Hallucinations

The word “hallucination” might bring to mind a person jumping out of a window to “fly” while high on LSD or an overmedicated person hearing voices that aren’t heard by others. While these events are possible due to hallucinations brought on by drugs, hallucinations can also be a sign of a psychiatric illness, such as schizophrenia. Read on to find out more about hallucinations, what causes them and how to treat them.

Definition of Hallucinations

Hallucinations are when a person senses (sees, hears, feels, smells, tastes) things while awake that do not exist, but have been created by the mind.[1,2]

Types of Hallucinations and Signs & Symptoms

The types of hallucinations are based on which sense they affect.

Auditory hallucinations

Also called command hallucinations, are the most frequent hallucination which involve hearing voices that tell the person to do something. Approximately 75% of people with schizophrenia experience auditory hallucinations; 20% to 50% of people with bipolar disorder experience them; 10% of those with major depression with psychotic features experience them; and 40% of those with post-traumatic stress disorder experience them.[1,3]

A person experiencing this hallucination might have the following symptoms:[1]

  • Appear preoccupied and unaware of his or her surroundings
  • Talk to himself or herself
  • Have difficulty understanding or following conversations, and misinterpret the words and actions of others
  • May isolate himself or herself or use radio or other sounds to tune out the voices

Visual, tactile, smell, and taste hallucinations

Visual, tactile, smell, and taste hallucinations are usually identifiable by the person’s interaction with the hallucination such as the following:[1]

  • Visual focus on something you cannot see
  • Touching, scratching or brushing things off themselves that aren’t there
  • Sniffing or holding their nose
  • Spitting out food

Causes of Hallucinations

Hallucinations can be caused by a variety of things, including the following:[2,4]

  • Being drunk or high, or coming down from such drugs as marijuana, LSD, cocaine/crack, PCP, amphetamines, heroin, ketamine, and alcohol
  • Severe dehydration
  • Delirium or dementia
  • Epilepsy that involves a part of the brain called the temporal lobe (odor hallucinations are most common)
  • Fever, especially in children and the elderly
  • Narcolepsy and sleep disturbances
  • Psychiatric illness, such as schizophrenia, bipolar disorder, psychotic depression
  • Sensory problems, such as blindness or deafness (Seen in Charles Bonnet syndrome andd Anton’s syndrome)
  • Severe illness, including liver failure, kidney failure, AIDS, Parkinson’s Disease and brain cancer

Treatments for Hallucinations

Visual hallucinations

While effective treatment of visual hallucinations is dependent on the cause of the hallucinations, some people may benefit from formal psychotherapeutic interventions, such as cognitive behavioral therapy. The following are other treatments for each cause.[4]

Psychotic illness and delirium. Neuroleptic medications are the mainstay of treatment for visual hallucinations due to psychotic illness. These medications are also beneficial for the management of delirium.

  • Parkinson’s disease. Antipsychotic medications quetiapine and clozapine.
    Alzheimer’s dementia. In some forms of Alzheimer’s, cholinesterase inhibitors may have some benefit because they improve the effectiveness of acetylcholine, which is a chemical messenger that assists memory, thought and judgment.[5]
  • Seizures. Anticonvulsant drugs are used as a mood stabilizer.[6]
  • Tumors. Surgery and radiation.
  • Migraines. Triptans drugs work by promoting constriction of blood vessels and blocking pain pathways in the brain. Beta blockers, which are commonly used to treat high blood pressure and coronary artery disease, may reduce the frequency and severity of migraines.[7]

Auditory hallucinations

Since auditory hallucinations occur mostly due to psychiatric disorders, antipsychotic medications are usually treated. Other methods include the following:

  • Repetitive transcranial magnetic stimulation (rTMS), which plays a role in altering neural activity over language cortical regions, has been shown to reduce the frequency and severity of auditory hallucinations in treatment-resistant cases.[4,8] This method is used in combination with antipsychotic medication.
  • Cognitive-behavioral therapy, focuses on evaluating and monitoring a person’s perceptions, beliefs, and reasoning; promoting alternative ways of coping; and reducing distress. Anxiety reduction strategies are particularly effective in reducing the impact of voices.[9-12]
  • Combination of family and psychological interventions. Studies show that family and psychological interventions as well as medication, may be the most beneficial treatment for auditory hallucinations.[13]
  • Support and self-help groups. There is increasing evidence that support groups can help alleviate the impact of voices. Self-help groups help encourage people to take responsibility for their hallucinatory experience, to accept the voices and to cope with them.[14]

References

  1. Canadian Mental Health Association. Hallucinations and Delusions: How to Respond. [PDF] Retrieved February 10, 2013, from http://www.cmha.bc.ca/files/6-hallucinations_delusions.pdf.
  2. MedlinePlus. Hallucinations. Retrieved June 2, 2013, from http://www.nlm.nih.gov/medlineplus/ency/article/003258.htm.
  3. Choong C, Hunter MD, Woodruff PW. Auditory hallucinations in those populations that do not suffer from schizophrenia. Curr Psychiatry Rep. 2007;9:206-212.
  4. National Institutes of Health. Ryan C. Teeple, B.S., Jason P. Caplan, M.D., and Theodore A. Stern, M.D. Visual Hallucinations: Differential Diagnosis and Treatment. Retrieved June 9, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660156/.
  5. WebMD. Cholinesterase Inhibitors for Alzheimer’s Disease. Retrieved June 9, 2013, from http://www.webmd.com/alzheimers/cholinesterase-inhibitors-for-alzheimers-disease.
  6. WedMD. Anticonvulsant Medication for Bipolar Disorder. Retrieved June 10, 2013, from http://www.webmd.com/bipolar-disorder/anticonvulsant-medication.
  7. Mayo Clinic. Migraine treatments and drugs. Retrieved June 10, 2013, from http://www.mayoclinic.com/health/migraine-headache/DS00120/DSECTION=treatments-and-drugs.
  8. Aleman A, Sommer IE, Kahn RS. Efficacy of slow repetitive transcranial magnetic stimulation in the treatment of resistant auditory hallucinations in schizophrenia: a meta-analysis. J Clin Psychiatry. 2007;68:416-421.
  9. Hoffman RE, Gueorguieva R, Hawkins KA, et al. Temporoparietal transcranial magnetic stimulation for auditory auditory hallucinations: safety, efficacy and moderators in a fifty patient sample. Biol Psychiatry. 2005;58:97-104.
  10. Haddock G, Slade PD, Bentall RP, et al. A comparison of the long-term effectiveness of distraction and focusing in the treatment of auditory hallucinations. Br J Med Psychol. 1998;71:339-349.
  11. Rector NA, Beck AT. Cognitive behavioral therapy for schizophrenia: an empirical review. J Nerv Ment Dis. 2001;189:278-287.
  12. Wykes T. Psychological treatment for voices in psychosis. Cogn Neuropsychiatry. 2004;9:25-41.
  13. de Haan L, Linszen DH, Lenior ME, et al. Duration of untreated psychosis and outcome of schizophrenia: delay in intensive psychosocial treatment versus delay in treatment with antipsychotic medication. Schizophr Bull. 2003;29:341-348.
  14. Romme M, Escher A. Hearing voices. Schizophr Bull. 1989;15:209-216.

By C. J. Newton, MA, Therapists.com Editor

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