Home Health Big Book of Emergency Department Psychiatry
Hallucinogens work on the neural networks in the brain that utilize serotonin. The prefrontal cortex is the primary brain area affected by hallucinogen intoxication. In the brain, LSD, psilocybin, and DMT act on the 5-HT serotonin receptors (Aghajanian and Marek 1999; Glennon et al. 1984; Halberstadt and Geyer 2011; Strassman 1996).
Recent use of any hallucinogen can create a plethora of perceptual and physical changes in the user. Hallucinations can occur along with altered sensory experiences, changing the user’s physical manifestation of sight, audition, tactile, and olfaction. A swapping of sensory experiences called synesthesia is sometimes experienced during which the affected person will see sounds or hear colors. It can be common for the user to exhibit intense emotional states and an altered perception of the passage of time. Physical changes including increased energy, pupillary dilation, tachycardia, sweating, palpitations, blurry vision, tremors, nausea, and incoordination may occur (Bey and Patel 2007; National Institute on Drug Abuse 2016a).
Hallucinogen-Persisting Perception Disorder
Various negative consequences can present long after a hallucinogen has been used. Persistent psychosis is one long-term effect that can develop even after just one dose of a hallucinogen. Symptoms that mimic a psychotic disorder are present in persistent psychosis. Visual disturbances, thought disorganization, paranoia, and mood dysregulation are common experiences.
Hallucinogen-persisting perception disorder (HPPD) is another possible long-term effect of hallucinogen use. In HPPD, the individual can re-experience geometric hallucinations and false perceptions of movement in their peripheral vision; the individual may also experience flashes of intense color and see halos and trails from moving objects (Espiard et al. 2005). Symptoms that mimic neurological illness, such as stroke or brain tumor, can be present (Hermle et al. 2012; National Institute on Drug Abuse 2016a).
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