THE POST-LSD SYNDROME: Diagnosis and Treatment - Softcover

Roth M.D., Edwin I.

Softcover

ISBN 10: 1546244751 ISBN 13: 9781546244752

Publisher: AuthorHouse, 2018

Synopsis

I want to bring attention to a generally unrecognized condition, which results in a serious dysfunction in people who have experienced LSD. These patients are typically misdiagnosed as having an emotional problem but actually have a disturbance of brain function caused by prolonged effects of LSD. Their symptoms include axniety, insomnia, intellectual impairment and emotional instability. Unfortunately, none of the 500-plus patients I have seen had received effective treatment. The prognosis with effective treatment is excellent, and patients are relieved and grateful when they achieve a remission. When patients experience the post-LSD syndrome for years, with minimal benefit from ineffective medication, they become mentally and physically exhausted... The natural progression is to then turn to addictive substances for relief. The substance of choice in the majority of my patients has been alcohol. This patient?s gratifying improvement contrasts with his original grim, suicidal condition which had developed over years of misery and dysfunction caused by the POST-LSD SYNDROME and alcoholism. One wonders how prevalent are suicides in patients whose Syndrome is unrecognized and untreated.

About this title

About the Author

Dr. Roth was born and raised in East Cleveland, Ohio. He graduated from Adelbert College and the Medical School of Western Reserve U. He then trained in Pediatrics at Jacobi Hospital in the Bronx, New York, and was drafted from his Residency to serve in the USAF during the Cuban Missile Crisis. He served in Spain and Morocco in the Strategic Air Command (SAC) as a Pediatrician. Upon his discharge, he returned to Cleveland as a Resident in Psychiatry and then a Fellow in Child Psychiatry at University Hospitals of Cleveland. After a year as Child Psychiatric Consultant to B&C Hospital, he became Director of the Child Psychiatry OPD for six years. He became a diplomate of the American Board of Psychiatry and Neurology and then of the American Board of Child Psychiatry. He went into full time private practice in 1975, and was a Consultant for many years to Cuyahoga County at Juvenile Court, Metzenbaum Childrens Center, and Hudson Boys School. He was also a Treatment Team Leader at Bellefaire Residential Treatment Center. His main focus has been direct clinical practice. He graduated from the Cleveland Psychoanalytic Institute in both Adult and Child Psychoanalysis, and has engaged in the full time practice of Adult, Child and Adolescent Psychiatry and Adult and Child Psychoanalysis for over 30 years. After relocating to Palm Desert in southern California in 1997, Dr. Roth began to become aware of the patients who became the subject of this book. Working in his private practice and as a part-time Psychiatrist for Riverside County Mental Health and then for the California Department of Corrections and Rehabilitation at Chuckawalla Valley State Prison, he came in contact with patients who presented a different pathology than he had noted previously. He became increasingly aware of the existence of this condition, The Post-LSD Syndrome, and its surprising lack of recognition. He then researched the literature intensively, only to find a total lack of recognition in the literature. Because of the severity of the disturbance, its attendant suffering, and the relative treatability of the condition, Dr. Roth felt The Post-LSD Syndrome should be brought to public attention. The website for Dr. Roth and this book can be accessed at edwinrothmd.com or at the post-lsdsyndrome.com.

Excerpt. © Reprinted by permission. All rights reserved.

The Post-LSD Syndrome

Diagnosis and Treatment Revised Edition

By Edwin I. Roth

AuthorHouse

Copyright © 2018 Edwin I. Roth, M.D.
All rights reserved.

ISBN: 978-1-5462-4475-2

Contents

Dedication, vii, 
Foreword, ix, 
Chapter 1 The Clinical Syndrome, 1, 
Chapter 2 LSD, 15, 
Chapter 3 Treatment, Course of Illness, and Prognosis, 23, 
Chapter 4 Alcoholism, 31, 
Chapter 5 Depression, 37, 
Chapter 6 Addiction, 40, 
Chapter 7 Suicide, 43, 
Chapter 8 Special Cases, 47, 
Chapter 9 Barry, 54, 
Bibliography, 59, 
Author Biography, 61, 

CHAPTER 1

The Clinical Syndrome

I want to bring attention to a generally unrecognized, serious, at times severe, dysfunction in people, which is usually misdiagnosed as an emotional problem, but is actually an organic disturbance of brain function caused by the prolonged effect of LSD. I have termed this condition The Post-LSD Syndrome. The bad news is that there is a severe condition, The Post-LSD Syndrome (TPLSDS), which can result from even a single exposure to LSD, even decades after the exposure. The good news is that proper treatment can induce a complete remission fairly easily.

