Hallucinations

Background

• The perception of auditory, visual, tactile, or gustatory sensations that are not present
• Etiology may be from underlying psychiatric disorder or organic cause.
• In non-auditory hallucinations, assume organic pathology unit proven otherwise.

Differential Diagnosis

Organic Causes

• Alcohol Withdrawal - hallucinosis without altered sensorium, predominately auditory & usually begins 24-48 hours after last drink
• Anticholinergic Toxicity
• GHB Intoxication
• Mushroom Poisoning
• Bath Salts
• Tricyclic (TCA) Toxicity
• Methanol Intoxication
• Salvia Intoxication
• Ertapenem Toxicity
• Encephalitis

Psychiatric Causes

• Schizophrenia
• Dementia
• Parkinson's Disease

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 in small studies