LSD
3
7/17/2019 LSD http://slidepdf.com/reader/full/lsd563dba25550346aa9aa31f4a 1/3 67 ARTURO G. LERNER AND SHAUL LEV RAN ABSTRACT A side effect associated with the use o LSD is the return o perceptual disturbances which anteriorly emerged during intoxication, despite absence o present use. Here we present the case o a patient with a previous history o sporadic and recreational cannabis, alcohol and LSD consumption who reported LSD associated “Alice in Wonderland Syndrome” (AIWS) or Todd’s syndrome. AIWS is basically characterized by four frequent visual illusions: macropsia, micropsia, pelopsia and teleopsia. AIWS only appeared during LSD consumption and continued afer LSD suspension, namely, Hallucinogen Persisting Perception Disorder (HPPD). This phenomenon did not cause a major unctional impairment but provoked sufficient worry and concern due to its persistent continuation. The patient reused medical treatment and continued psychiatric ollow-up. At the one year follow-up he reported complete remission. To the best o our knowledge this is the first reported case o AIWS which persist afer LSD interruption (HPPD) in the proessional literature. Reasons or this intriguing, benign, reversible and apparently harmless side effect are proposed. Address for Correspondence: Arturo G. Lerner, MD, Lev Hasharon Mental Health Medical Center, POB 90.000, Netanya 42100, Israel [email protected], [email protected] inspired by Lewis Carroll’s book, Alice’s Adventures in Wonderland (2). Te amed hallucinogenic red and white toadstool apparently ingested by Alice was Amanita Muscaria or Fly Agaric, which possesses the psychoactive alkaloid muscimol (3). Tis transient or chronic syndrome may have multiple etiologies (4) and basically consists o multiple visual aberrations. Four visual illusions have been primarily described: macropsia (objects are per- ceived larger than their actual size), micropsia (objects are perceived smaller than their actual size), pelopsia (objects are perceived nearer than they actually are) and teleopsia (objects are perceived much urther away than they actually are). Tese visual distortions have been reported when looking at still or moving objects, human and non-human beings (5). AIWS has been described in different conditions such as (representative, yet not exhaustive, list): migraine headaches (6), migraine’s aura (7), influenza A inection (8), inectious mononucleosis (9) and rontal lobe epilepsy (10). Although AIWS has been reported by hallucinogen users during LSD intoxi- cations or “trips” (5), it has never been reported afer LSD suspension, namely as an AIWS appearing as part o hallucinogen persisting perception disorder (HPPD). As defined in DSM-5, HPPD may recapitulate the prior substance intoxication, reflecting the primary perceptual experience, i.e., visual imagery experienced under hal- lucinogen intoxication should be re-experienced during HPPD (11). Proessional literature on HPPD has been extensively reviewed (12). We present the case o a patient with a prior history o cannabis, alcohol and LSD sporadic recreational intake, who sought proessional consultation or the presence o LSD-induced AIWS, afer suspending all substance use. INTRODUCTION “Alice in Wonderland Syndrome” (AIWS) or odd’s syndrome is a condition predominately characterized or complex perceptual disturbances (1). Te name was LSD-associated “Alice in Wonderland Syndrome” (AIWS): A Hallucinogen Persisting Perception Disorder (HPPD) Case Report Arturo G. Lerner, MD, 1,2 and Shaul Lev Ran, MD, 3 1 Lev Hasharon Mental Health Medical Center, Pardessya, Israel 2 Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel 3 Addiction Medicine Clinic, Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel Isr J Psy chiatry Relat Sci - Vol. 52 - No 1 (2015)
description
Syndrome
Transcript of LSD
7172019 LSD
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67
ARTURO G LERNER AND SHAUL LEV RAN
ABSTRACT
A side effect associated with the use o LSD is the return
o perceptual disturbances which anteriorly emerged
