What are the different types of hallucinogens. How do they affect the human body and mind. What are the risks and dangers associated with their use.

The Diverse World of Hallucinogens

Hallucinogens are a fascinating and diverse group of psychoactive substances that can profoundly alter the way we perceive the world around us. These drugs, often referred to as “psychedelics,” come in a variety of forms and can have a wide range of effects on the human mind and body. Understanding the different types of hallucinogens and their unique properties is crucial for both recreational users and those seeking to explore the potential therapeutic benefits of these powerful compounds.

Categorizing Hallucinogens

Hallucinogens can be broadly classified into several key categories, each with its own distinctive characteristics and effects. These include:

1. Indolealkylamines: This category includes the well-known LSD (d-lysergic acid diethlyamide), as well as other naturally occurring compounds like LSA (d-lysergic amide), psilocybin, psilocin, and DMT (dimethyltryptamine).
2. Phenylethylamines: Drugs in this group include mescaline, found in the peyote cactus, and a variety of “designer drugs” such as MDA, MDMA (ecstasy), PMA, 2-CB, STP, and TMA.
3. Arylcycloalkylamines: Notable members of this category are PCP (phencyclidine) and ketamine.
4. Cannabinoids: The primary psychoactive compound in this group is THC (tetrahydrocannabinol), found in marijuana, hash, and hash oil.
5. Anticholinergics: Drugs in this category are derived from the Solanaceae plant family, which includes deadly nightshade (Atropa belladonna) and jimsonweed (Datura stramonium).
6. Diterpenes: The hallucinogenic compound salvinorin-A, found in the plant Salvia divinorum, belongs to this category.

The History and Cultural Significance of Hallucinogens

Hallucinogens have been used for centuries in various cultural and religious contexts, often as part of spiritual practices and rituals. From the peyote ceremonies of Native American tribes to the ayahuasca rituals of the Amazon, these substances have played a significant role in shaping human experiences and understanding of the world. In the 1960s and 1970s, the use of hallucinogens became closely associated with the counterculture movement, as young people explored the altered states of consciousness promised by these drugs.

The Effects of Hallucinogens

The effects of hallucinogens can vary greatly depending on factors such as the specific drug used, the dose, the user’s mood and environment, and any underlying medical or psychiatric conditions. In general, hallucinogens can produce a wide range of psychoactive effects, including:

• Altered perception of sights, sounds, and other sensations
• Distorted sense of time and reality
• Intensified emotions, ranging from ecstasy to terror
• Synesthesia, where senses become blended (e.g., “seeing” sounds)
• Hallucinations, where the user believes that drug-induced visions or perceptions are real

The Risks and Dangers of Hallucinogen Use

While hallucinogens can produce profound and enlightening experiences, they also carry significant risks and dangers. Overdose, adverse reactions, and long-term psychological effects are all potential concerns. Additionally, the use of hallucinogens can be particularly risky for individuals with pre-existing mental health conditions or a family history of such disorders. It is crucial to approach the use of these substances with caution and to seek professional guidance when necessary.

Therapeutic Potential and Future Research

In recent years, there has been a growing interest in exploring the potential therapeutic benefits of hallucinogens, particularly in the treatment of conditions like depression, anxiety, and addiction. Ongoing research has shown promising results, and the future of hallucinogen-assisted therapy holds the potential to revolutionize our understanding and treatment of various mental health challenges. However, the use of these substances must be approached with the utmost care and supervision by qualified professionals.

Conclusion

The world of hallucinogens is a complex and fascinating one, with a rich history and the potential for both personal growth and therapeutic breakthroughs. By understanding the different types of hallucinogens, their effects, and the associated risks, we can navigate this realm with greater awareness and caution. As research continues to explore the therapeutic possibilities of these powerful compounds, the future of hallucinogen use may hold valuable insights for the betterment of human health and well-being.

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​Hallucinogens are psychedelic drugs that can potentially change the way people see, hear, taste, smell or feel, and also affect mood and thought.

Official Name

​Hallucinogens

What is it?

