292.89 Hallucinogen Intoxication

Refer, in addition, to the text and criteria for Substance Intoxication (see p. 199). The essential feature of Hallucinogen Intoxication is the presence of clinically significant maladaptive behavioral or psychological changes (e.g., marked anxiety or depression, ideas of reference, difficulty focusing attention, fear of losing one's mind, paranoid ideation, impaired judgment, or impaired social or occupational functioning) that develop during or shortly after (within minutes to a few hours of) hallucinogen use (Criteria A and B). Perceptual changes are a central part of intoxication, developing during or shortly after hallucinogen use and occur in a state of full wakefulness and alertness (Criterion C). These changes include subjective intensification of perceptions, depersonalization, derealization, illusions, hallucinations, and synesthesias. In addition, the diagnosis requires that two of the following physiological signs are also present: pupillary dilation, tachycardia, sweating, palpitations, blurring of vision, tremors, and incoordination (Criterion D). The symptoms must not be due to a general medical condition and are not better accounted for by another mental disorder (Criterion E).

Hallucinogen Intoxication usually begins with some stimulant effects such as restlessness and autonomic activation. Nausea may occur. A sequence of experiences then follows, with higher doses producing more intense symptoms. Feelings of euphoria may alternate rapidly with depression or anxiety. Initial visual illusions or enhanced sensory experience may give way to hallucinations. At low doses, the perceptual changes frequently do not include hallucinations. Synesthesias (a blending of senses) may result, for example, in sounds being "seen." The hallucinations are usually visual, often of geometric forms or figures, sometimes of persons and objects. More rarely, auditory or tactile hallucinations are experienced. In most cases, reality testing is preserved (i.e., the individual knows that the effects are substance induced).

Diagnostic criteria for 292.89 Hallucinogen Intoxication

1. Recent use of a hallucinogen.
2. Clinically significant maladaptive behavioral or psychological changes (e.g., marked anxiety or depression, ideas of reference, fear of losing one's mind, paranoid ideation, impaired judgment, or impaired social or occupational functioning) that developed during, or shortly after, hallucinogen use.
3. 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.
4. Two (or more) of the following signs, developing during, or shortly after, hallucinogen use:
   1. pupillary dilation
   2. tachycardia
   3. sweating
   4. palpitations
   5. blurring of vision
   6. tremors
   7. incoordination
5. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision^TM. Copyright 2000 American Psychiatric Association. All Rights Reserved.