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Toxicology – LSD and Psilocybin (Hallucinogen Toxicity)
Source
Lysergic acid diethylamide (LSD) is a synthetic hallucinogen derived from ergot and is typically administered on blotter paper, sugar cubes, gelatin, or as liquid placed on the tongue. Psilocybin is a naturally occurring psychedelic compound found in certain mushrooms, commonly referred to as “magic mushrooms.”
Typical Presentation
Individuals often present after recreational use with altered perception. A common scenario involves a person experiencing a “bad trip” characterized by fear, anxiety, or distress following ingestion.
Clinical Features
Neuropsychiatric effects predominate, including visual and auditory hallucinations, synesthesia (blending of senses), and distorted perception of time. In adverse reactions, patients may experience intense fear, panic, depression, or psychosis. Physical findings may include dilated pupils, increased heart rate, elevated blood pressure, hyperthermia, and agitation. These substances can also worsen or reveal underlying psychiatric conditions.
Mechanism of Action
Both LSD and psilocybin act primarily on serotonin receptors, particularly the 5-HT2A subtype, producing their hallucinogenic effects. After oral ingestion, onset typically occurs within 1 to 2 hours, with effects lasting up to 12 hours depending on dose. Tolerance develops quickly but also resolves rapidly after discontinuation.
Management
Treatment is supportive. A calm environment and reassurance are essential. Benzodiazepines may be used to manage anxiety, agitation, and autonomic symptoms such as tachycardia.
Key Points
Source
Lysergic acid diethylamide (LSD) is a synthetic hallucinogen derived from ergot and is typically administered on blotter paper, sugar cubes, gelatin, or as liquid placed on the tongue. Psilocybin is a naturally occurring psychedelic compound found in certain mushrooms, commonly referred to as “magic mushrooms.”
Typical Presentation
Individuals often present after recreational use with altered perception. A common scenario involves a person experiencing a “bad trip” characterized by fear, anxiety, or distress following ingestion.
Clinical Features
Neuropsychiatric effects predominate, including visual and auditory hallucinations, synesthesia (blending of senses), and distorted perception of time. In adverse reactions, patients may experience intense fear, panic, depression, or psychosis. Physical findings may include dilated pupils, increased heart rate, elevated blood pressure, hyperthermia, and agitation. These substances can also worsen or reveal underlying psychiatric conditions.
Mechanism of Action
Both LSD and psilocybin act primarily on serotonin receptors, particularly the 5-HT2A subtype, producing their hallucinogenic effects. After oral ingestion, onset typically occurs within 1 to 2 hours, with effects lasting up to 12 hours depending on dose. Tolerance develops quickly but also resolves rapidly after discontinuation.
Management
Treatment is supportive. A calm environment and reassurance are essential. Benzodiazepines may be used to manage anxiety, agitation, and autonomic symptoms such as tachycardia.
Key Points
- The user’s mindset (“set”) and environment (“setting”) strongly influence the experience.
- Hallucinogen effects can vary widely depending on dose and individual susceptibility.
- These substances can precipitate or exacerbate psychiatric disorders in vulnerable individuals.
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