Hallucination : Causes, Types, Treatment and Symptoms

Hallucinations are false sensory impressions in which a person sees, hears, feels, smells, or tastes things that are not present yet appear to be extremely real to them. These experiences, which can occur in any sensory channel and are frequently accompanied by symptoms, usually indicate underlying neurological, psychological, or medical disorders.

Most Common Hallucination Symptoms:

• Hearing sounds or music that are not present.
• Hearing voices that can be positive, negative, or commanding.
• Seeing people, shapes, lights, or objects that aren’t really there.
• Feeling sensations such as bugs crawling on or under the skin, or being touched when no one is around.
• Smelling odors that others cannot detect.
• Tasting things not actually present, often unpleasant or metallic flavors.
• Feeling of detachment from reality, confusion, or distress.

Common, Uncommon or Underlying Causes of Hallucination

A variety of problems, such as mental health issues, medical illnesses, problems with the brain, drug or alcohol abuse, and rare physiological issues, cause hallucinations. Hence, it’s crucial to get a complete check-up with your specialist and find out the exact cause to treat or manage it.

• Psychiatric causes: Schizophrenia, bipolar disorder, and severe depression.
• Neurological causes: Dementia, Parkinson’s disease, and Alzheimer’s disease.
• Substance intoxication or withdrawal: From drugs such as LSD, cocaine, or amphetamines
• Sleep deprivation due to sleep disorders
• Postpartum psychosis in new parents
• Infectious disease or extremely high fever in children or the elderly
• Delirium due to electrolyte imbalance
• Terminal illness, like advanced HIV/AIDS, or rarely, metabolic disorders
• Charles Bonnet syndrome: Having visual impairment-related hallucinations
• Psychosis-related disorders that often reflect a break from reality

Note: Individuals, when prescribed certain neurological medications like anti-epileptic medications in order to treat certain underlying conditions, may showcase hallucination as a side effect.

When to Seek a Specialist for Your Hallucination?

If hallucinations are persistent, concerning, or impacting daily life, it is recommended that you consult with a specialist. It is essential to promptly consult a physician or contact emergency services, as the underlying psychiatric, neurological, or substance-related causes frequently require urgent medical attention and necessitate immediate diagnosis and treatment.

• If hallucinations involve detachment from reality, sudden confusion, worsening intensity, or risk of harm.
• Hearing voices that command harm to yourself or others
• Becoming very agitated, aggressive, or confused
• Rapidly worsening hallucinations
• Loss of touch with reality or making nonsensical statements
• Experiencing hallucinations alongside sudden behavioral changes or severe distress
• Smelling phantom odors may indicate neurological conditions like epilepsy or Parkinson’s disease.
• Hallucinations occur with severe anxiety or sleep disturbances that impair functioning.

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Diagnostic Approach for Hallucination

The specialist-approved approach to hallucinations consists of a thorough clinical evaluation and targeted investigations to accurately diagnose the underlying medical, neurological, psychiatric, or substance-related cause, followed by tailored treatment that may include medications, psychotherapy, and supportive care.

1. Clinical History and Symptom Assessment:
   On the hallucination type and duration, and asking about psychiatric history, substance use, medical issues, co-occurring psychiatric symptoms, and recent life events.
2. Physical and Neurological Examinations:
   A physical exam to check for medical/neurological disorders, as well as a mental state exam to examine appearance, behavior, mood, thought, and cognition.
3. Laboratory and diagnostic Tests:
   It rules out metabolic/toxic/systemic reasons, urine toxicology for substance abuse, neuroimaging (MRI/CT) for brain abnormalities, and an EEG if seizures are suspected.
4. Psychiatric Evaluation:
   Employs diagnostic criteria (such as DSM-5 or ICD-10) to distinguish hallucinations caused by schizophrenia, mood disorders, delirium, or other mental diseases.
5. Additional consideration:
   The specialist will also look into drug side effects and withdrawal symptoms, as well as sensory deficiencies, such as Charles Bonnet syndrome with vision impairment.

Types of Hallucinations

Hallucinations are classified based on the sensory modality involved, and this classification helps specialists adapt the diagnostic strategy, which involves neuroimaging, lab tests, and mental evaluation to determine the type and underlying cause.

Some common types of Hallucinations include:

• Auditory hallucination
• Visual hallucination
• Tactile hallucination
• Olfactory hallucination
• Gustatory hallucination
• Hypnopompic hallucination (while waking up)
• Hypnagogic hallucination (while falling asleep)
• Visual impairment-related hallucination
• Somatic or other hallucinations

How to Treat Hallucination Symptoms?

The treatment of hallucinations is tailored to the specific type, severity, and underlying cause of the condition. It usually involves a combination of medication, therapy, lifestyle adjustments, and support strategies that require ongoing management to achieve the best possible results.
For underlying causes, treatments & rehabilitative strategies include:

• There are certain neurological and anti-psychotic medications prescribed to better counter the side effects and treat hallucinations.
• Avoid medications that may cause hallucinations as a side effect.
• Cessation of the substance, detoxification, or rehabilitation is critical in the case of substance abuse.
• Cognitive behavioural therapy, when combined with medications, helps people build coping skills, reduce suffering, and challenge unhelpful ideas.
• Supportive counselling and family therapy to help understand and manage symptoms better.
• Improve sleep hygiene and stress management to decrease hallucination frequency and severity.
• Avoid recreational drug use and alcohol abuse.
• Attend support groups or have a calming and familiar peer support, and safely practice coping strategies.
• Electroconvulsive therapy for severe and treatment-resistant cases.
• Repetitive transcranial magnetic stimulation (rTMS) is performed against medication-resistant auditory hallucinations.

What if Hallucination is Left Untreated?

If hallucinations are left untreated, they can develop serious issues, including impacts on health and quality of life, and require urgent diagnosis and management by a specialist to achieve better outcomes and avoid the hazards associated with untreated psychosis lasting longer.

Some possible complications of an untreated Hallucinations include:

• Worsening symptoms: The Severity of hallucinations leads to more frequent, intense, and harder-to-control hallucinations.
• Functional impairment: Inability to maintain employment, academic performance, or daily living activities due to confusion and impaired concentration.
• Social isolation: Withdrawal from family, friends, and social support network, due to the inability to differentiate between reality and hallucination.
• Psychological distress: It involves the risk of self-harm, increased anxiety, paranoia, and depression.
• Legal troubles, incarceration, and financial instability: Erratic behaviour due to unmanaged symptoms.
• Co-existing medical deterioration: progression of underlying causes like schizophrenia, neurological conditions, and vit B12, causing irreversible damage.
• Harmful situations may require the need to stabilize the person.

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