Hallucinations: Difference between revisions

 
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==Background==
==Background==
*The perception of auditory, visual, tactile, or gustatory sensations without an actual stimulus
*Etiology may be from underlying psychiatric disorder or organic cause.
*Etiology may be from underlying psychiatric disorder or organic cause.
''In non-auditory hallucinations, assume organic pathology until proven otherwise.''


==Clinical Features==
*The perception of auditory, visual, tactile, or gustatory sensations without an actual stimulus


==Differential Diagnosis==
==Differential Diagnosis==
===Organic Causes===
{{Hallucinogen types}}
#[[Alcohol Withdrawal]] - hallucinosis without altered sensorium, predominately auditory & usually begins 24-48 hours after last drink
#[[Anticholinergic Toxicity]]
#Hallucinogen Intoxication
##Psilocybin/[[Mushroom Poisoning]]
##LSD
##Mescaline (Peyote)
##[[Ecstasy (MDMA)]]
##[[PCP]]
##[[Bath Salts]]
##[[Salvia|Salvia Intoxication]]
##Marijuana
#[[Methanol Toxicity]]
#[[Tricyclic (TCA) Toxicity]]
#[[GHB|GHB Intoxication]]
#[[Ertapenem]] Toxicity
#[[Encephalitis]]
#[[Hypocalcemia]]/[[Hypercalcemia]]
 
===Psychiatric Causes <ref>Visual Hallucinations: Differential Diagnosis and Treatment. PMID PMC2660156</ref>===
*Schizophrenia
*Schizo-affective Disorder
*[[Dementia]]
*[[Delirium]]
*[[Migraine]]
*[[Seizure]]
*[[Parkinson's Disease]]
*Charles Bonnet Syndrome (in the visually impaired)
 
==Workup==
''Workup should be targeted toward specific diagnosis. Cranial imaging is only useful if localized neurological findings or [[Headache Red Flags | headache red flags]] ''


*If concerned for suicidal or unknown toxic ingestion:
==Evaluation==
**Aspirin
*Workup should be targeted toward specific diagnosis.
**Tylenol level
*In non-auditory hallucinations, assume organic pathology until proven otherwise.
**ECG
*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==
==Management==
*Treat the underlying pathology.
*Treat the underlying pathology.
*In the case of Alcohol Withdrawl Hallucinosis, no standard therapy has been established,<ref> Neuroleptic treatment of alcohol hallucinosis: case series. PMID 18030655</ref> although tx 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]].
*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]].
 
==Disposition==


==See Also==
==See Also==
*[[General Psych Workup]]
*[[General psychiatric approach]]
*[[Alcohol Withdrawal]]
*[[Psychosis]]
*[[Hallucinogens]]
 
==External Links==


==Sources==
==References==
<references/>
<references/>


[[Category:Neuro]][[Category:Tox]]
[[Category:Neurology]]
[[Category:Toxicology]]

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

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.

Disposition

See Also

External Links

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