Hallucinations: Difference between revisions
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==Background== | ==Background== | ||
*Etiology may be from underlying psychiatric disorder or organic cause. | *Etiology may be from underlying psychiatric disorder or organic cause. | ||
==Clinical Features== | ==Clinical Features== | ||
*The perception of auditory, visual, tactile, or gustatory sensations without an actual stimulus | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Hallucinogen types}} | {{Hallucinogen types}} | ||
==Evaluation== | ==Evaluation== | ||
*Workup should be targeted toward specific diagnosis. | *Workup should be targeted toward specific diagnosis. | ||
*In non-auditory hallucinations, assume organic pathology until proven otherwise. | *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: | *If concern for suicidal or unknown toxic ingestion: | ||
**Acetaminophen level | **Acetaminophen level | ||
| Line 40: | Line 19: | ||
==Management== | ==Management== | ||
*Treat the underlying pathology. | *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,<ref> Neuroleptic treatment of alcohol hallucinosis: case series. PMID 18030655</ref> although treatment with neuroleptics (e.g. Haldol) has shown some benefit. <ref>Alcohol-induced hallucinosis. Clinical aspects, pathophysiology and therapy. PMID 9064548</ref> Also continue to treat the [[Alcohol Withdrawl |alcohol withdrawal]]. | *In the case of alcohol withdrawal hallucinosis, no standard therapy has been established,<ref> Neuroleptic treatment of alcohol hallucinosis: case series. PMID 18030655</ref> although treatment with neuroleptics (e.g. Haldol) has shown some benefit. <ref>Alcohol-induced hallucinosis. Clinical aspects, pathophysiology and therapy. PMID 9064548</ref> Also continue to treat the [[Alcohol Withdrawl |alcohol withdrawal]]. | ||
==Disposition== | |||
==See Also== | ==See Also== | ||
*[[General psychiatric approach]] | *[[General psychiatric approach]] | ||
*[[ | *[[Psychosis]] | ||
==External Links== | |||
==References== | ==References== | ||
Latest revision as of 23:32, 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
- Lysergic acid diethylamide (LSD)
- Psilocybin ("magic mushrooms")
- N,N-Dimethyltryptamine (DMT)
- 5-methoxy- dimethyltryptamine (5-MeO-DMT)
- 25C-NBOMe
Enactogens
- Designer amphetamines
- Bath salts
- Ecstasy (MDMA)
- Mescaline (peyote)
- Synthetic cannabinoids
Dissociative Agents
- Phencyclidine (PCP)
- Ketamine
- Dextromethorphan
- Nitrous oxide
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
- 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
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 [1]
- Schizophrenia, schizoaffective disorder, schizophreniform disorder
- Depression with psychotic features
- Bipolar disorder
- Charles Bonnet Syndrome (in the visually impaired)
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.