Hallucinations

Background

• The perception of auditory, visual, tactile, or gustatory sensations without an actual stimulus
• Etiology may be from underlying psychiatric disorder or organic cause.

In non-auditory hallucinations, assume organic pathology until proven otherwise.

Differential Diagnosis

Organic Causes

1. Alcohol Withdrawal - hallucinosis without altered sensorium, predominately auditory & usually begins 24-48 hours after last drink
2. Anticholinergic Toxicity
3. Hallucinogen Intoxication
   1. Psilocybin/Mushroom Poisoning
   2. LSD
   3. Mescaline
   4. Ecstasy (MDMA)
   5. PCP
   6. Bath Salts
   7. Salvia Intoxication
   8. Marijuana
4. Methanol Toxicity
5. Tricyclic (TCA) Toxicity
6. GHB Intoxication
7. Ertapenem Toxicity
8. Encephalitis
9. Hypocalcemia/Hypercalcemia

Psychiatric Causes

• 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

• 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, although tx with neuroleptics (e.g. Haldol) has shown some benefit. Also continue to treat the alcohol withdrawal.

See Also

• General Psych Workup
• Alcohol Withdrawal