during intoxication despite absence o present use
Here we present the case o a patient with a previous
history o sporadic and recreational cannabis alcohol and
LSD consumption who reported LSD associated ldquoAlice
in Wonderland Syndromerdquo (AIWS) or Toddrsquos syndrome
AIWS is basically characterized by four frequent visual
illusions macropsia micropsia pelopsia and teleopsia
AIWS only appeared during LSD consumption and
continued afer LSD suspension namely Hallucinogen
Persisting Perception Disorder (HPPD) This phenomenon
did not cause a major unctional impairment but provokedsufficient worry and concern due to its persistent
continuation The patient reused medical treatment
and continued psychiatric ollow-up At the one year
follow-up he reported complete remission
To the best o our knowledge this is the first reported case
o AIWS which persist afer LSD interruption (HPPD) in
the proessional literature Reasons or this intriguing
benign reversible and apparently harmless side effect
are proposed
Address for Correspondence Arturo G Lerner MD Lev Hasharon Mental Health Medical Center POB 90000 Netanya 42100 Israelalernerlev-hasharoncoil lerneraminternet-zahavnet
inspired by Lewis Carrollrsquos book Alicersquos Adventures inWonderland (2) Te amed hallucinogenic red and whitetoadstool apparently ingested by Alice was AmanitaMuscaria or Fly Agaric which possesses the psychoactive
alkaloid muscimol (3) Tis transient or chronic syndromemay have multiple etiologies (4) and basically consistso multiple visual aberrations Four visual illusions havebeen primarily described macropsia (objects are per-ceived larger than their actual size) micropsia (objectsare perceived smaller than their actual size) pelopsia(objects are perceived nearer than they actually are) andteleopsia (objects are perceived much urther away thanthey actually are) Tese visual distortions have beenreported when looking at still or moving objects humanand non-human beings (5) AIWS has been described
in different conditions such as (representative yet notexhaustive list) migraine headaches (6) migrainersquos aura(7) influenza A inection (8) inectious mononucleosis(9) and rontal lobe epilepsy (10) Although AIWS hasbeen reported by hallucinogen users during LSD intoxi-cations or ldquotripsrdquo (5) it has never been reported aferLSD suspension namely as an AIWS appearing as parto hallucinogen persisting perception disorder (HPPD)
As defined in DSM-5 HPPD may recapitulate the priorsubstance intoxication reflecting the primary perceptualexperience ie visual imagery experienced under hal-lucinogen intoxication should be re-experienced during
HPPD (11) Proessional literature on HPPD has beenextensively reviewed (12)
We present the case o a patient with a prior history ocannabis alcohol and LSD sporadic recreational intakewho sought proessional consultation or the presence oLSD-induced AIWS afer suspending all substance use
INTRODUCTION
ldquoAlice in Wonderland Syndromerdquo (AIWS) or oddrsquossyndrome is a condition predominately characterizedor complex perceptual disturbances (1) Te name was
LSD-associated ldquoAlice in Wonderland Syndromerdquo(AIWS) A Hallucinogen Persisting PerceptionDisorder (HPPD) Case ReportArturo G Lerner MD12 and Shaul Lev Ran MD3
1 Lev Hasharon Mental Health Medical Center Pardessya Israel2 Sackler School of Medicine Tel Aviv University Ramat Aviv Israel3 Addiction Medicine Clinic Department of Psychiatry Sheba Medi cal Center Tel Hashomer Israel
Isr J Psychiatry Relat Sci - Vol 52 - No 1 (2015)
7172019 LSD
httpslidepdfcomreaderfulllsd563dba25550346aa9aa31f4a 23
68
Isr J Psychiatry Relat Sci - Vol 51 - No 4 (2014)LSD983085ASSOCIATED ALICE IN WONDERLAND SYNDROME
Te patient gave inormed consent or the publicationo his case o the best o our knowledge this is the firstreport in the proessional literature
CASE REPORT
