Hallucinogen-Persisting Perception Disorder in a 16-Year-Old Adolescent

Hallucinogen-Persisting Perception Disorder (HPPD) is rare in adolescents. A 16-year-old male with major depressive disorder and polysubstance use (LSD, MDMA, psilocybin, cannabis, benzodiazepines) experienced auditory hallucinations and heightened hearing between MDMA use for eight months, plus auditory and visual hallucinations during a five-day inpatient stay. Treatment with aripiprazole 5 mg led to gradual symptom improvement, though symptoms did not fully resolve. Literature review indicates first-line treatments include clonidine and benzodiazepines; second-generation antipsychotics are generally less effective except aripiprazole. Diagnosis was complicated by polysubstance use, requiring distinction from non-substance-induced psychotic disorders.

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Abstract

Objective Hallucinogen-persisting Perception Disorder (HPPD) is a rare condition characterized by the re-experiencing of one or more perceptual symptoms that an individual experienced while intoxicated with a hallucinogenic substance when the individual is sober. While there are several case reports of HPPD in adult patients, there is a scarcity of documented cases in children and adolescents. The purpose of this article is to highlight the presentation, diagnosis, and treatment of HPPD in a 16-year-old male patient. Methods In this case report, the patient is a 16-year-old male with a history of major depressive disorder (MDD) and polysubstance use using Lysergic acid diethylamide (LSD), 3,4-Methylenedioxymethamphetamine (MDMA), psilocybin, cannabis, and benzodiazepines. He endorsed having auditory hallucinations and a heightened sense of hearing in between usage of MDMA for the past eight months and described auditory and visual hallucinations during his 5-day admission at the inpatient child psychiatric unit. Aripiprazole 5 mg was used as treatment for HPPD. Results On review of literature, the first-line treatment for HPPD with clonidine and benzodiazepine has been documented by few case reports. Second generation antipsychotics are documented to be less effective with the exception of aripiprazole. The authors witnessed gradual improvement in the patient’s symptoms with the use of aripiprazole, although it was not completely resolved during his hospital course. Conclusions This case demonstrates the presentation of HPPD and efficacy of aripiprazole in an adolescent patient. The diagnosis was further complicated by the patient’s history of polysubstance use, and determining a distinction from non-substance-induced psychotic disorders was paramount.