Mental Status Exam
 

Hallucinations

 
 
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Overview

  • Hallucinations are abnormal sensory symptoms that may manifest as visual, auditory, tactile or extraordinary disturbances. Hallucinations may be caused by organic disease or psychiatric disorders.
    • Types of Hallucinations

    • Auditory hallucinations - including commentary, insulting voices, Gedanklautwerden, echo de la pensee
    • Visual hallucinations - may be simple (such as flashes or colours) or complex (such as people, animals or objects)
    • Olfactory / gustatory hallucinationsSuggestive of frontal / temporal injury
    • Tactile hallucinationsCan occur in delerium tremens or with cocaine
    • Extracampine hallucinations: sensations that would be physically impossible, such as seeing through walls
    • Causes of Hallucinations

    • Psychiatric - schizophrenia, schizoaffective disorder, psychotic depression, delirium, Lewy body dementia
    • Neurological - space-occupying lesion, temporal lobe epilepsy, migraine
    • Metabolic - hepatic encephalopathy
    • Drugs - amphetamines, delirium tremens
  • Once hallucinations stop, patients with organic disease tend to recognise that they were false, while patients with functional illness tend to maintain a lack of insight.

Auditory Hallucinations

  • Continuous commentaryClassically a feature of schizophrenia, though may also occur in delirium or dementia
  • Fragmented, insulting voicesCommon in very depressed patients with delusions of guilt
  • Gedanklautwerden: hearing one's thoughts spoken just before they are occurring
  • Echo de la pensee: hearing one's thoughts spoken just after they have occurred

Visual Hallucinations

    • Interpretation

    • Simple visual hallucinations - flashes, dots, colours, patternsSuggestive of ocular pathology, seizure or migraine aura
    • Complex visual hallucinations - objects, animals, peopleSuggestive of Lewy body dementia or delirium, though can occur in severe psychosis
    • Autoscopic hallucinations: a visual hallucination of the patient's own self.
    • Anton's syndrome (cortical blindness): the patient reports that they are able to see and can describe the world around them, despite clear evidence that they are blindOccurs in the setting of bilateral occipital strokes
    • Causes of Visual Hallucinations

    • Sensory deprivation in normal people
    • Dementia with Lewy Bodies
    • Delirium
    • Severe psychosis
    • Anton's syndrome (cortical blindness)
    • Migraine aura
    • Seizure
 
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