Types of hallucinogens: LSD, mescaline, psilocybin, PCP, cannabis, ecstasy, ketamine, salvia and others.

The term hallucinogen refers to many different drugs, which are often called “psychedelic” drugs. While the effects of these drugs vary widely, all change the way people see, hear, taste, smell or feel, and affect mood and thought. At high doses, all may cause a person to hallucinate, or see, hear or feel things that aren’t really there.

Most of the hallucinogens used in North America belong to one of these six categories:

• indolealkylamines, which includes LSD (d-lysergic acid diethlyamide, a semi-synthetic substance originally derived from “ergot,” a fungus that grows on rye and other grains), LSA (d-lysergic amide, from morning glory seeds), psilocybin and psilocin (from Psilocybe mushrooms) and DMT (dimethyltryptamine, from the bark of the Virola tree, and other sources)
• phenylethylamines, which includes mescaline (found in peyote cactus), and “designer drugs” such as:
  • MDA (methylenedioxyamphetamine)
  • MDMA (ecstasy, 3,4-methylenedioxymethamphetamine)
  • PMA (paramethoxyamphetamine)
  • 2-CB (4-bromo-2,5-dimethoxyphenethylamine)
  • STP (2,5-dimethoxy-4-methylamphetamine)
  • TMA (trimethoxyamphetamine).
• arylcycloalkylamines, such as PCP (phencyclidine) and ketamine
• cannabinoids, especially THC (tetrahydrocannabinol), found in marijuana, hash and hash oil
• anticholinergics, from the plant family Solanaceae, which includes deadly nightshade (Atropa belladonna) and jimsonweed (Datura stramonium)
• the diterpene, salvinorin-A, from the plant Salvia divinorum.

Where does it come from?

Some hallucinogens come from mushrooms (psilocybin), cacti (mescaline) and other plants (cannabis, salvia). Of these, cannabis and psilocybin are almost always used in their natural form. Although LSD is used only in a synthesized form, a related drug, LSA, is found in nature. Other hallucinogens, such as MDMA and ketamine, are created in laboratories.

Who uses it?

Hallucinogens have been used since ancient times in religion, medicine, magic and prophecy. In the 1960s and 70s, hallucinogen use became a symbol of the counter-culture among young people in North America and Europe. In the 1990s, hallucinogen use was linked to the “rave” scene.

A 2007 survey of Ontario students in grades 7 to 12 reported that:

• 3.5 per cent had used ecstasy at least once in the past year
• 1.6 per cent had used LSD at least once in the past year
• 0.7 per cent had used PCP at least once in the past year
• 5. 5 per cent had used other hallucinogens (such as psilocybin and mescaline) at least once in the past year.

A 2004 survey of Canadians (aged 15+) reported that:

• 4.1 per cent had used ecstasy and 11.4 per cent had used LSD, PCP or other hallucinogens at least once in their lifetime
• 1.1 per cent had used ecstasy and 0.7 per cent had used LSD, PCP or other hallucinogens at least once in the past year.

How does it make you feel?

How hallucinogens make you feel depends on:

• how much you use
• how often and how long you use
• your mood, expectation and environment
• your age
• whether you have certain pre-existing medical or psychiatric conditions
• whether you’ve taken any alcohol or other drugs (illegal, prescription, over-the-counter or herbal).

Hallucinogens cause mostly psychoactive, or mind-altering, effects, which can be mild to intense. These effects vary from drug to drug, from person to person, from one drug-taking episode to the next, and can even change dramatically within one time of use. Effects can range from ecstasy to terror, from mild distortion of the senses to full hallucinations (where people believe that drug-induced visions or other perceptions are real).

Different types of hallucinogens produce different effects; for example:

LSD produces a kaleidoscope of visual patterns and changes perception. People who take LSD usually know that the hallucinations are not real; however, the effects can appear real.

Ecstasy enhances mood and produces feelings of empathy and intimacy.

Ketamine causes an out-of-body feeling, which may be pleasant or terrifying.

