Hallucinations

The types of hallucinations relate to the senses and can include:

• Auditory hallucinations are hearing voices or sounds, such as music, that are not there. These are the most common types of hallucination.

• Gustatory hallucinations are tasting something that you have not ingested.

• Olfactory hallucinations are smelling things that are not real.

• Tactile hallucinations are feeling sensations that have no real physical stimuli.

• Visual hallucinations are seeing things that are not there.

Even though the various types of hallucinations occur without external stimuli, they are very real to the person experiencing them.

Hallucinations may accompany other symptoms that vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the brain may also involve other body systems.

Hallucinations may accompany other psychological or cognitive symptoms including:

• Anxiety, irritability or agitation

• Changes in mood, personality or behavior

• Confusion, forgetfulness or disconnectedness

• Delusions

• Difficulty with memory, thinking, talking, comprehension, writing or reading

• Heightened arousal or awareness

• Mood depression or elevation

• Mood instability

• Poor judgment

• Sleep disturbances

• Withdrawal or depression

Hallucinations may accompany symptoms related to other body systems including:

• Appetite or weight changes

• Enlarged liver and glands, such as the spleen and lymph nodes

• Flu-like symptoms (fatigue, fever, sore throat, headache, cough, aches and pains)

• Impaired balance and coordination

• Incontinence, weakness, or sensory changes

• Low vision (Charles Bonnet Syndrome: visual hallucinations that occur in individuals with progressive visual loss)

• Muscle twitching, spasms or seizures

• Nausea with or without vomiting

• Swallowing difficulties

• Weakness (loss of strength)

In some cases, hallucinations may be a symptom of a life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

• Being a danger to oneself or others, including threatening, irrational or suicidal behavior

• Bluish coloration of the lips or fingernails

• Change in level of consciousness or alertness, such as passing out or unresponsiveness

• Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions

• Chest pain, chest tightness, chest pressure, palpitations

• High fever (higher than 101°F)

• Rapid heart rate (tachycardia), slow heart rate (bradycardia), or abnormal heart rhythms (arrhythmias)

• Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, slow breathing, not breathing, choking

• Seizure

• Severe and persistent vomiting

• Severe pain

• Trauma, such as bone deformity, burns, eye injuries, and other injuries

The specific cause of hallucinations is not known, but they can be associated with some psychiatric disorders or medical conditions. Substance abuse and withdrawal, medication side effects, sensory loss, sleep deprivation, and severe fatigue can all be associated with hallucinations.

Hallucinations may be caused by psychiatric conditions including:

• Bipolar disorder

• Psychotic depression (depression with disordered thought processes)

• Schizoid personality disorder (disorder characterized by detachment and isolation)

• Schizophrenia

• Schizotypal personality disorder (disorder characterized by a need for isolation, odd beliefs, and disordered thinking)

Hallucinations can have other causes including:

• Brain tumors

• Delirium

• Dementia

• Medication side effects

• Seizure disorders

• Severe fatigue

• Sleep deprivation

• Substance abuse

• Vision or hearing loss

In some cases, hallucinations may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

• Acute delirium (sudden onset of mental status changes due to illness or toxicity)

• Seizures

• Severe infections

• Stroke

Hallucinating is a reason for immediate medical care. Both psychiatric and medical conditions can cause hallucinations. In either case, the situation can become an emergency very quickly. Call 911 or go to your nearest emergency room any time someone is experiencing hallucinations.

To diagnose the cause of hallucinations, your doctor will take a medical history, perform an exam, and may order testing.

There are several questions your doctor may ask related to your hallucinations including:

• When did you first experience hallucinations?
  
• What types of hallucinations are you having?
  
• Can you describe your hallucinations?
  
• Did any events or stresses precede your hallucinations?
  
• Do you have any other symptoms?
  
• What medical, mental or psychiatric problems do you have?
  
• What medications are you taking?
  
• Do you drink any alcohol?
  
• Are you using any illicit drugs?

During the physical exam, your doctor will focus on ruling out physical conditions that could be causing hallucinations. If there is no medical or physical reason for the hallucinations, a psychiatric evaluation may be necessary. Input from family members is often helpful in understanding the situation. To diagnose mental disorders, doctors use diagnostic criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association.

In some cases, doctors may order testing to help diagnose the cause of hallucinations. This mainly involves blood tests to screen for alcohol and drugs and imaging exams, such as a brain CT (computerized tomography) scan or MRI (magnetic resonance imaging).

It is not always possible to diagnose an underlying cause or condition. If the problem persists and your provider is unable to determine a cause, seeking a second opinion may give you more information and answers.

Treating hallucinations depends entirely on the underlying cause. When schizophrenia or another mental health problem is to blame, medications are an important part of treatment. The goal is to control the symptoms of the disorder with the lowest possible dose.

Second-generation antipsychotics, such as aripiprazole (Abilify) or quetiapine (Seroquel), are the first-line choice. These drugs tend to have fewer side effects than earlier versions of antipsychotic medicines. It is also important for people with these conditions to avoid illicit drugs, nicotine and alcohol. These substances can make it harder to treat the underlying mental health problem.

Psychosocial interventions are also part of treatment for mental health issues. This includes psychotherapy, family therapy, and social skills and vocational training.

For people with hallucinations due to Alzheimer’s disease, behavioral approaches are usually first-line treatment. If these strategies fail, medications may be necessary. However, the use of antipsychotics in older people with dementia carries an increased risk of death. Only an experienced doctor should prescribe antipsychotics in this situation. It is very important to carefully weigh the risks and benefits of this treatment in this population.

Home remedies cannot treat hallucinations. But there are several things caregivers and those around someone who is hallucinating can do to help the situation. This includes:

• Do not argue with the person or try to convince them that the experience is not real. Convey reassurance and understanding instead.
• Make sure the person is safe by removing anything they could use to hurt themselves or others.
• Remain calm and offer comfort. Fear usually drives reactions to hallucinations.
• Remove upsetting stimuli, such as turning off a violent TV show or changing lighting that may be casting shadows.
• Use distraction, such as going for a walk or moving to another room.

For people with schizophrenia or other psychiatric causes of hallucinations, it can be helpful to practice relaxation techniques. Try meditation or another mind-body technique to reduce stress and promote healthy thoughts.

Because hallucinations can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

• Brain damage

• Coma

• Difficulties at work, in school, in social environments, and with relationships

• Drug and alcohol use and abuse

• Drug overdose or alcohol poisoning

• Increased risk of injury

• Legal or financial troubles

• Self-harm

• Suicide or violence