LAUSR

Hallucinogen persisting perception disorder (HPPD) is a rare syndrome characterised by the continued experience of perceptual symptoms despite the cessation of hallucinogen use. There are no established guidelines for pharmacological treatment of HPPD, with treatment largely informed by case reports. We report a case of HPPD to highlight the complexities of its management. TJ is a 22-year-old man, who selfpresented to an emergency department following a high lethality suicide attempt by hanging, in the context of established HPPD. His psychiatric history includes a history of polysubstance abuse, HPPD and major depressive disorder. The onset of HPPD occurred 3 years ago after taking ketamine, MDMA and nitrous oxide, with 2 days later the patient experiencing blurred vision, photophobia, ‘brain zaps’ and depersonalisation. Since then, TJ has had anxiety and depressive symptoms, severe chronic headaches, and reoccurrence of perceptual disturbances experienced during hallucinogen intoxication. This includes visual hallucinations (constant visual static, photopsia), visual illusions (afterimages), entoptic phenomena (mouches volantes, blue field entoptic phenomenon), metamorphopsia (kinetopsia) and other perceptual phenomena (derealisation, sensory disturbances – photophobia, phonophobia, osmophobia, auditory hallucinations/tinnitus).