Salvia causes intense, short-lived hallucinogenic effects, such as smelling sounds or hearing colours.

How long does the feeling last?

The effects of some hallucinogens, such as LSD, last for hours, while others, such as salvia, last only a short time.

Is it addictive?

Most people who use hallucinogens do so occasionally. Repeated use of hallucinogens such as LSD or ecstasy leads to tolerance, where the drug has reduced or no effect. Sensitivity to the drug returns if the person stops using it for a period of time, and then starts again. Stopping use of hallucinogens does not usually cause symptoms of withdrawal. However, people can develop psychological dependence, in which they feel they need the drug.

Is it dangerous?

Most of these drugs are illegal and unregulated, and may include toxins, or not even contain the drug they are sold as. For example, drugs sold as ecstasy are usually not pure MDMA, and have been found to contain other drugs, such as methamphetamine. Drugs sold as mescaline are almost always something else.

Hallucinogens affect perception and behaviour. Taking them may cause people to become disoriented, have poor judgment and take risks.

Many hallucinogens can have very unpleasant or toxic effects (e. g., jimsonweed, deadly nightshade). Hallucinogenic plants can be mistaken for other toxic or lethal plants, for example, mushrooms.

Although research is scarce, taking hallucinogens during pregnancy may affect the development of the baby, and increase the chance of miscarriage.

What are the long-term effects of using it?

Hallucinogen use may, on rare occasions, result in “flashbacks,” or replays of the drug experience, days, weeks or even years after the drug was taken. Some people who take hallucinogens feel depressed or anxious long after they took the drug.

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Hallucinogens – Better Health Channel

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Summary

Read the full fact sheet

• Hallucinogens are illegal drugs that alter a person’s perception of reality.
• These drugs are either synthetically manufactured or derived from plants.
• People who regularly use hallucinogens may experience ‘flashbacks’, which can occur days, weeks, months or even years after taking the hallucinogen.

Hallucinogens are a type of drug that changes a person’s perception of reality. Also known as ‘psychedelic drugs’, hallucinogens make a person see, feel and hear things that aren’t real, or distort their interpretation of what’s going on around them. Some are quick acting, others take longer to take effect. Being under the influence of a hallucinogen is commonly called ‘tripping’.Some hallucinogens are manufactured, like LSD (lysergic acid diethylamide), PCP (phencyclidine, or ‘angel dust’) and ketamine. Others are naturally occurring compounds found in particular plants. For instance, the peyote cactus produces the hallucinogen mescaline, while psilocybin is found in certain mushrooms, known as ‘magic mushrooms’.

Types of hallucinogens

Hallucinogens come in a number of different forms. For example:

• LSD is a powerful drug – typically, small squares of blotting paper or gelatine are soaked in LSD, which are then swallowed, although it may also come in tablets or capsules.
• PCP usually comes in the form of tablets, capsules or powders of various colours. It is usually swallowed, sniffed or injected, but is sometimes smoked.
• Ketamine is used by medical practitioners and veterinarians as an aesthetic. It is often used illegally as a hallucinogenic drug. It can be made into tablets or pills, or dissolved in liquid. It is usually swallowed, snorted or injected.
• Magic mushrooms can be cooked, boiled into a drink or eaten raw.
• Mescaline from the peyote cactus can be found as a white powder, while dried, ground peyote buttons can be found as capsules. It is usually swallowed, but can be chewed or smoked.
• Ayahuasca is a plant based hallucinogenic tea. Traditionally used in parts of South America, Ayahuasca has become popular amongst western travellers.

Some depressant and stimulant drugs also have a hallucinogenic effect in high doses, including cannabis and ecstasy. Since a person’s sense of distance, time and objective reality are warped when under the influence of hallucinogens, serious injury and accidental death are real risks.

