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Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find one of our Presentation of HPPD
Synonyms: HPPD, 'flashbacks'
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What is hallucinogen persisting perception disorder?schizophrenia and not be associated with waking or falling to sleep when hypnopompic or hypnagogic hallucinations are a more likely cause.HPPD can be differentiated into:2
HPPD I: generally short-term, non-distressing, benign and reversible state accompanied by a pleasant affect.
HPPD 2: generally long-term, distressing, pervasive, either slowly reversible or irreversible, non-benign state accompanied by an unpleasant affect.
How common is HPPD? (Epidemiology)
It is very uncommon on a population basis and probably still extremely rare in the population that has taken hallucinogenic drugs. No reliable prevalence data are available. However, a vast list of psychoactive substances has been identified and linked with the development of HPPD, including magic mushrooms, ketamine, dextromethorphan, MDMA and MDA, and cannabis and synthetic cannabinoids.1
Risk factors3
There are no known risk factors for HPPD.
Lysergic acid diethylamide (LSD) is the hallucinogen most frequently associated with HPPD.
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Presentation of HPPD4
Symptoms
Visual hallucinations in the form of trailing colours.
The sensation that something is moving in the peripheral field of vision although there is nothing there.
Trailing phenomena - moving objects leave trails or after-images.
Positive after-images (an image that retains the original colour).
Colour flashes when lighting is low.
Colours of increased intensity.
Haloes surrounding objects.
Macropsia and micropsia (objects appear respectively larger or smaller than normal).
Differential diagnosis5 Parkinson's disease and L-dopa.Factitious illness.
Acute withdrawal from alcohol or drugs (take full substance use history).
Ocular disease causing perceptual disturbance.
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Investigations
There are no useful confirmatory tests. Screening blood tests, cerebral imaging and electroencephalography (EEG) may be used to exclude other causes of the symptoms.
Management of HPPD1 3
Refer to a specialist centre experienced in dealing with substance abuse.
Treatment options include clonazepam, benzodiazepines, antipsychotics, anticonvulsants and opioid antagonists.
However, these treatments have demonstrated only limited success in treating HPPD.
Antidepressants may help in the management of coexisting anxiety and depressive disorders.
Prognosis2
The prognosis is variable, with a short term favourable prognosis for HPPD 1 and a more protracted, less favourable outcome for HPPD 2.
Prevention of HPPD6
Avoidance of hallucinogenic and other recreational drugs associated with the condition. Failing that, avoidance of excessive or frequently repeated use of these drugs.
Further reading and references
- Orsolini L, Papanti GD, De Berardis D, et al; The "Endless Trip" among the NPS Users: Psychopathology and Psychopharmacology in the Hallucinogen-Persisting Perception Disorder. A Systematic Review. Front Psychiatry. 2017 Nov 20;8:240. doi: 10.3389/fpsyt.2017.00240. eCollection 2017.
- HPPD FAQ; erowid.org 2009
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Article history
The information on this page is written and peer reviewed by qualified clinicians.
Next review due: 21 May 2028
23 May 2023 | Latest version
Last updated by
Dr Doug McKechnie, MRCGP
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HPPD I: generally short-term, non-distressing, benign and reversible state accompanied by a pleasant affect.
HPPD 2: generally long-term, distressing, pervasive, either slowly reversible or irreversible, non-benign state accompanied by an unpleasant affect.
Continue reading below
Presentation of HPPD4
Symptoms
Visual hallucinations in the form of trailing colours.
The sensation that something is moving in the peripheral field of vision although there is nothing there.
Trailing phenomena - moving objects leave trails or after-images.
Positive after-images (an image that retains the original colour).
Colour flashes when lighting is low.
Colours of increased intensity.
Haloes surrounding objects.
Macropsia and micropsia (objects appear respectively larger or smaller than normal).
Differential diagnosis5 Parkinson's disease and L-dopa.Factitious illness.
Acute withdrawal from alcohol or drugs (take full substance use history).
Ocular disease causing perceptual disturbance.
Continue reading below
Investigations
There are no useful confirmatory tests. Screening blood tests, cerebral imaging and electroencephalography (EEG) may be used to exclude other causes of the symptoms.
Management of HPPD1 3
Refer to a specialist centre experienced in dealing with substance abuse.
Treatment options include clonazepam, benzodiazepines, antipsychotics, anticonvulsants and opioid antagonists.
However, these treatments have demonstrated only limited success in treating HPPD.
Antidepressants may help in the management of coexisting anxiety and depressive disorders.
Prognosis2
The prognosis is variable, with a short term favourable prognosis for HPPD 1 and a more protracted, less favourable outcome for HPPD 2.
Prevention of HPPD6
Avoidance of hallucinogenic and other recreational drugs associated with the condition. Failing that, avoidance of excessive or frequently repeated use of these drugs.
Further reading and references
- Orsolini L, Papanti GD, De Berardis D, et al; The "Endless Trip" among the NPS Users: Psychopathology and Psychopharmacology in the Hallucinogen-Persisting Perception Disorder. A Systematic Review. Front Psychiatry. 2017 Nov 20;8:240. doi: 10.3389/fpsyt.2017.00240. eCollection 2017.
- HPPD FAQ; erowid.org 2009
Continue reading below
Article history
The information on this page is written and peer reviewed by qualified clinicians.
Next review due: 21 May 2028
23 May 2023 | Latest version
Last updated by
Dr Doug McKechnie, MRCGP
Are you protected against flu?
See if you are eligible for a free NHS flu jab today.
Feeling unwell?
Assess your symptoms online for free
Factitious illness.
Acute withdrawal from alcohol or drugs (take full substance use history).
Ocular disease causing perceptual disturbance.
Continue reading below
Investigations
There are no useful confirmatory tests. Screening blood tests, cerebral imaging and electroencephalography (EEG) may be used to exclude other causes of the symptoms.
Management of HPPD1 3
Refer to a specialist centre experienced in dealing with substance abuse.
Treatment options include clonazepam, benzodiazepines, antipsychotics, anticonvulsants and opioid antagonists.
However, these treatments have demonstrated only limited success in treating HPPD.
Antidepressants may help in the management of coexisting anxiety and depressive disorders.
Prognosis2
The prognosis is variable, with a short term favourable prognosis for HPPD 1 and a more protracted, less favourable outcome for HPPD 2.
Prevention of HPPD6
Avoidance of hallucinogenic and other recreational drugs associated with the condition. Failing that, avoidance of excessive or frequently repeated use of these drugs.
Further reading and references
- Orsolini L, Papanti GD, De Berardis D, et al; The "Endless Trip" among the NPS Users: Psychopathology and Psychopharmacology in the Hallucinogen-Persisting Perception Disorder. A Systematic Review. Front Psychiatry. 2017 Nov 20;8:240. doi: 10.3389/fpsyt.2017.00240. eCollection 2017.
- HPPD FAQ; erowid.org 2009
Continue reading below
Article history
The information on this page is written and peer reviewed by qualified clinicians.
Next review due: 21 May 2028
23 May 2023 | Latest version
Last updated by
Dr Doug McKechnie, MRCGP
Are you protected against flu?
See if you are eligible for a free NHS flu jab today.
Feeling unwell?
Assess your symptoms online for free