LSD abuse
The combination of visual hallucinations, anxiety, panic, and depression are
suggestive of use of a hallucinogen, such as lysergic acid diethylamide (LSD).
Hallucinogens are compounds that, in nontoxic doses, cause distortions in
perceptions without loss of consciousness. Agents traditionally classified as
hallucinogens include LSD, mescaline, psilocybin, morning glory, nutmeg, and
jimson weed. It is important to recognize, however, that hallucinations also may
be produced by phencyclidine (PCP), cocaine, marijuana, and amphetamine
derivatives such as methylenedioxymethamphetamine (MDMA, "Ecstasy").
The use of hallucinogens by adolescents peaked in 1979, when approximately 18%
of high school seniors reported ever having tried one of these substances. In
1999, 14% of high school seniors reported having used a hallucinogen; 12% had
used LSD, 3% PCP, and 8% MDMA. The mechanism of action of hallucinogens varies
with the agent used. LSD is a sympathomimetic and, therefore, some of the
earliest symptoms and signs (beginning within minutes of ingestion) are
nausea, flushing, chills, dilated pupils, tachycardia, and hypertension. LSD is
concentrated in the visual cortex and limbic and reticular activating systems
where it binds to serotonin receptors, producing central nervous system effects
within 15 to 20 minutes. Visual or auditory hallucinations are typical, and
patients may experience synesthesias, which represent sensory confusion in
which colors are heard or smells seen. Some users experience a sense that they
or others are aging rapidly; others develop paranoia, depression, panic, and
anxiety. Severe toxicity may produce coma, respiratory arrest, hyperpyrexia,
coagulopathy, or seizures. Long-term consequences of LSD use include
flashbacks, personality changes, depressive symptoms, or psychosis. Despite
these adverse effects, hallucinogens, including LSD, do not appear to produce
physical dependence or a withdrawal state.
Intoxication with barbiturates, benzodiazepines, ethanol, or opiates produces
sedation, not agitation, and is not associated with hallucinations. Furthermore,
depressants (eg, barbiturates, benzodiazepines) and opiates cause miotic
pupils, decreased body temperature, and decreased blood pressure, not signs of
sympathetic stimulation, as seen in the adolescent in the vignette.
References:
Hurlbut KM, Joliff H, Hall AH, Fish SS, Rumack BH. LSD. In: Toll LL,
Hurlbut KM, eds. Poisindex System. Englewood, Co: Micromedex, Inc;
expires 12/2000. Available at:
www.micromedex.com.
Johnston LD, Bachman JG, O'Malley PM, Schulenberg JE, Wallace J.
Monitoring the future: a continuing study of American youth. 1999.
Available at:
http://www.monitoringthefuture
Schwartz B, Alderman EM. Substances of abuse. Pediatr Rev. 1997;18:204-215