Mr A is a 26-year-old single male university student whocompleted compulsory military service and did not haveany previous police or criminal records He had a five-year past history o occasional ldquosocialrdquo cannabis and alco-hol use during weekends and holidays He also reportedrecreational use o LSD He ulfilled DSM-5 ull criteriaor tobacco use disorder (11) During LSD intoxicationhe reported the presence o our requent visual illusionsnamely macropsia micropsia pelopsia and teleopsia Tese visual distortions were reported when looking at still ormoving objects human and non-human beings When
interviewed Mr A unhesitatingly and precisely attributedpsychedelic experience solely to LSD intake wo days afercompletely stopping all substance use due to a longer thanexpected hallucinogenic experience associated with slightanxiety he surprisingly noticed the returning o some visualimagery previously experienced For example books wereseen slightly closer chairs were seen slightly urther awayhis hands were seen larger than they actually were his dogrsquoshead was seen smaller (13) Interestingly some still objectswere observed slightly moving back and orth and perceivedcloser ie pelopsia and urther away ie teleopsia (14) He
clearly did not expect the return o this visual imagery As thecondition persisted Mr A started expressing preoccupationand discomort He elt intimidated and disheartened andsought a psychiatric consultation On examination there wasno prior or present history o acute or chronic neurologicalophthalmological or other co-morbid medical illnesses orco-occurring psychiatric disorders A complete physicalneurological (including EEG) and laboratory examinations
showed no abnormal findingsMr A was not interested in ldquochemicalrdquo pharmaco-
logical treatment and agreed to psychiatric ollow-upAfer approximately one year these visual disturbances
completely disappeared
DISCUSSION
Te suggested mechanism underlying recapitulationand reproduction o visual disturbances originally expe-rienced during LSD intoxication has been extensivelydiscussed (15-17) Comprehensive understanding othis clinical syndrome remains unanswered
Te unique clinical aspect o this case is the absenceo almost all the recurrent common visual disturbancesdescribed in the proessional literature (11 12 15-20)Moreover the striking resemblance to ormer descriptiono AIWS in other pathological contexts is remarkable As
the main perceptual disturbance is visual much o theresearch pertaining to potential mechanisms underlyingthese disorders ocus on the Lateral Geniculate Nucleus(LGN) Te LGN which is located in the thalamus hasbeen associated to visual perception pathways and may beaffected by LSD toxic effects (21 22) Tese toxic effectsmight result in temporary impairment at LGN whichmight lead to benign disinhibition o visual processorsand the genesis o recurrent visual disturbances (23)ransient absence deficiency or insufficient inhibitoryactivity o the visual pathway may permit and enable visual stimulus to persist Tis proposal may explicate
reported visual disturbances in this case macropsiamicropsia pelopsia and teleopsia which may reflectthe ailure o each respective responsible visual unction(15 23-25) Macropsia and micropsia may arise rommagnification or miniaturization o perceived imageson the grounds o abnormal cortical processing (24 25)related to LSD induced damage at cortical levels (17) Itcould be additionally speculated that LSD intake mightproduce short-term limited and reversible damage o theLGN leading to dysunction o the parvocellular cellswhich may modulate the perception o orms and shapes
namely macropsia and micropsia and magnocellularscells which may modulate the perception o movemento still objects namely pelopsia and teleopsia (17 23-25)
A single clinical case report has obvious limitations Itshould be stressed that cannabis use was not reported asthe cause o any hallucinogenic experience Te primaryassumption is that the patient is capable o rememberingthe experienced ldquotriprdquo and adequately describe the cur-rent phenomena Possible LSD-inflicted transient andpermanent damage at LGN and other nuclei is poorlyand insufficiently understood Te specific developmento AIWS afer LSD consumption in the specific patient
