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.

Differential Diagnosis

Hallucinogens

• LSD
• 25C-NBOMe
• Phencyclidine
• Mescaline (Peyote)
• Psilocybin/Mushroom Poisoning
• N,N-Dimethyltryptamine
• Ecstasy (MDMA)
• PCP
• Bath Salts
• Salvia toxicity
• Marijuana
• Absinthe

Sedative/hypnotic toxicity

• Toxic alcohols
  • Ethanol
  • Ethylene glycol
  • Methanol
  • Isopropyl alcohol
• Benzodiazepines
  • Flunitrazepam (Rohypnol)
• Gamma hydroxybutyrate (GHB)
• Barbiturates
• Opioids
  • Lomotil toxicity
• Chloral hydrate
• Absinthe

Dissociative drugs

• Dextromethorphan
• Ketamine
• Nitrous oxide
• Phencyclidine (PCP)

Other Organic Causes

• Alcohol Withdrawal
• Anticholinergic Toxicity
• Tricyclic (TCA) Toxicity
• Ertapenem Toxicity
• Encephalitis
• Hypocalcemia/Hypercalcemia

Psychiatric Causes

• Schizophrenia, schizo-affective Disorder
• Dementia
• Delirium
• Migraine
• Seizure
• Parkinson's Disease
• Charles Bonnet Syndrome (in the visually impaired)

Evaluation

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

See Also

• General Psych Workup
• Alcohol Withdrawal
• Hallucinogens

References

Authors

Jonathan Osgood, Ross Donaldson, Daniel Ostermayer, Neil Young, Claire