Synthetic hallucinogens

In recent years, a wide range of synthetic products, claiming to have similar effects to hallucinogens, have also been available in Australia. The active ingredient in these products can potentially be a number of chemicals. These synthetic hallucinogens include NBOMes and PMA, and are often sold as other drugs, yet contain very different ingredients, leading to potentially harmful and unexpected effects

How hallucinogens work

Hallucinogens target specific centres of the brain to alter its understanding of sensory input. For instance, a person may be looking at a blank wall, but their hallucinating brain may interpret the blank wall as moving and swirling, or perhaps covered in insects.

Effects of hallucinogens

The effects of hallucinogens depend on the type of drug, the strength of the dose, the functioning of the person taking them and their state of mind.

Generally, some of the common effects of hallucinogens include:

• hallucinations of sight, sound, taste and touch
• a blurring of the senses, such as sounds being ‘felt’ or colours being ‘heard’
• feeling detached from the body
• distortions of time, direction and distance
• relaxation
• accelerated heart rate
• dilated pupils
• nausea and loss of appetite.

Hallucinogens and ‘bad trips’

Hallucinogens are unpredictable drugs. Just because someone has an enjoyable ‘trip’ the first time, doesn’t guarantee they will always have pleasant experiences.

Every person runs the risk of having a ‘bad trip’. Symptoms can include nightmarish hallucinations, extreme panic, paranoia and nausea. It is also possible to have a mixture of good and bad experiences in the one trip.

Other unpleasant side effects can include:

• muscle spasms and loss of coordination
• convulsions and unconsciousness
• aggressive, hostile and violent behaviour
• catatonic syndrome, which means the user falls into a ‘zombie-like’ state.

If an overdose is suspected, dial triple zero (000) for an ambulance immediately.

Dependence, tolerance and withdrawal

Like many other drugs, it is possible to build up a tolerance to hallucinogens. This means larger and larger doses need to be taken to achieve the same effect.

Some people develop a psychological dependence and feel that regular drug use is an important part of their lives. Research indicates that people can become physically dependent on hallucinogens like PCP or ketamine. If a person stops taking the drug, they may experience withdrawal symptoms.
Damage from long-term use of hallucinogens

Some people may experience ‘flashbacks’, which can happen days, weeks, months or even years after taking the drug. They briefly relive the hallucinations of a previous trip so powerfully that it seems as if they have been transported back in time and space, or they may experience distortions of their present reality.

Having hallucinations when not under the influence of any hallucinogenic drugs can be very frightening.
Treatment for drug dependence

Treatment options for drug dependence include detoxification, individual counselling and group therapy. See your doctor for information and referral, or contact an alcohol and other drug service in your area.

Where to get help

• If an overdose is suspected, call triple zero (000) for an ambulance immediately
• Your GP (doctor)
• Alcohol and other drug service
• DrugInfoExternal Link Tel. 1300 85 85 84 – information and referral services for anyone seeking help for alcohol or drug use
• DirectLineExternal Link Tel. 1800 888 236 – for 24-hour confidential drug and alcohol telephone counselling, information and referral
• Self Help Addiction Resource Centre (SHARC)External Link Tel. 1300 660 068 – for information and support for people concerned about a relative or friend using drugs
• Youth Drug and Alcohol Advice serviceExternal Link (YoDAA), Victoria Tel. (03) 9415 8881 (9am to 5pm, Monday to Friday)

• HallucinogensExternal Link, Alcohol and Drug Foundation.
• KetamineExternal Link, Alcohol and Drug Foundation.
• NBOMesExternal Link, Alcohol and Drug Foundation.
• PMA and PMMAExternal Link, Alcohol and Drug Foundation.
• HallucinogensExternal Link, 2007, Family Drug Support, Australia.
• Degenhardt L, Bruno R, Topp L 2010, ‘Is ecstasy a drug of dependence?External Link’, Drug and Alcohol Dependence, vol. 107, no.1, pp. 1–10.
• Cottler L, Leung KS, Ben Abdallah A 2009, ‘Test retest reliability of DSM-IV adopted criteria for MDMA abuse and dependence: a cross-national studyExternal Link’, Addiction vol. 104, no. 10, pp. 1679–1690.
• Gillespie NA, Neale MC, Prescott CA, et al. 2007, ‘Factor and item-response analysis DSM-IV criteria for abuse of and dependence on cannabis, cocaine, hallucinogens, sedatives, stimulants and opioidsExternal Link’, Addiction, vol. 102, no. 6, pp. 920–930.

