
- Tachycardia
- Sweating
- Palpitations
- Blurring of vision
- Tremors
- Incoordination
Criterion E
The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.
Signs and Symptoms
- LSD intoxication: Perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, flashbacks (usually non-disturbing).
- MDMA intoxication: hallucinogenic stimulant: euphoria, hallucinations, disinhibition, hyperactivity, increased thirst, bruxism, distorted sensory and time perception.
- Life-threatening effects include hypertension, tachycardia, hyperthermia, hyponatremia, serotonin syndrome.
- Fatal hyperthermia can be a consequence from MDMA use in rare cases.[5]
- MDMA withdrawal: depression, fatigue, change in appetite, difficulty concentrating, anxiety.
Differential Diagnosis
- Other substance intoxication
- Intoxication with amphetamines, cocaine (or other stimulants), anticholinergics, inhalants, and phencyclidine may present similarly. Toxicological tests are useful to make the distinction.
- Other mental disorders
- Other disorders and conditions to be considered include schizophrenia, depression, withdrawal from other drugs (e.g. - sedatives, alcohol),
- Other medical conditions
- Certain metabolic disorders such as hypoglycemia, seizure disorders, tumors of the central nervous system, and vascular insults may present similarly.
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- Other hallucinogen intoxication is different from HPPD because the symptoms in the HPPD continue episodically or continuously for weeks (or even longer) after the most recent intoxication.
- Other hallucinogen-induced disorders
- Other hallucinogen intoxication is distinguished from the other hallucinogen-induced disorders (e.g., - hallucinogen-induced anxiety disorder, with onset during intoxication) because the symptoms in these latter disorders predominate the clinical presentation and warrant additional, independent clinical attention.