Hallucinations: Difference between revisions

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==Differential Diagnosis==
==Differential Diagnosis==
{{Hallucinogen types}}
{{Hallucinogen types}}
===Organic causes===
*[[Delirium]]
*[[Intracranial mass]] to occipital or temporal lobes
*[[Encephalitis]], [[limbic encephalitis]], [[anti-NMDA receptor encephalitis]]
*[[Migraine]]
*[[Seizure]]
*[[Hypocalcemia]]/[[Hypercalcemia]]
*[[Rift valley fever]]
*[[Rabies]]
*[[Syphilis]]
*[[Vitamin B7 deficiency]]
*[[Pellagra]]
*[[Dementia]]
*[[Parkinson's Disease]]
{{Sedatve/hypnotic toxicity types}}
====Other Toxicologic Causes====
*[[Alcohol Withdrawal]]
*[[Anticholinergic Toxicity]]
*[[Tricyclic (TCA) Toxicity]]
*[[Synthetic cannabinoids]]
*[[Inhalant abuse]]
*[[Nitrogen narcosis]]
*[[GHB withdrawal]]
*[[Hydrocarbon toxicity]]
*[[Heavy metal toxicity]]
*Multiple medications: [[montelukast]], [[doxapram]], [[hyoscyamine]], [[tizanidine]], [[peramivir]], [[amantadine]], [[rimantadine]], [[bromocriptine]], [[methylergonovine]], [[benztropine]], [[doxepin]], [[voriconazole]], [[acyclovir]], [[valacyclovir]], [[ganciclovir]], [[cimetidine]], [[penicillin G Procaine]], [[clarithromycin]], [[metoclopramide]]
*[[Inhalant abuse]]
===Psychiatric Causes <ref>Visual Hallucinations: Differential Diagnosis and Treatment. PMID PMC2660156</ref>===
*[[Schizophrenia]], [[schizoaffective disorder]], [[schizophreniform disorder]]
*[[Depression]] with psychotic features
*[[Bipolar disorder]]
*Charles Bonnet Syndrome (in the visually impaired)


==Evaluation==
==Evaluation==

Revision as of 21:03, 12 January 2021

Background

  • Etiology may be from underlying psychiatric disorder or organic cause.

Clinical Features

  • The perception of auditory, visual, tactile, or gustatory sensations without an actual stimulus

Differential Diagnosis

Hallucinations

Serotonin-Like Agents

Enactogens

Dissociative Agents

Plant-based Hallucinogenics

  • Marijuana
  • Salvia
  • Absinthe
  • Isoxazole Mushrooms
  • Hawaiian baby woodrose (Argyreia nervosa)
  • Hawaiian woodrose (Merremia tuberosa)
  • Morning glory (Ipomoea violacea)
  • Olili- uqui (Rivea corymbosa)

Organic causes

Other Toxicologic Causes

Psychiatric Causes [1]

Evaluation

  • Workup should be targeted toward specific diagnosis.
  • In non-auditory hallucinations, assume organic pathology until proven otherwise.
  • New diagnosis of psychiatric disease as cause of hallucinations should generally not be made in ED without first ruling out organic pathology
  • If concern for suicidal or unknown toxic ingestion:
    • Acetaminophen level
    • Salicylate level
    • ECG

Management

  • Treat the underlying pathology.
  • If hallucinations distressing, can trial dose of PO antipsychotic
  • In the case of alcohol withdrawal hallucinosis, no standard therapy has been established,[2] although treatment with neuroleptics (e.g. Haldol) has shown some benefit. [3] Also continue to treat the alcohol withdrawal.

See Also

References

  1. Visual Hallucinations: Differential Diagnosis and Treatment. PMID PMC2660156
  2. Neuroleptic treatment of alcohol hallucinosis: case series. PMID 18030655
  3. Alcohol-induced hallucinosis. Clinical aspects, pathophysiology and therapy. PMID 9064548