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
• Encephelitis

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

Sources

Tintinalli