remains largely unexplainable Research may incrementour knowledge regarding the mechanism o action o LSDand related clinical phenomena
o our knowledge this is the first case o HPPD-associated AIWS which may contribute to clinicalknowledge Exploring the possibility o HPPD in itsmany orms among individuals with prior LSD use is rec-ommended However conclusions rom an uncontrolledcase report should be drawn with appropriate caution
7172019 LSD
httpslidepdfcomreaderfulllsd563dba25550346aa9aa31f4a 33
69
ARTURO G LERNER AND SHAUL LEV RAN
References1 odd J Te syndrome of Alice in Wonderland Canadian Med Assoc
J 1955 73 701-704
2 Lewis Carrol Alicersquos adventures in wonderland UK Macmillan 1865
3 Michelot D Melendez-Howell LM Amanita muscaria Chemistrybiology toxicology and ethnomycology Mycological Research 2003
107 131-1464 Losada-Del Pozo R Cantariacuten-Extremera V Garciacutea-Pentildeas JJ Duat-
Rodriacuteguez A Loacutepez-Mariacuten L Gutieacuterrez-Solana LG Ruiz-Falcoacute MLCharacteristics and evolution of patients with Alice in Wonderlandsyndrome Rev Neurol 201153641-648
5 Lerner AG Unpublished data
6 Pacheva IH Ivanov IS Migraine variants - occurrence in pediatricneurology practice Clin Neurol Neurosur 2013 1151775-1783
7 Bayen E Cleret de Langavant L Feacutenelon G Te Alice in Wonderlandsyndrome An unusual aura in migraine Rev Neurol 2012 168457-459
8 Kuo SC Yeh YW Chen CY Weng JP zeng NS Possible associationbetween Alice in Wonderland syndrome and influenza A infection JNeuropsychiatry Clin Neurosci 2012 24E7-8
9 Lahat E Berkovitch M Barr J Paret G Barzilai A Abnormal visualevoked potential in children with Alice in Wonderland syndrome due
to infectious mononucleosis J Child Neurol 1999 14 732-73510 Zwijnenburg PJ Wennink JM Laman DM Linssen WH Alice in
Wonderland syndrome A clinical presentation o rontal lobe epilepsyNeuropediatrics 2002 33 53-55
11 American Psychiatric Association Diagnostic and Statistical Manualo Mental Disorders Fifh Edition DSM-5 Washington DC AmericanPsychiatric Association 2013
12 Halpern JH Pope HG Hallucinogen persisting perception disorderWhat do we know afer 50 years Drug Alcohol Depend 2003 69109-119
13 Chand PK Murthy P Understanding a strange phenomenon Lilliputianhallucinations German J Psychiatry 2007 10 21-24
14 Lorch M Language and memory disorder in the case o Jonathan SwifConsiderations on retrospective diagnosis Brain 2006 129 3127-3137
15 Lerner AG Gelkop M Skladman I Oyffe I Finkel B Sigal M WeizmanA Flashback and hallucinogen persisting perception disorder Clinicalaspects and pharmacological treatment approach Isr J Psychiatry RelatSci 2002 39 92-99
16 Lerner AG Gelkopf M Skalman I Rudinski R Nachshon H Bleich
A Clonazepam treatment of LSD-induced hallucination persistingperception disorder with anxiety features Int Clin Psychopharmacol2003 18 101-105
17 Lerner AG Rudinski D Bor O Goodman C Flashback and HPPDA clinical- oriented concise review Isr J Psychiatry Relat Sci 201451296-302
18 Abraham HD Aldridge AM Gogia P Te psychopharmacology ofhallucinogens Neuropsychopharmacology 1996 14285-298
19 Abraham HD Visual phenomenology o the LSD flashbacks Arch GenPsychiatry 1983 40884-889
20 Abraham HD Aldridge AM Adverse consequences of lysergic aciddiethylamide Addiction 1993 881327-1334
21 Evarts EV Landau W Freygang W Jr Marshall WH Some effects oflysergic acid diethylamide and bufotenine on electrical activity in thecatrsquos visual system Am J Physiol 1955 182594-598
22 Bishop PO Field G Hennessy BL Smith JR Action of d-lysergic aciddiethylamide on lateral geniculate synapses J Neurophysiol 195821529-549
23 Lerner AG Rudinski D Goodman Cand Lev Ran S Flashback andHPPD LSD flashbacks ndash Te appearance of new visual imagery notexperienced during initial intoxication wo case reports Isr J PsychiatryRelat Sci 2014 51307-309
24 Abe K Oda N Araki R Igata M Macropsia micropsia and episodicillusions in Japanese adolescents J Am Acad Child Adolesc Psychiatry1989 28493-496
25 Schneck JM Macropsia Am J Psychiatry 1965 1211123-1124
7172019 LSD