As I see it, TPLSDS is a discrete, unique group of severe symptoms which can be viewed as a tetrad of 1) a severe anxiety state, 2) a severe sleep disturbance, 3) impaired intellectual functioning, and 4) emotional instability. Most patients experience an acute onset with extreme anxiety, panic, inability to sleep, inability to concentrate and think clearly, and surges of emotion. Some fear they are becoming psychotic. Many patients remain acutely symptomatic for years unless treated effectively. Among the patients I saw, none had received effective treatment, and had been ill for months or years. Some had gone into a spontaneous remission for a time, then had a recurrence of symptoms. This cycle can occur repeatedly. Some patients who are acutely ill for a prolonged period may eventually go into a chronic phase which I will discuss below.

The Symptoms of the Basic Condition

The following is a detailed description of the symptoms and clinical findings of the tetrad that constitutes the basic condition of the TPLSDS. The four symptoms may have a simultaneous onset, but frequently the anxiety is primary, followed within a few days by the insomnia. The impaired intellectual functioning follows in a few days to several weeks, and the emotional instability accompanies it, or follows shortly after. By the time a physician is consulted, usually all symptoms are present.

1) The anxiety is a severe and most distressing symptom, often close to a panic state, and usually causes patients to seek treatment. They usually have no psychological explanation for their anxiety. This overwhelming anxiety is often accompanied by a sense of dread, doom, and despair and a fear of impending death. It is akin to what was termed LSD panic in the past. It can occur frequently, last for hours, and even be present most of the time, interfering severely with ability to function. Some patients say they would rather be dead than experience the severe anxiety for a prolonged period.

The anxiety often causes somatic symptoms, e.g., dyspnea, tachycardia, chest pain, weakness, sweating, dizziness, and faintness. Patients often present at an Emergency Room fearing a heart attack, and some have been briefly admitted to a Cardiac Unit. This severe anxiety causes patients to desperately seek a measure of relief, and they turn to medications, alcohol, or illegal drugs with incomplete benefit, but many become addicted while seeking relief.

Some patients linked their feeling of panic to prior experience with LSD, and said they experienced the same panic currently as they did when they used LSD months or years previously. Some reported reexperiencing somatic symptoms; e.g., visual distortions, hallucinations, odors, a bad taste, etc. One patient reported a sequence of tightening of his throat, then feeling unable to breathe, and then having a bad taste in his throat just as he'd experienced during his last few LSD trips many years previously. It was these connections to LSD which patients brought which enabled me to recognize the role of LSD in causing TPLSDS. Surprisingly, patients consistently reported that doctors insisted that LSD was unrelated to their condition, even when the patients told of their past use and the return of old symptoms caused by the past use.

2) The sleep disturbance, like the anxiety, is present in virtually all patients with this condition, and is equally responsible for patients seeking treatment. The sleep problem has unique, distressing qualities. It typically consists of severe insomnia, racing thoughts when trying to fall asleep, and vivid, terrifying nightmares. Patients are unable to fall asleep, tossing for hours, sleep fitfully, and awaken frequently. They achieve little or no sound sleep, and are irritable and exhausted, unable to function the next day, especially at work. They often resort to a variety of measures, particularly prescription medications, alcohol, and/or marijuana, to try to gain some sleep.

They report racing thoughts may occur during the day, but are particularly prominent at night. Patients describe thinking rapidly of one thing after another, jumping from subject to subject, with a feeling that the mind can't shut off. They feel they have no control over their thoughts, which they describe with metaphors such as a runaway train, a tornado of thoughts, and a movie that never ends. The thoughts cover all subjects which concern them, and the patients report their minds jump from one subject to another without resolving any of the concerns and without formulating any constructive course of action.

The unique, distressing nightmares are the final and most significant symptom of the sleep disturbance. They are remarkably vivid, intense, horrible, usually bizarre and unreal, and typically have a psychotic-like lack of restraint and control. The dreamer typically awakens disoriented and terrified, convinced that the dream was real, and is greatly relieved when able to gradually reorient and realize he was dreaming.

The dreams may present a realistic situation, or an actual memory, in an extreme and distorted way, or a bizarre, unreal situation involving monsters, aliens, or devils. The dreamer typically is threatened in a very dangerous situation, is often on the verge of being killed, and may even actually die in the dream, which rarely occurs in the common nightmare. Or a loved one, such as a child, may be in mortal danger, and may actually be murdered. The dreamer may kill assailants to defend the child or himself. The dreams often are in color, and bloody.