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Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional. The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances. The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website.

Reviewed on: 17-10-2018

Treatment of hallucinations in schizophrenia and other disorders of the nervous system

cholinergic neurotransmission, increased dopamine synthesis and deafferentation), on which further tactics of patient management depend. In another earlier article published in the Schizophrenia Bulletin, the same authors explore the evidence base for treatments for hallucinations in schizophrenia and other mental and neurological disorders. This article is more focused on clinical practice, thereby organically supplementing the latter, which to a greater extent considers precisely the fundamental aspects of hallucinations and the psychopharmacological effects on them. Below are the main points of the article “The Treatment of Hallucinations in Schizophrenia Spectrum Disorders”.

Hallucinations can occur in the context of many disorders and syndromes. Therefore, the choice of treatment tactics depends not only on the type of perceptual delusions and the impact on daily functioning, but also on the underlying disorder. At times, it can be very difficult to identify the underlying disorder because hallucinations, such as those in borderline personality disorder, psychotic depression, or temporal lobe epilepsy, may be indistinguishable from hallucinations in schizophrenia on a phenomenological level.

Associated symptoms such as paroxysmal activity, motor symptoms of parkinsonism, loss of vision or hearing are the most reliable signs used in the differential diagnosis. Some people who hallucinate only sporadically may simply be concerned that their experience is a sign of a mental disorder, without being concerned about the hallucinations themselves. For others, the burden of hallucinations cannot outweigh the side effects of their treatment. As a result, treatment may not be applicable in all cases. This article will look at some of the errors that are often associated with hallucinations, as well as specific treatment options for them.

Schizophrenia can be accompanied by hallucinations in any sensory modality. In 70% of cases, they are auditory in nature, and in 50% of cases, visual hallucinations are observed. Other types of hallucinations are less common.

Antipsychotics are known to be the only type of medication successfully used to treat hallucinations in schizophrenia. Only 8% of patients with a first psychotic episode still experience hallucinations after 1 year of treatment. However, no clinical studies have yet been published comparing the efficacy of various antipsychotic drugs for the single and specific indication of hallucinations. Therefore, data from the European First Psychotic Episode Study, which evaluated the effectiveness of 5 antipsychotic drugs in the treatment of hallucinations, were used for analysis. Olanzapine, amisulpride, ziprasidone, and quetiapine were found to be equally effective against hallucinations; haloperidol, according to the authors of the study, cannot be the drug of first choice.

If the first choice drug does not improve, it is best to switch to another drug after 2-4 weeks of treatment. Clozapine is the drug of choice for patients who are resistant to two adequate courses of antipsychotics. To prevent relapse, treatment should be continued with the same antipsychotic and preferably at the same dose. Long-acting forms should be considered for all patients because the risk of non-compliance is very high.

Cognitive behavioral therapy (CBT) may be used in addition to antipsychotic therapy. CBT is aimed at reducing the emotional stress associated with auditory hallucinations, it teaches the patient to ignore the “voices” and focus on future plans and goals, which affects the quality of life of patients. However, CBT has no effect on the frequency of hallucinations.

On the other hand, transcranial magnetic stimulation (TMS) can reduce the frequency and severity of auditory hallucinations. Several meta-analyses have demonstrated efficacy for low-frequency repetitive TMS in the left temporoparietal region compared to placebo. As a consequence, TMS currently has the status of a potentially useful treatment for auditory hallucinations, but only in combination with modern antipsychotic therapy.

Several guidelines mention electroconvulsive therapy (ECT) as the last step in the treatment of resistant psychoses in schizophrenia. Although several studies have shown clinical improvement after ECT use, a specific reduction in the severity of hallucinations has never been assessed at the group level.

