Hallucinations: Difference between revisions
Ostermayer (talk | contribs) (Text replacement - "Category:Neuro" to "Category:Neurology") |
|||
| Line 51: | Line 51: | ||
<references/> | <references/> | ||
[[Category: | [[Category:Neurology]][[Category:Tox]] | ||
Revision as of 14:15, 22 March 2016
Background
- The perception of auditory, visual, tactile, or gustatory sensations without an actual stimulus
- Etiology may be from underlying psychiatric disorder or organic cause.
Clinical Features
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)
Sedative/hypnotic toxicity
- Absinthe
- Barbiturates
- Benzodiazepines
- Chloral hydrate
- Gamma hydroxybutyrate (GHB)
- Baclofen toxicity
- Opioids
- Toxic alcohols
- Xylazine toxicity
Dissociative drugs
Other Organic Causes
- Alcohol Withdrawal
- Anticholinergic Toxicity
- Tricyclic (TCA) Toxicity
- Ertapenem Toxicity
- Encephalitis
- Hypocalcemia/Hypercalcemia
Psychiatric Causes [2]
- Schizophrenia
- Schizo-affective Disorder
- Dementia
- Delirium
- Migraine
- Seizure
- Parkinson's Disease
- Charles Bonnet Syndrome (in the visually impaired)
Diagnosis
Workup should be targeted toward specific diagnosis. Cranial imaging is only useful if localized neurological findings or headache red flags
In non-auditory hallucinations, assume organic pathology until proven otherwise.
- If concerned for suicidal or unknown toxic ingestion:
- Aspirin
- Tylenol level
- ECG
Management
- Treat the underlying pathology.
- In the case of Alcohol Withdrawl Hallucinosis, no standard therapy has been established,[3] although tx with neuroleptics (e.g. Haldol) has shown some benefit. [4] Also continue to treat the alcohol withdrawal.
See Also
References
- ↑ Visual Hallucinations: Differential Diagnosis and Treatment. PMID PMC2660156
- ↑ Visual Hallucinations: Differential Diagnosis and Treatment. PMID PMC2660156
- ↑ Neuroleptic treatment of alcohol hallucinosis: case series. PMID 18030655
- ↑ Alcohol-induced hallucinosis. Clinical aspects, pathophysiology and therapy. PMID 9064548