httpslidepdfcomreaderfulllsd563dba25550346aa9aa31f4a 23
68
Isr J Psychiatry Relat Sci - Vol 51 - No 4 (2014)LSD983085ASSOCIATED ALICE IN WONDERLAND SYNDROME
Te patient gave inormed consent or the publicationo his case o the best o our knowledge this is the firstreport in the proessional literature
CASE REPORT
Mr A is a 26-year-old single male university student whocompleted compulsory military service and did not haveany previous police or criminal records He had a five-year past history o occasional ldquosocialrdquo cannabis and alco-hol use during weekends and holidays He also reportedrecreational use o LSD He ulfilled DSM-5 ull criteriaor tobacco use disorder (11) During LSD intoxicationhe reported the presence o our requent visual illusionsnamely macropsia micropsia pelopsia and teleopsia Tese visual distortions were reported when looking at still ormoving objects human and non-human beings When
interviewed Mr A unhesitatingly and precisely attributedpsychedelic experience solely to LSD intake wo days afercompletely stopping all substance use due to a longer thanexpected hallucinogenic experience associated with slightanxiety he surprisingly noticed the returning o some visualimagery previously experienced For example books wereseen slightly closer chairs were seen slightly urther awayhis hands were seen larger than they actually were his dogrsquoshead was seen smaller (13) Interestingly some still objectswere observed slightly moving back and orth and perceivedcloser ie pelopsia and urther away ie teleopsia (14) He
clearly did not expect the return o this visual imagery As thecondition persisted Mr A started expressing preoccupationand discomort He elt intimidated and disheartened andsought a psychiatric consultation On examination there wasno prior or present history o acute or chronic neurologicalophthalmological or other co-morbid medical illnesses orco-occurring psychiatric disorders A complete physicalneurological (including EEG) and laboratory examinations
showed no abnormal findingsMr A was not interested in ldquochemicalrdquo pharmaco-
logical treatment and agreed to psychiatric ollow-upAfer approximately one year these visual disturbances
completely disappeared
DISCUSSION
Te suggested mechanism underlying recapitulationand reproduction o visual disturbances originally expe-rienced during LSD intoxication has been extensivelydiscussed (15-17) Comprehensive understanding othis clinical syndrome remains unanswered
Te unique clinical aspect o this case is the absenceo almost all the recurrent common visual disturbancesdescribed in the proessional literature (11 12 15-20)Moreover the striking resemblance to ormer descriptiono AIWS in other pathological contexts is remarkable As
the main perceptual disturbance is visual much o theresearch pertaining to potential mechanisms underlyingthese disorders ocus on the Lateral Geniculate Nucleus(LGN) Te LGN which is located in the thalamus hasbeen associated to visual perception pathways and may beaffected by LSD toxic effects (21 22) Tese toxic effectsmight result in temporary impairment at LGN whichmight lead to benign disinhibition o visual processorsand the genesis o recurrent visual disturbances (23)ransient absence deficiency or insufficient inhibitoryactivity o the visual pathway may permit and enable visual stimulus to persist Tis proposal may explicate
reported visual disturbances in this case macropsiamicropsia pelopsia and teleopsia which may reflectthe ailure o each respective responsible visual unction(15 23-25) Macropsia and micropsia may arise rommagnification or miniaturization o perceived imageson the grounds o abnormal cortical processing (24 25)related to LSD induced damage at cortical levels (17) Itcould be additionally speculated that LSD intake mightproduce short-term limited and reversible damage o theLGN leading to dysunction o the parvocellular cellswhich may modulate the perception o orms and shapes
namely macropsia and micropsia and magnocellularscells which may modulate the perception o movemento still objects namely pelopsia and teleopsia (17 23-25)
