Hallucinations

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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