Delirium is an acute neuropsychiatric syndrome characterized by psychotic symptoms such as hallucinations and delusions in the presence of reduced attention, fluctuating consciousness and other cognitive functions. This condition is very common in patients admitted to intensive care units, with an incidence of 32%, and is markedly associated with poor prognosis and increased mortality.

The only etiological treatment for delirium is to improve the patient’s physical condition. Symptomatic treatment of hallucinations and other symptoms of delirium should begin with measures aimed at normalizing the circadian rhythm and orientation of the patient. Pharmacological treatment should preferably consist of haloperidol or olanzapine, as recommended in the latest NICE guidelines. Although benzodiazepines are widely used for the treatment of delirium, their use is recommended only for alcoholic delirium. Cholinesterase inhibitors are not recommended, as evidenced by a randomized clinical trial of rivastigmine in patients with delirium admitted to the intensive care unit. This study was terminated at an early stage due to a significant increase in mortality and duration of delirium compared with the control group.

The prevalence of hallucinations and other psychotic symptoms among patients with PD is 80%. In the case of Lewy body dementia, pathogenetically closely associated with PD, these figures are even higher, especially for visual hallucinations. Auditory hallucinations are present in 20% of cases.

The pathophysiology of psychosis in PD and Lewy body dementia involves a complex interplay of extrinsic and disease-related factors, including central dopaminergic activity, imbalance of the dopaminergic and cholinergic neurotransmitter systems, dysfunction of the visual pathways, alterations in the regulation of the sleep-wake cycle, and weakened focus. However, the most important external factor in the development of hallucinations in the context of PD is drug treatment.

Treatment strategies: Decrease antiparkinsonian medications, increase low-dose “atypical” antipsychotics, and possibly cholinesterase inhibitors. Eng and Welty reviewed 13 studies of antipsychotic treatment in patients with PD and concluded that long-term therapy with clozapine is indeed effective, while the results of studies on the use of quetiapine are inconsistent. Only one double-blind, placebo-controlled study in 188 patients with PD and hallucinations confirms the effectiveness of the cholinesterase inhibitor rivastigmine. Thus, although the use of cholinesterase inhibitors, especially rivastigmine, appears to be a promising treatment for hallucinations in PD, the studies cited support the use of clozapine alone.

In AD, the occurrence of psychosis in 30-50% of cases has serious consequences for both patients and caregivers. Cholinesterase inhibitors such as donepezil may have a beneficial effect on hallucinations with a relatively mild side effect profile. Another study on the treatment of psychosis in asthma examined the efficacy of olanzapine, quetiapine, risperidone, and placebo for 36 weeks. The results showed that risperidone was more effective than the other two drugs and placebo. However, these drugs should be taken with caution due to the increased risk of complications in elderly patients.

As a consequence, antipsychotics are strongly discouraged as the first choice for treating psychotic symptoms in AD. Extrapyramidal symptoms and arrhythmias due to QT interval prolongation are frequent complications of “typical” antipsychotic drugs, while various cerebrovascular pathologies occur more often with the use of “atypical” antipsychotics. However, these drugs should be used when the severity of symptoms is extreme or when symptoms do not respond to other types of drugs or non-pharmacological interventions.

The reported incidence of hallucinations and other psychotic symptoms in epilepsy is 3.3%, and in temporal lobe epilepsy it is as high as 14%. Hallucinations may occur shortly before (aura), during, or after an epileptic seizure, but often occur independently of any motor seizures. Often the hallucinations resemble those that occur in patients diagnosed with schizophrenia and are referred to as “schizophrenic psychoses of epilepsy”.

Treatment of hallucinations should primarily involve the minimization of any drug that may mediate these symptoms. Various antiepileptic drugs such as phenobarbital, zonisamide, levetiracetam and gabapentin are known to induce hallucinations. In such cases, reducing the dose or switching to another antiepileptic drug can lead to a relatively rapid relief of hallucinations.

When antiepileptic drugs cannot be reduced or discontinued, antipsychotics are the drugs of choice. Clozapine and chlorpromazine should be avoided due to their epileptogenic properties, while quetiapine, risperidone and haloperidol are generally well tolerated.