A single clinical case report has obvious limitations Itshould be stressed that cannabis use was not reported asthe cause o any hallucinogenic experience Te primaryassumption is that the patient is capable o rememberingthe experienced ldquotriprdquo and adequately describe the cur-rent phenomena Possible LSD-inflicted transient andpermanent damage at LGN and other nuclei is poorlyand insufficiently understood Te specific developmento AIWS afer LSD consumption in the specific patient
remains largely unexplainable Research may incrementour knowledge regarding the mechanism o action o LSDand related clinical phenomena
o our knowledge this is the first case o HPPD-associated AIWS which may contribute to clinicalknowledge Exploring the possibility o HPPD in itsmany orms among individuals with prior LSD use is rec-ommended However conclusions rom an uncontrolledcase report should be drawn with appropriate caution
7172019 LSD
httpslidepdfcomreaderfulllsd563dba25550346aa9aa31f4a 33
69
ARTURO G LERNER AND SHAUL LEV RAN
References1 odd J Te syndrome of Alice in Wonderland Canadian Med Assoc
J 1955 73 701-704
2 Lewis Carrol Alicersquos adventures in wonderland UK Macmillan 1865
3 Michelot D Melendez-Howell LM Amanita muscaria Chemistrybiology toxicology and ethnomycology Mycological Research 2003
107 131-1464 Losada-Del Pozo R Cantariacuten-Extremera V Garciacutea-Pentildeas JJ Duat-
Rodriacuteguez A Loacutepez-Mariacuten L Gutieacuterrez-Solana LG Ruiz-Falcoacute MLCharacteristics and evolution of patients with Alice in Wonderlandsyndrome Rev Neurol 201153641-648
5 Lerner AG Unpublished data
6 Pacheva IH Ivanov IS Migraine variants - occurrence in pediatricneurology practice Clin Neurol Neurosur 2013 1151775-1783
7 Bayen E Cleret de Langavant L Feacutenelon G Te Alice in Wonderlandsyndrome An unusual aura in migraine Rev Neurol 2012 168457-459
8 Kuo SC Yeh YW Chen CY Weng JP zeng NS Possible associationbetween Alice in Wonderland syndrome and influenza A infection JNeuropsychiatry Clin Neurosci 2012 24E7-8
9 Lahat E Berkovitch M Barr J Paret G Barzilai A Abnormal visualevoked potential in children with Alice in Wonderland syndrome due
to infectious mononucleosis J Child Neurol 1999 14 732-73510 Zwijnenburg PJ Wennink JM Laman DM Linssen WH Alice in
Wonderland syndrome A clinical presentation o rontal lobe epilepsyNeuropediatrics 2002 33 53-55
11 American Psychiatric Association Diagnostic and Statistical Manualo Mental Disorders Fifh Edition DSM-5 Washington DC AmericanPsychiatric Association 2013
12 Halpern JH Pope HG Hallucinogen persisting perception disorderWhat do we know afer 50 years Drug Alcohol Depend 2003 69109-119
13 Chand PK Murthy P Understanding a strange phenomenon Lilliputianhallucinations German J Psychiatry 2007 10 21-24
14 Lorch M Language and memory disorder in the case o Jonathan SwifConsiderations on retrospective diagnosis Brain 2006 129 3127-3137
15 Lerner AG Gelkop M Skladman I Oyffe I Finkel B Sigal M WeizmanA Flashback and hallucinogen persisting perception disorder Clinicalaspects and pharmacological treatment approach Isr J Psychiatry RelatSci 2002 39 92-99
16 Lerner AG Gelkopf M Skalman I Rudinski R Nachshon H Bleich
A Clonazepam treatment of LSD-induced hallucination persistingperception disorder with anxiety features Int Clin Psychopharmacol2003 18 101-105
17 Lerner AG Rudinski D Bor O Goodman C Flashback and HPPDA clinical- oriented concise review Isr J Psychiatry Relat Sci 201451296-302
18 Abraham HD Aldridge AM Gogia P Te psychopharmacology ofhallucinogens Neuropsychopharmacology 1996 14285-298
19 Abraham HD Visual phenomenology o the LSD flashbacks Arch GenPsychiatry 1983 40884-889
20 Abraham HD Aldridge AM Adverse consequences of lysergic aciddiethylamide Addiction 1993 881327-1334
21 Evarts EV Landau W Freygang W Jr Marshall WH Some effects oflysergic acid diethylamide and bufotenine on electrical activity in thecatrsquos visual system Am J Physiol 1955 182594-598
22 Bishop PO Field G Hennessy BL Smith JR Action of d-lysergic aciddiethylamide on lateral geniculate synapses J Neurophysiol 195821529-549
