Additional information on hallucinogen-related disorders
Additional Information on Hallucinogen-Related Disorders
Associated Features and Disorders
When intoxicated with a hallucinogen, individuals may be voluble and discursive and show rapid alternation of moods. Fearfulness and anxiety may become intense, with dread of insanity or death. Many hallucinogenic substances have stimulant effects (e.g., tachycardia, mild hypertension, hyperthermia, and pupillary dilation) and may cause some of the features of Amphetamine Intoxication. The perceptual disturbances and impaired judgment associated with Hallucinogen Intoxication may result in injuries or fatalities from automobile accidents, physical fights, or attempts to "fly" from high places. Environmental factors and the personality and expectations of the individual using the hallucinogen may contribute to the nature and severity of Hallucinogen Intoxication. Intoxication may also be associated with physiological changes, including increases in blood glucose, cortisol, ACTH, and prolactin. Hallucinogen Persisting Perception Disorder may produce considerable anxiety and concern and may be more common in suggestible persons. It remains controversial whether the chronic hallucinogen use produces a Psychotic Disorder de novo, triggers psychotic symptoms only in vulnerable persons, or is simply an early and continuing sign of an evolving psychotic process. Hallucinogen Abuse and Dependence also frequently occur in persons with preexisting adolescent Conduct Disorder or adult Antisocial Personality Disorder. LSD intoxication may be confirmed by urine toxicology.
Specific Culture, Age, and Gender Features
Hallucinogens may be used as part of established religious practices such as peyote in the Native American Church. Within the United States, there are regional differences and changes in patterns of use over the decades. Hallucinogen Intoxication usually first occurs in adolescence, and younger users may tend to experience more disruptive emotions. Hallucinogen use and Intoxication appear to be three times more common among males than among females.
Prevalence
Hallucinogens came into vogue in the United States in the 1960s. Over the years, a variety of these agents have been popular, but in the 1990s the two most commonly used drugs of this class have been LSD and MDMA. It is estimated that the peak prevalence of intake of hallucinogens in the United States was between 1966 and about 1970, with a subsequent decline, but there is some evidence of a modest increase beginning in approximately 1990.
According to a 1996 national survey of drug use, 10% of people aged 12 and older acknowledged ever having used a hallucinogen. The age group reporting the highest proportion who had ever used one of these drugs was 18- to 25-year-olds (16%), including 7% in the past year and 2% in the prior month. Among high school seniors, data from a 1997 national survey indicated that 15% acknowledged ever having taken a hallucinogen, including 10% in the prior year. It should be noted that because these surveys measured patterns of use rather than disorders, it is not known how many of those in the survey who used hallucinogens had symptoms that met the criteria for Dependence or Abuse.
A 1992 community survey conducted in the United States reported lifetime rates of Hallucinogen Abuse or Dependence to be about 0.6%, with a 12-month prevalence rate of about 0.1%.
Course
Hallucinogen Intoxication may be a brief and isolated event or may occur repeatedly. The intoxication may be prolonged if doses are frequently repeated during an episode. Frequent dosing, however, tends to reduce the intoxicating effects because of the development of tolerance. Depending on the drug and its route of administration, peak effects occur within a few minutes to a few hours, and intoxication ends within a few hours to a few days after dosing ends. The high prevalence of "ever having used" hallucinogens among those ages 26-34 years and the lower prevalence of recent use in that group suggest that many individuals may stop using hallucinogens as they get older. Some individuals who use hallucinogen report "flashbacks" that are not associated with any impairment or distress. On the other hand, flashbacks can cause impairment or distress in some individuals (Hallucinogen Persisting Perception Disorder; see above).
Differential Diagnosis
For a general discussion of the differential diagnosis of Substance-Related Disorders, see p. 207. Hallucinogen-Induced Disorders may be characterized by symptoms (e.g., delusions) that resemble primary mental disorders (e.g., Schizophreniform Disorder versus Hallucinogen-Induced Psychotic Disorder, With Delusions, With Onset During Intoxication). See p. 210 for a discussion of this differential diagnosis.
Hallucinogen Intoxication should be differentiated from Amphetamine or Phencyclidine Intoxication. Toxicological tests are useful in making this distinction. Intoxication with anticholinergics can also produce hallucinations, but they are often associated with physical findings of pupillary dilation, fever, dry mouth and skin, flushed face, and visual disturbances. 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 are in excess of those usually associated with Hallucinogen Intoxication and are severe enough to warrant independent clinical attention.
Hallucinogen Intoxication is distinguished from Hallucinogen Persisting Perception Disorder (Flashbacks) by the fact that the latter continues episodically for weeks (or longer) after the most recent intoxication. In Hallucinogen Persisting Perception Disorder, the individual does not believe that the perception represents external reality, whereas a person with a Psychotic Disorder often believes that the perception is real. Hallucinogen Persisting Perception Disorder may be distinguished from migraine, epilepsy, or a neurological condition by neuro-ophthalmological history, physical examination, and appropriate laboratory evaluation.