Background: Previous reports document visual illusions resembling hallucinogen persisting perception
disorder (HPPD) after risperidone treatment in patients with histories of previous
LSD exposure. Methods: We report a case with visual disturbances resembling HPPD after each of three consecutive
risperidone dose increases. Results: Contrasting with previous reports, our patient lacked any history of substance abuse,
particularly hallucinogen exposure. She lacked neurologic or other contributory illnesses.
Illusions generally remitted within 48 hours each time. Coadministration of trazodone
and clonazepam may have contributed to these phenomena, although clonazepam has been
used to treat this condition. She had been unusually sensitive to the side-effects
of many psychotropics. Conclusions: This case is unique due to the absence of substance abuse. This and another report
note heightened sensitivity to medication side-effects. Visual phenomena resembling
HPPD evidently can occur with risperidone and, possibly, other atypical antipsychotics
and certain antidepressants regardless of previous hallucinogen use. Several lines
of evidence implicate reduced 5HT2a serotonin receptor stimulation rather than increased
5HT2c stimulation.
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M.D. Edward C. Lauterbach
Professor of Psychiatry and Internal Medicine (Neurology) Department of Psychiatry
and Behavioral Sciences Mercer University School of Medicine
1550 College Street
Macon, GA 31207
U.S.A.
Phone: (912) 301-5337