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Lysergide
See also Cannabinoids
General information
Lysergide (lysergic acid diethylamide, LSD) is a hallucinogen that is usually taken orally. Its initial effects, anticholinergic and sympathomimetic in type, occur within about half an hour and include tachycardia, hyperthermia, mydriasis, piloerection, hypertension, and occasionally nausea and vomiting. The more important psychoactive effects develop 1–2 hours later and can last 24–48 hours. They are principally changes in perception, mood, and behavior, leading in many cases to acute panic, hallucinations, delusions, and in some cases a classical psychosis. Perception may be strikingly heightened and distorted, and initial perceptions may mask and overshadow later sensory perception. Users often grossly exaggerate their mental and emotional capacities, attributing to themselves extraordinary powers. Visual hallucinations, loss of appreciation of time and space, and instability of mood are common. Meaningfulness and a sense of universal union often predominate. A significant problem in street purchase is the uncertain quality and likely impurity of the material obtained. Doses of 25 mg and more are sufficient to cause its psychophysiological effects, which are generally dose-related up to 500 mg. The half-life is about 3 hours, but the effects last considerably longer [ ].
Acute panic attacks and hallucinogen-induced psychotic disorder often occur when people with pre-existing personality disorder or pre-psychotic personalities use hallucinogens. Suicide and self-injury have been reported. Prolonged psychotic disorders can occur, but psychiatric opinion is divided as to whether these occur only in people with pre-existing disorders or in healthy individuals as well. “Flashbacks” occur particularly when there has been prolonged heavy use, but eventually disappear [ , ]. Self-injury and suicide can result [ ].
Hypersensitivity reactions are exceedingly rare and no reports have been validated. Tumor-inducing effects are possible, as a consequence of various reports from animal and human studies that chromosomal abnormalities may be associated with exposure to LSD. However, its mutagenic effects in practice are questionable, and no useful evidence for or against its potential for carcinogenicity has been produced [ ].
Organs and systems
Cardiovascular
Vasoconstriction, affecting both cerebral and peripheral circulations, has been associated with LSD [ ], but it is not usually significant at ordinary doses in people with a normal circulatory system.
Nervous system
Hallucinogen-induced mood disorder is associated with changes in affect, varying from euphoria to manic-like symptoms, panic/fear, and depression, often occurring within minutes and often varying in the same individual on different occasions. Changes in sensory perception, with a loss of ability to distinguish temporal or spatial reality and sensory hallucinations, particularly visual and tactile, are frequent, with a tendency to assume godlike attributes. These features often merge in a psychosis, particularly with repeated use. Whether chronic psychosis after LSD is the result of the drug or of a combination of the drug and predisposing factors is currently unanswerable [ ].
The repeated use of LSD is associated not only with psychoses, but also with more specific neurological signs and symptoms, including ataxia, incoordination, dysphasia, paresthesia, and tremor. Convulsions have been reported. “Flashback,” or the return of hallucinogenic effects, occurs in almost a quarter of those who have used LSD, particularly if they have also used other CNS stimulants, such as alcohol or marijuana [ , ]. They can experience distortions of perception of objects, space, or time, which intrude without warning into reality, resulting in delusions, panic, and unusual images. A “trailing phenomenon” has also been reported, in which the visual perception of objects is reduced to a series of interrupted pictures rather than a constant view [ ]. The frequency of these events may slowly abate over several years, but in a significant number their incidence later increases [ , ].
Sensory systems
Apart from visual hallucinations (discussed under the section Nervous system in this monograph), diplopia, blurred vision, mydriasis, and other visual disturbances occur [ ]. Pupillary dilatation, combined with altered sensory appreciation, has led to a number of instances of retinal damage after continued direct exposure to the sun [ ].
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