Hallucinations

1 Hallucinations Summary

Hallucinations are sensations of something unreal created by the mind. The sensation may be in any one of the senses including smell, taste or auditory.

Thus in hallucination, a person may hear a voice that does not exist in real or see something that is unreal. It may be caused by a mental or physical illness, or as a side effect of medications.

There are different types of hallucinations: 

Visual hallucinations – this involves visual senses and is categorized by seeing things that are not real. It may be of objects, people, lights or simple patterns. A hallucinating person may see a person or light that is not present in the light.

Olfactory hallucinations – this involves hallucinations that are related to the sense of smell. The smell may be unpleasant smell or a strange smell. It also includes the hallucination that the body smells bad. Some may feel the pleasant smell of flowers when they are present in real.

Auditory hallucinations – this is one of the most common types of hallucinations. The hallucinating person may hear people speaking to them. The voices may be heard as a neutral or an angry tone. They may also be heard as repeated tapping noise or give the feeling as if someone is walking in the attic.

Gustatory hallucinations – hallucinations involving the taste is referred to as gustatory hallucinations. The taste may be unheard of and very unpleasant. These type of hallucinations are commonly seen in epileptic patients.

Tactile hallucinations – hallucinations relating to movement or touch is referred to as tactile hallucinations. People with this type of hallucinations may complain of bugs crawling in their body or the movement of organs inside the body. They may also feel as if someone’s hand is touching the body.

Temporary hallucinations – these feelings are temporary and usually occurs when the person is undergoing a trauma. The person may see or hear another person who just died a few days back. The hallucination may fade as the pain of loss reduces.

A number of psychological and cognitive symptoms accompany hallucinations. This includes anxiety, mood swings, confusion, memory loss, delusions, heightened arousal, poor judgment, sleep problems, and depression. Appetite loss, flu-like symptoms, enlargement of liver, incontinence, muscle twitch, nausea and difficulty in swallowing are also seen associated with hallucinations.

Symptoms that warrant medical attention are:

  • Bluish color of nails and lips
  • Suicidal behavior
  • Change in level of consciousness
  • Sudden change in behavior
  • Chest pain
  • Tightness in chest
  • High fever
  • Rapid heart rate
  • Seizures
  • Severe pain
  • Vomiting
  • Trauma

Hallucinations are caused by a number of factors like mental illness, substance abuse, lack of sleep, and certain medications. Conditions like schizophrenia, Parkinson’s disease, Alzheimer’s disease, and Charles Bonnet syndrome have hallucinations as one of the symptoms.

Medical history and physical examination give important clues about the cause of hallucinations. Tests like an electroencephalogram (EEG) and MRI are used in confirming the diagnosis of the cause.

Treatment depends on the underlying cause of hallucinations. Medications, psychotherapy, surgery, radiation therapy and cognitive behavioral therapy are used in treating the different conditions that lead to hallucinations.

2 Causes

There are multiple causes for hallucinations including mental illnesses, substance abuse, sleep deprivation, and certain medications. Mental conditions like schizophrenia, dementia and delirium are some of the common causes of hallucinations.

Alcohol abuse and taking drugs may also lead to seeing and hearing things that are unreal. Not having enough sleep for a long time increases the chance of hallucinations. Certain medications like those used in the treatment of psychosis and depression may lead to hallucinations.

Some possible causes of hallucinations are: 