Visually impaired patients may experience complex visual hallucinations, a condition known as Charles Bonnet syndrome. Similarly, people with progressive hearing loss may develop auditory hallucinations in the form of music, voices, or other sounds.

It is believed that such hallucinations are actually phenomena due to deafferentation of areas of the visual or auditory association cortex, which can lead to so-called “phantom perceptions”. Cognitive defects and social isolation may act as additional risk factors.

Patients who understand their unrealistic nature tend to suffer less from them, although they may still be distressed by the fear of “inevitable madness”. The assurance and explanation that visual or auditory misperceptions do not imply any mental disorder can have a powerful therapeutic effect.

According to the authors, psychotropic treatment is not always necessary, since the relief of hallucinations may stop either spontaneously or after the end of social isolation. The first choice treatment is to restore vision or hearing, for example by cataract surgery, ear cleaning or hearing aids.

When such interventions have failed, pharmacological treatment may be considered, although the benefits of treatment may not always outweigh the disadvantages of side effects. Although antipsychotics, antiepileptics, and cholinesterase inhibitors have previously been reported to be effective in these cases, there are currently no randomized trials of these types of drugs in patients with sensory deaferentation hallucinations. If pharmacological treatment is deemed necessary, quetiapine or lamotrigine may be considered as the drugs of choice. TMS has also been used for this type of hallucination, but results are still inconclusive.

The material was prepared as part of the ProSchizophrenia project, a specialized section of the official website of the Russian Society of Psychiatrists dedicated to schizophrenia, modern approaches to its diagnosis and treatment.

Prepared by: Kasyanov E.D.

Source: Sommer I. et al The Treatment of Hallucinations in Schizophrenia Spectrum Disorders. Schizophrenia Bulletin, Volume 38, Issue 4, 18 June 2012, Pages 704–714, https://doi.org/10.1093/schbul/sbs034

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What happens when haloperidol is stopped in people with schizophrenia

Cochrane Evidence Synthesis and Methods ►

Survey question

What are the effects of withdrawal of the antipsychotic haloperidol in stable people with schizophrenia while taking haloperidol.

Relevance

In schizophrenia, the links between thoughts, emotions, and behavior are broken, leading to impaired thinking and perception, inappropriate actions and feelings, and social isolation. Haloperidol is one of the first drugs to treat schizophrenia. Haloperidol is known to be effective in treating the psychotic symptoms (such as delusions and hallucinations) of schizophrenia, but it can cause unpleasant side effects. The effects of discontinuing or discontinuing haloperidol are not well understood.

Search for evidence

We electronically searched the Cochrane Schizophrenia Trial Registry (last on 24 January 2019) to find trials in which people with schizophrenia and stable on haloperidol were randomized to stop or continue taking haloperidol. The review authors found and reviewed 54 records.

Discovered evidence

Five trials met the requirements of the review and provided acceptable data.

Evidence from randomized controlled trials is of very low quality and suggests that stopping haloperidol is associated with worse outcomes in terms of overall improvement in symptoms (general well-being) in people with schizophrenia. They also show that people who stop taking haloperidol are more likely to experience a relapse (return of symptoms) within the first year after treatment. There were no trials with evidence of what happens after the first year. The number of participants who dropped out of the study early (which may be an indicator of treatment satisfaction) was similar for both treatment options.

The very low quality of available evidence is due to methodological weaknesses in the included trials. This reduces our confidence in the reliability of the results and limits their applicability in the real world.

Terminals

Disappointingly few studies were found, and the size and quality of these studies were limited. The available evidence does not fully answer important questions regarding the effects of haloperidol withdrawal. In particular, there is no evidence regarding the side effects of haloperidol. New, better tests are needed.

If you found this evidence helpful, please consider donating to Cochrane. We are a charity that produces accessible evidence to help people make health and care decisions.

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Translation notes:

Translation: Anastasia Aleksandrovna Zolotova.