Psych · Addiction psychiatry — hallucinogen-related disorders
Hallucinogen-related disorders
Also known as Hallucinogen use disorder · Psychedelic intoxication · LSD intoxication · Psilocybin adverse effects · Bad trip · Hallucinogen persisting perception disorder · HPPD · Classic psychedelics · Serotonergic hallucinogens
Fellowship-depth atlas on hallucinogen-related disorders — classic serotonergic psychedelics (LSD, psilocybin, mescaline, DMT), intoxication and bad-trip care, low dependence liability versus use disorder, HPPD, substance-induced psychosis, set/setting risk, and the clinical interface with psychedelic-assisted therapy research. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Severe medical toxicity, hyperthermia, seizure, focal neurology or suspected adulterant (e.g. NBOMe sold as LSD) — medical emergency before psychiatric labelling
- Dangerous behaviour under intoxication (traffic, heights, self-harm, aggression) — secure environment and continuous observation
- Serotonin toxicity risk with MAOI-containing ayahuasca/harmala alkaloids plus serotonergic agents
- First-episode psychosis after use with family history of psychosis — dual formulation; do not force lifelong primary psychosis label on day one without timeline
- Persistent distressing visual phenomena after cessation (HPPD) with functional impairment — not dismiss as 'just flashbacks'
- Patient requesting unsupervised microdosing as treatment after trial headlines — research protocol is not recreational prescribing
Meet the patient
A 21-year-old is brought by ambulance from a weekend festival, pupils saucer-wide, whispering that the walls are "breathing the future at him." His friends say he took "acid" three hours ago. His mates are calm; he is not. His temp is 38.9, HR 118, and he just tried to walk through a glass door.[1][12]
Two questions are live before you do anything else: is this a pure classic intoxication, or something nastier hiding in the blotter? and is he safe to sit in a side room with a cup of tea? This topic answers both at consultant depth.[1][2]
References12ShowHide
- [1]Johnson MW, Richards WA, Griffiths RR Human hallucinogen research: guidelines for safety J Psychopharmacol, 2008.PMID 18593734
- [2]Nichols DE Psychedelics Pharmacol Rev, 2016.PMID 26841800
- [3]Halpern JH, Pope HG Jr Hallucinogen persisting perception disorder: what do we know after 50 years? Drug Alcohol Depend, 2003.PMID 12609692
- [4]Martinotti G, Santacroce R, Pettorruso M, et al. Hallucinogen Persisting Perception Disorder: Etiology, Clinical Features, and Therapeutic Perspectives Brain Sci, 2018.PMID 29547576
- [5]Carbonaro TM, Bradstreet MP, Barrett FS, et al. Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences J Psychopharmacol, 2016.PMID 27578767
- [6]Studerus E, Kometer M, Hasler F, Vollenweider FX Acute, subacute and long-term subjective effects of psilocybin in healthy humans: a pooled analysis of experimental studies J Psychopharmacol, 2011.PMID 20855349
- [7]Krebs TS, Johansen PØ Psychedelics and mental health: a population study PLoS One, 2013.PMID 23976938
- [8]Nutt DJ, King LA, Phillips LD Drug harms in the UK: a multicriteria decision analysis Lancet, 2010.PMID 21036393
- [9]Goodwin GM, Aaronson ST, Alvarez O, et al. Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression N Engl J Med, 2022.PMID 36322843
- [10]Bogenschutz MP, Ross S, Bhatt S, et al. Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder: A Randomized Clinical Trial JAMA Psychiatry, 2022.PMID 36001306
- [11]Carhart-Harris R, Giribaldi B, Watts R, et al. Trial of Psilocybin versus Escitalopram for Depression N Engl J Med, 2021.PMID 33852780
- [12]Kopra EI, Ferris JA, Winstock AR, et al. Adverse experiences resulting in emergency medical treatment seeking following the use of magic mushrooms J Psychopharmacol, 2022.PMID 35388724