  • Psychosis – People with psychosis have a disrupted or abnormal relation with reality. It is one of the most common causes of hallucinations.
  • Schizophrenia – schizophrenia refers to a group of psychiatric disorders in which people lose base with reality. Hallucinations are one of the most common symptoms of this disorder.
  • Alzheimer’s disease – is a condition characterized by memory and cognitive loss. Apart from dementia, Alzheimer’s may lead to hallucinations of different types.
  • Dementia – this is a mental illness characterized by a decline in cognitive functioning. Dementia may have hallucinations as one of the symptoms.
  • Alcohol withdrawal delirium – this condition is a medical emergency caused by alcohol withdrawal. Characterized by severe changes in brain and hallucinations of different types, it should be immediately brought to the attention of the doctor.
  • Hyponatremia – hyponatremia or low blood sodium, is caused by an imbalance in water and sodium content in blood. A sudden drop in sodium levels in the blood may result in hallucinations.
  • Epilepsy – Epilepsy, a neurological disorder, may cause auditory and visual hallucinations.
  • Narcolepsy – narcolepsy is a neurological disorder characterized by drowsiness and sleep attacks. People with this condition may have hallucinations as if they are falling asleep or waking up from a deep sleep.
  • A migraine – classical migraines, or migraines with aura, cause the temporary disturbance in the vision before the onset of symptoms. These visual disturbances referred to as an aura, are visual hallucinations.
  • An overdose of caffeine – studies show that people who take an overdose of caffeine have an increased risk of hallucinations. For a normal, healthy adult the recommended dose of caffeine is 400 mg per day.
  • Drug abuse – People who have an overdose of marijuana are more likely to hallucinate and have acute psychosis.
  • Hypoglycemia – hypoglycemia or low blood sugar level, may lead to scattered thoughts, and hallucinations and delusions.
  • Cryptococcal meningitis – it is a fungal infection of the meninges, the membrane covering the brain and spinal cord. It may lead to hallucinations, lethargy, and even personality changes.
  • Wernicke-Korsakoff syndrome – caused by lack of vitamin B1, this condition may result in visual hallucinations.
  • Partial seizures – auditory and visual hallucinations may be seen as a symptom of partial seizures.
  • Delirium – delirium is a sudden change in the brain that results in confusion and emotional disruptions. It is a medical emergency and should be given medical attention as soon as possible.
  • Primary cerebral lymphoma – also known as brain lymphoma, this condition may cause hallucinations of different types.
  • Mad cow disease – Mad cow disease or Creutzfeldt-Jakob disease is an infectious disease that leads to degeneration of the brain. The disease may cause hallucinations.
  • Schizoaffective disorder – this is a psychological condition characterized by both psychosis and mood disorder. The different subtypes of this condition have hallucinations as one of the symptoms.

Some other causes of hallucinations include: 

  • Terminal illnesses
  • High fever
  • Social isolation – as in elderly people who are away from family and friends.
  • Deafness and blindness – many people with visual problems experience hallucinations. This is referred to as Charles Bonnet Syndrome and is more commonly seen in elderly people.

3 Diagnosis and Treatment

Those who have hallucinations should meet the physician for a checkup. Presenting symptoms and physical examination are the best diagnostic measures for the underlying cause of hallucinations.

Some of the causes of hallucinations are medical emergencies and should be treated immediately. People with hallucinations need support and company as they tend to become nervous and frightened.

The fear and paranoia may trigger self-destructive behavior. In children, hallucinations may not necessarily be a symptom of the mental condition.

Doctor may obtain information on:

  • Onset of hallucinations
  • Time of the day when hallucinations occur
  • Medications taken
  • History of emotional trauma in life
  • History of substance abuse
  • Other symptoms like agitation, confusion, fever, headache or vomiting

The information may be provided by the accompanying person rather than the patient himself. Some other tests also may be recommended to identify the problem. EEG is suggested to detect the unusual electrical activity in the brain.

It is usually used to identify hallucinations caused by seizures. MRI is used to visualize abnormalities in the brain like tumor and stroke, which may cause hallucinations.

Treatment is based on the underlying cause of the condition. Medications are used for the treatment of schizophrenia and dementia. Epilepsy is controlled using anti-seizure drugs.

Visual problems like macular degeneration, glaucoma and cataracts are also relieved by medications. Tumors may be treated using surgery. For people with migraine drugs like triptans and beta-blockers are suggested.

Hallucinations linked to psychosis is treated using pimavanserin. This is usually recommended for people with Parkinson’s disease. Antipsychotics are the treatment of choice for people with psychosis.

Cognitive behavioral therapy is a psychotherapy used to slow down the progression of psychosis, particularly in patients who are at a high risk of developing psychosis. In this therapy, the doctor helps the patient to identify an alternative meaning for hallucinations.

They also help the person to develop coping strategies for the issues that cause hallucinations. For example, the person may be taught to visualize a scary visual hallucination as a funny or more acceptable image for better coping.

The outcome of treatment may also depend on the underlying cause of hallucinations. Behavioral changes like avoiding excessive drinking and drug abuse are needed.

If the person is not sleeping enough, steps should be taken to help the person relax and sleep better. Compliance with the medications of mental illness is very important in the successful treatment of the condition.

For a better and long-term success of the treatment, early diagnosis and treatment of the underlying condition are very important. Thus, seeking prompt medical care for hallucinations will help in treating the condition.

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