LSD-associated “Alice in Wonderland Syndrome”(AIWS): A Hallucinogen Persisting Perception Disorder (HPPD) Case Report

This case study discusses the LSD-linked “Alice in Wonderland Syndrome”(AIWS) or Todd’s syndrome in a patient with a history of sporadic and recreational cannabis, alcohol, and LSD use. The observation suggests that AIWS only manifested during LSD use and continued post LSD suspension, namely, Hallucinogen Persisting Perception Disorder (HPPD). While this did not result in a major functional impairment, it induced considerable worry and concern because of its persistent continuation.

Abstract

“A side effect associated with the use of LSD is the return of perceptual disturbances which anteriorly emerged during intoxication, despite absence of present use. Here we present the case of a patient with a previous history of sporadic and recreational cannabis, alcohol and LSD consumption who reported LSD associated “Alice in Wonderland Syndrome” (AIWS) or Todd’s syndrome. AIWS is basically characterized by four frequent visual illusions: macropsia, micropsia, pelopsia and teleopsia. AIWS only appeared during LSD consumption and continued after LSD suspension, namely, Hallucinogen Persisting Perception Disorder (HPPD). This phenomenon did not cause a major functional impairment but provoked sufficient worry and concern due to its persistent continuation. The patient refused medical treatment and continued psychiatric follow-up. At the one year follow-up he reported complete remission. To the best of our knowledge this is the first reported case of AIWS which persist after LSD interruption (HPPD) in the professional literature. Reasons for this intriguing, benign, reversible and apparently harmless side effect are proposed.“

Authors: Arturo G. Lerner & Shaul Lev Ran

Summary of LSD-associated Alice in Wonderland Syndrome

Alice’s Adventures in Wonderland is inspired by Amanita Muscaria, a hallucinogenic mushroom that possesses the psychoactive alkaloid muscimol. This syndrome may have multiple etiologies and consists of multiple visual aberrations, such as macropsia, micropsia, pelopsia and teleopsia.

A patient with a prior history of cannabis, alcohol and LSD sporadic recreational intake sought professional consultation for the presence of LSD-induced AIWS.