23 Lerner AG Rudinski D Goodman Cand Lev Ran S Flashback andHPPD LSD flashbacks ndash Te appearance of new visual imagery notexperienced during initial intoxication wo case reports Isr J PsychiatryRelat Sci 2014 51307-309
24 Abe K Oda N Araki R Igata M Macropsia micropsia and episodicillusions in Japanese adolescents J Am Acad Child Adolesc Psychiatry1989 28493-496
25 Schneck JM Macropsia Am J Psychiatry 1965 1211123-1124
7172019 LSD
httpslidepdfcomreaderfulllsd563dba25550346aa9aa31f4a 33
69
ARTURO G LERNER AND SHAUL LEV RAN
References1 odd J Te syndrome of Alice in Wonderland Canadian Med Assoc
J 1955 73 701-704
2 Lewis Carrol Alicersquos adventures in wonderland UK Macmillan 1865
3 Michelot D Melendez-Howell LM Amanita muscaria Chemistrybiology toxicology and ethnomycology Mycological Research 2003
107 131-1464 Losada-Del Pozo R Cantariacuten-Extremera V Garciacutea-Pentildeas JJ Duat-
Rodriacuteguez A Loacutepez-Mariacuten L Gutieacuterrez-Solana LG Ruiz-Falcoacute MLCharacteristics and evolution of patients with Alice in Wonderlandsyndrome Rev Neurol 201153641-648
5 Lerner AG Unpublished data
6 Pacheva IH Ivanov IS Migraine variants - occurrence in pediatricneurology practice Clin Neurol Neurosur 2013 1151775-1783
7 Bayen E Cleret de Langavant L Feacutenelon G Te Alice in Wonderlandsyndrome An unusual aura in migraine Rev Neurol 2012 168457-459
8 Kuo SC Yeh YW Chen CY Weng JP zeng NS Possible associationbetween Alice in Wonderland syndrome and influenza A infection JNeuropsychiatry Clin Neurosci 2012 24E7-8
9 Lahat E Berkovitch M Barr J Paret G Barzilai A Abnormal visualevoked potential in children with Alice in Wonderland syndrome due
to infectious mononucleosis J Child Neurol 1999 14 732-73510 Zwijnenburg PJ Wennink JM Laman DM Linssen WH Alice in
Wonderland syndrome A clinical presentation o rontal lobe epilepsyNeuropediatrics 2002 33 53-55
11 American Psychiatric Association Diagnostic and Statistical Manualo Mental Disorders Fifh Edition DSM-5 Washington DC AmericanPsychiatric Association 2013
12 Halpern JH Pope HG Hallucinogen persisting perception disorderWhat do we know afer 50 years Drug Alcohol Depend 2003 69109-119
13 Chand PK Murthy P Understanding a strange phenomenon Lilliputianhallucinations German J Psychiatry 2007 10 21-24
14 Lorch M Language and memory disorder in the case o Jonathan SwifConsiderations on retrospective diagnosis Brain 2006 129 3127-3137
15 Lerner AG Gelkop M Skladman I Oyffe I Finkel B Sigal M WeizmanA Flashback and hallucinogen persisting perception disorder Clinicalaspects and pharmacological treatment approach Isr J Psychiatry RelatSci 2002 39 92-99
16 Lerner AG Gelkopf M Skalman I Rudinski R Nachshon H Bleich
A Clonazepam treatment of LSD-induced hallucination persistingperception disorder with anxiety features Int Clin Psychopharmacol2003 18 101-105
17 Lerner AG Rudinski D Bor O Goodman C Flashback and HPPDA clinical- oriented concise review Isr J Psychiatry Relat Sci 201451296-302
18 Abraham HD Aldridge AM Gogia P Te psychopharmacology ofhallucinogens Neuropsychopharmacology 1996 14285-298
19 Abraham HD Visual phenomenology o the LSD flashbacks Arch GenPsychiatry 1983 40884-889
20 Abraham HD Aldridge AM Adverse consequences of lysergic aciddiethylamide Addiction 1993 881327-1334
21 Evarts EV Landau W Freygang W Jr Marshall WH Some effects oflysergic acid diethylamide and bufotenine on electrical activity in thecatrsquos visual system Am J Physiol 1955 182594-598
22 Bishop PO Field G Hennessy BL Smith JR Action of d-lysergic aciddiethylamide on lateral geniculate synapses J Neurophysiol 195821529-549
23 Lerner AG Rudinski D Goodman Cand Lev Ran S Flashback andHPPD LSD flashbacks ndash Te appearance of new visual imagery notexperienced during initial intoxication wo case reports Isr J PsychiatryRelat Sci 2014 51307-309
24 Abe K Oda N Araki R Igata M Macropsia micropsia and episodicillusions in Japanese adolescents J Am Acad Child Adolesc Psychiatry1989 28493-496
25 Schneck JM Macropsia Am J Psychiatry 1965 1211123-1124
