(Lysergic acid diethylamide, LSD, psilocybin, mescaline)
Hallucinogens are a heterogeneous group of substances that can cause very unpredictable, idiosyncratic reactions. Intoxication typically causes hallucinations, associated with an altered perception, impaired judgment, self-centeredness and depersonalization. There is no stereotypical withdrawal symptoms. The diagnosis is made clinically. Treatment is supportive.
To the traditional hallucinogens include lysergic acid diethylamide (LSD), psilocybin and mescaline. All are made from natural materials:
Hallucinogens are a heterogeneous group of substances that can cause very unpredictable, idiosyncratic reactions. Intoxication typically causes hallucinations, associated with an altered perception, impaired judgment, self-centeredness and depersonalization. There is no stereotypical withdrawal symptoms. The diagnosis is made clinically. Treatment is supportive. To the traditional hallucinogens include lysergic acid diethylamide (LSD), psilocybin and mescaline. All are made from natural materials: LSD from a fungus that contaminated often wheat and rye flour. Psilocybin from different types of mushrooms mescaline from the peyote cactus Many of the new synthetic compounds ( “designer drugs”) were prepared, usually on the basis of tryptamine or Phenylethylaminmolekülen. Tryptamine to include N, N-dimethyltryptamine (DMT) and 5-methoxy-N, N-Diisopropyltryptamin- (5-MeO-DIPT). To make matters more complicated, many illegal drugs are sold under a false name and in fact contain other substances, often ketamine or phencyclidine (PCP), anesthetics, dextromethorphan or other substances. Some other psychotropic substances, including marijuana, also have hallucinogenic properties. The term hallucinogens for this group of substances is still maintained, although these substances are not necessarily cause hallucinations. but are still less true of other terms such as psychedelics or psychotomimetics. Pathophysiology LSD, psilocybin and many designer hallucinogens are serotonin receptor agonists. With mescaline, a phenylethylamine similar to amphetamines, the exact mechanism of action has not been determined. The type of application and the effects are different: LSD is taken orally by drogenimprägniertem blotting paper or as tablets. The effect usually occurs within 30 to 60 minutes after ingestion; the effect of time is usually 12-24 hours. Psilocybin is taken orally; the effect lasts for about 4-6 hours to complete. Mescaline is taken orally. The onset of action is usually 30-90 minutes instead of taking; the duration of the effect is about 12 h. DMT has, when it is smoked, an onset of action after 2-5 min; the duration of action is usually 20-60 minutes (this explains the common in the United States named “Businessman’s lunch”). There is a strong tolerance to LSD, but does not last long developed. If it comes to development of tolerance to any of these substances, there is also a cross-tolerance towards the other. The psychological dependence is very different, there are no signs of physical dependence or withdrawal symptoms. Symptoms and complaints Intoxication leads to altered perceptions, including synesthesia (z. B. listening to sounds, hearing of colors), intensification of perception, enhanced empathy, depersonalization (feeling that the self is not real), a distorted perception the environment, and changes in mood (usually euphoric, sometimes depressed). Users often report a combination of these effects as a “trip”. Periods of intense psychological effects can alternate with periods of lucidity. LSD can also have multiple physical effects, including mydriasis, blurred vision, sweating, heart palpitations, and impaired coordination. Many other hallucinogens verursahen nausea and vomiting. In all, the judgment is impaired. The reactions to hallucinogens depend on several factors, including expectations of consumers, its ability in dealing with the perception disorders and situational circumstances. With LSD delusions and hallucinations occur, but are rare. Rarely are anxiety attacks, extreme anxiety and panic disorders. Psilocybin and mescaline more likely to cause hallucinations. If hallucinogenic reactions occur, they subside usually quickly if they are treated properly in a safe environment. For some sufferers, however, these disorders hold a long time (esp. After LSD) and can pass into a chronic psychotic state. It is not yet clear whether this condition causes in this case the consumption of psychotropic substance only at existing readiness or revealing or may cause him even in a previously stable personality. Chronic effects in some individuals it may especially after long and frequent consumption of hallucinogens (especially LSD) for some time to come after the last dose reactions. Characteristics of this recurrent episodes (flashbacks, persistent cognitive impairment after Halluzinogengebrauch) are optical distortion, but also interference with other sensations (z. B. of time, space and body sensation), or hallucinations. However, flashbacks can be triggered by marijuana, alcohol or barbiturates, due to stress or fatigue, also occur for no apparent reason. The mechanisms of action are not known. Flashbacks sound usually within 6-12 months, but may recur for years. Diagnosis Clinical evaluation Diagnosis is clinically usually. Blood Will be determined not routinely. Except for PCP most hallucinogens are not included in routine urine tests on substances. Treatment In acute intoxication: supportive care and relief of anxiety and agitation for stubborn psychosis: psychiatric care often enough a tranquil atmosphere and soothing persuasion that the bizarre thoughts, visions and noise caused by the psychotropic substance. Anxiolytics such as lorazepam and diazepam can help to reduce the often intense fear. Persistent psychotic states or other mental disorders require specialized psychiatric treatment. Temporary or not excessively burdensome flashbacks other hand, must not necessarily be treated specifically. Are these flashbacks, however, associated with anxiety or depression, they should be treated with anxiolytics.