Many patients cannot fall asleep after awakening from one of these horrible dreams for fear it will recur. Many patients who do not dream actually abort the dreams by awakening frequently, and thus they may report that they sleep very little. It cannot be overemphasized how uniquely horrible, terrifying, and upsetting these dreams are, with an unusual intensity and vividness that is usually seen only in a delirium or a psychosis. I believe these dreams are pathognomonic of TPLSDS when they occur in the absence of a psychosis or a delirium.

3) The impaired intellectual functioning is mild to severe and can be devastating. Patients feel distracted and unable to focus, concentrate, or think clearly. They often are unable to watch TV or play a game. They may become unable to read, finding themselves rereading pages and unable to recall what they just read. Their memory deteriorates, and they may become unable to study, work, or learn. They become unable to think through and solve problems. Some fail academically or withdraw from classes, some quit or lose their jobs, and some fail in their businesses. However, patients retain a core of healthy ego and superego functioning, with judgement, standards, values, ambition, goals, and relationships, and thus are distressed by their inability to function, the resultant harm to their careers, and the financial consequences to their families. They cannot explain their dysfunction and feel upset with themselves as if they are voluntarily misbehaving. On superficial examination some patients appear to be intact, as their mental status performance on general knowledge, abstractions, calculations, etc. is often adequate. However, most report they are not responding as well as they should; they feel something is blocking their mind.

4) The emotional instability is described by patients as getting stressed easily and becoming overwhelmed with emotion, usually anger or tears. Many become tearful easily and embarrass themselves by crying in public with only mild provocation. Some become irritable and argumentative, may get surges of anger which are difficult to control, and may have violent impulses which are not characteristic of them. As a result of this emotional lability, many feel uncomfortable around people and seek to withdraw and isolate themselves. Objectively, this emotional lability may be seen as tearfulness or anger in the clinical session, and the patients may feel embarrassed and apologize. In some patients, especially men who have experienced TPLSDS for years, the anger surges may be prominent, even dominating, and lead to brawling and sadism. Such patients may feel this behavior is an inherent part of their personality which could never change. However, the anger may actually be ego-alien and undesirable, and some patients become aware that they dislike the aggression after they begin to benefit from treatment.

Let me describe some typical patients to bring the clinical picture into a clear focus. These patients demonstrate remarkable similarities in their presentation and discussion of their clinical pathology, and their response to treatment. In this section I will refer to treatment briefly and save the comprehensive discussion for Chapter Three.

Case 1) Mrs. A. was an intelligent, educated, personable 42-year old married woman who had experienced increasing anxiety and depression for two years, and sought consultation with me because she felt weekly counseling and medications were not helping. First and foremost, she had a sleep disturbance consisting of severe insomnia, racing thoughts which kept her awake for hours, and terrifying, vivid, nightmares when she finally fell asleep. She also had anxiety attacks during the day which bordered on panic and made her feel disabled and unable to function. She had trouble concentrating, and generally felt confused and distracted. An extremely competent person basicly, she knew she was performing poorly. She often felt irritable and tearful.

Her severe anxiety was prominent and impressive. She had no manifestations of psychosis, e.g., she had no thought disorder or disturbance of affect, and her ego was basically intact, although her performance and her ability to cope with anxiety, affects, and stress was impaired. She felt her satisfactory performance on the mental status exam I gave her was actually below her true ability. She denied any drug use or alcohol abuse, but, upon reflection, did recall a terrible experience at a party when she was 17. She felt something had been put into her drink because she developed a prolonged "bad trip" in which she felt panic, felt she was going to die, was frightened, agitated and paranoid, and had visual disturbances. She hallucinated and thought the walls were moving in on her. She was unable to sleep that night, but finally felt better the next day. We concluded she most likely had been slipped some LSD, which she knew was at the party. She said her mind never felt quite right after that — she always felt anxious, easily disturbed and distracted.

She agreed to medication, and I started her on a low dose of Olanzapine (Zyprexa), an antipsychotic. To her great relief and our mutual surprise, when she returned one week later she reported a remarkable improvement. Her sleep disturbance had cleared up completely! She no longer had racing thoughts, insomnia, or nightmares, and she slept soundly all night. Her anxiety had also decreased significantly. Her symptoms gradually improved over the next few weeks; she felt less distracted, more able to focus and concentrate, and was less depressed. Over the next few months her symptoms faded away. She decreased her Olanzapine, gradually discontinued her other medications, and went into full remission. She was elated and grateful, and felt she was herself again. She felt she had no need for further therapy or counseling.

