Hallucinogen persisting perception disorder in adolescence: a complex case of lysergic acid diethylamide-induced visual disturbances with trauma-associated exacerbation
Neuroscience Applied – January 01, 2026
Source: OpenAlex
Summary
Hallucinogen Persisting Perception Disorder (HPPD) affects 1-5% of psychedelic users, with a higher prevalence among frequent LSD and synthetic cannabinoid users. Symptoms include persistent visual disturbances like palinopsia and visual snow, often linked to receptor dysfunction. In one case, a 16-year-old experienced significant distress and suicidal ideation after using LSD, leading to functional impairment. Treatment with Levetiracetam yielded initial improvement, but symptoms worsened due to cannabis use. Ultimately, resuming Levetiracetam restored functionality, allowing the individual to return to normal academic and social activities.
Abstract
Hallucinogen Persisting Perception Disorder (HPPD) is a condition affecting 1-5% of psychedelic users, with higher prevalence observed among recurrentLSD consumers and synthetic cannabinoid users [1]. The disorder is characterised by persistent visual disturbances including palinopsia and visual snow, along with dissociative symptoms, which have been neurobiologically linked to 5-HT2A receptor dysfunction and visual cortex hyperactivation [2];[3]. Approximately 20% of cases progress to chronic forms, often associated with early onset and polysubstance use history, necessitating comprehensive therapeutic approaches [1]. We present the case of a 16 year-old with an acute presentation compatible with HPPD after recreational use of lysergic acid diethylamide (LSD). All identifiable data has been removed. A is a 16 year-old young person who presented to an outpatient mental health service with perceptual abnormalities after using LSD for the second time. A’s symptoms had been present for 3 months prior to the assessment, and consisted of visual snow, micropsia and changes in the image definition of objects, with the outlines of objects abruptly becoming much neater. A reported that the symptoms were episodic and sudden.Since the beginning of the symptoms, A had unfortunately been through an extremely traumatic event, the nature of which will not be disclosed in order to protect A’s privacy. A found that situations linked to the trauma trigger episodes of HPPD symptoms and this caused significant distress, including significant suicidal ideation due to how overwhelming these symptoms were. A did not present with flashbacks of the traumatic event. A's functionality had been significantly impaired, with A spending most of the time at home, not going out due to fear of these symptoms reappearing. A did not present with other perceptual abnormalities, delusional beliefs or first-rank symptoms pointing towards a diagnosis of psychosis. A’s mood was low as are result of these symptoms, but denied presenting with depressive symptoms or other mood symptoms prior to the onset of HPPD. A was initially prescribed Levetiracetam up to 750mg twice a day, with initial good response and functional recovery. However, after a few weeks A’s symptoms worsened again, which led to a switch to Lamotrigine up to 50mg with no response. A eventually acknowledged believing that the symptom worsening after initial stability was due to a relapse in substance misuse (cannabis use), and requested to try Levetiracetam again with the intention to avoid drugs this time. Lamotrigine was discontinued and Levetiracetam was introduced gradually up to a dose of 750mg twice a day, with good response. A’s symptoms improved to the point where A could go back to his usual academic and social activities without being impaired by them. Although the visual snow persisted in an attenuated manner, A did not want to increase the dose of Levetiracetam or change to a different medication, and was happy with the prescription. A went on to his previous routine and also engaged in ongoing psychological support for the presenting symptoms.