Case 2) Mr. B. was a 27-year-old professional who presented severely distressed by severe anxiety, horrible nightmares, and feeling distracted and unable to focus, concentrate, or work for over a year. He was seeing a Psychiatrist who had prescribed various tranquilizers and antidepressants which did not help. He feared people could detect his anxiety, so he tried to avoid looking them in the eye and isolated himself as much as possible. His sleep was disturbed by horrible, vivid nightmares with monsters in which he was in danger, became enraged, and injured people and monsters. He dreaded these dreams, and the anger that accompanied them. He felt he stressed out easily, feared having to make a work presentation, could not cope with people or his job, cried frequently, and lost his job and his girl friend.

He felt his problems stemmed from having taken LSD two years previously, but his psychiatrists had disagreed. He said he'd had the same anxiety and inability to focus when he took the LSD hit, and then they cleared up after a few days. However, less than a year later the anxiety returned, and other symptoms started and progressed. He said he had been using a little marijuana about three times a week for years and it relaxed him. I agreed with him about the LSD and we agreed to start him on Olanzapine and to taper him off of his medications and marijuana. His symptoms improved dramatically after the first dose, and he rather quickly went into full remission. He said he felt much better with people, was ready to return to work, but first wanted to take a special trip which he and a friend had planned. He no longer felt too ill to make the trip. He said he'd take his Olanzapine at the lower dose, but hoped he could do without it soon.

Case 3) Ms. C. was an immature 21-year old woman who had been in therapy since 17 for anxiety and depression. Various medications had been unhelpful. She had just completed a one-year training program which certified her in her career, and was about to start her first job. However, a month prior to her presentation to me, she developed severe panic attacks with nausea, dizziness, difficulty breathing, insomnia, and racing thoughts. She felt unable to think clearly, and felt she was going to die. On mental status, her ego was basically intact, however, she had extreme anxiety, had trouble coping with stresses, and had trouble concentrating. She felt angry and volatile. She hoped weekly therapy would enable her to feel better and to be effective in her new job, and we agreed to start. She reduced the dosage of her antidepressant which she thought had made her worse, and reduced her use of alcohol and marijuana, which she had been taking for her insomnia. However, she then developed vividly terrifying nightmares from which she awoke in a panic.

She then revealed she had smoked some marijuana about 6 months previously which she feared had been laced with LSD, because it caused a terrifying experience in which she felt panic and nausea, couldn't breathe, and felt she was going to die. The walls felt like they were moving in on her, she saw bright colors, sounds were louder, and she felt she couldn't focus on anything. She went to an emergency room and got a shot which stopped the episode, and she thought she was over it. Her boyfriend used a lot of LSD, always pressed her to join him in using it, but had promised never to force it on her. She agreed to medication, and I prescribed Olanzapine. She immediately felt calmer after she took the first dose, and was able to sleep well. However, she felt drugged and overmedicated. We reduced the dose with excellent results. Her racing thoughts and nightmares stopped, her anxiety and anger gradually decreased, and within 3 weeks all presenting symptoms had improved considerably.

After several months she was in full remission from TPLSDS. She worked on her emotional issues in her therapy more effectively. She had much more ego strength with which to work on them, i.e., she was no longer overwhelmed by affects and anxiety because of interference from LSD effects and could gain relief from the therapeutic process. After several months she no longer felt depressed, and she decided to leave the boy friend. She continued her Olanzapine daily for over a year, gradually decreasing the dosage to every other evening, while she continued in psychotherapy for a second year until she moved out of state to go to college.

Case 4) Mr. D. was a 17-yr old high school senior who was on a holiday with his parents visiting family in my area. He had panic attacks so severe that they caused him to vomit, and he felt unable to concentrate or think. He felt he had something physically wrong and felt that he would die. He complained that for the past month he'd had insomnia, terrible nightmares, horrible rushing thoughts, and severe anxiety which culminated in the panic attacks. He felt unable to function, hadn't been able to go to school, felt agitated and irritable, ready to explode, and had recently crashed and totaled his van. He felt these symptoms were precipitated by his smoking marijuana about a month previously, because at the time he had felt weird and sick, and was reminded of a bad episode, a bad trip, he'd had about a year previously when he'd thought he had been slipped some LSD.

(Continues...)

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Edition details

• Publisher: AuthorHouse
• Publication date: 2018
• Language: English
• ISBN 10: 1546244751
• ISBN 13: 9781546244752
• Binding: Paperback
• Number of pages: 74