Hallucinations

Hallucinations: Excerpt from In A Page: Pediatric Signs and Symptoms

Hallucinations are defined as perceptual experiences that do not occur in reality. They may be auditory (most common), visual, tactile, or olfactory.

Differential Diagnosis

• Hallucinogenic drugs
  –LSD, “mushrooms,” mescaline, and PCP are primarily hallucinogens
  –Amphetamines, cocaine, inhalants, and marijuana may also produce hallucinations
• CNS acute events
  –Trauma
  –CNS infection
  –Hypoxic events

• Psychosis
  –Defined as a mental state with significant impairment in cognition, interpersonal relations, and reality testing
  –Hallucinations may be a major or minor component
  –Psychosis may be psychiatric or organic (secondary to CNS insult)

• Schizophrenia
  –A disorder of impaired perception, cognition, interpersonal relations, and behavior with illogical and disordered thought content
  –Hallucinations (most often auditory) and delusions are common findings
  –Onset is frequently in adolescence
  –Frequently a positive family history

• Seizure disorders
  –Prominent auras may manifest as perceptual disturbances; visual and olfactory are the most common; tactile may also occur
• Narcolepsy
  –Hypnagogic hallucinations are hallucinations that occur while falling asleep; they may be visual or auditory
• Medications
  –Antipsychotics, anticholinergics, and corticosteroids can rarely cause hallucinations

Workup and Diagnosis

• History
  –History of mental illness
  –Recent behavioral patterns including relationships, self-care, and school performance
  –Medication and illicit drug use
  –Trauma, CNS infection, hypoxic episodes
  –Family history of mental illness

• Physical exam
  –Vital signs: Hallucinogens, amphetamines, and cocaine may cause tachycardia, hypertension, and hyperthermia
  –Hallucinogens, amphetamines, and cocaine may also cause pupillary changes, tremor, ataxia, arrhythmia, and hyperreflexia

• Mental status exam
  –Orientation and general appearance
  –Long- and short-term memory
  –Affect and behavior
  –Thought processing and content
  –Speech and language
• Labs
  –Urine and serum toxicologic screen
• Studies
  –Cranial imaging is most useful when there is a history of head trauma
  –EEG for patients in whom a seizure is suspected

Treatment

• Hallucinogens and other drugs of abuse
  –May require intensive outpatient or inpatient management for successful cessation
  –Cessation of the drug usually results in cessation of hallucination; however, for some hallucinogens such as LSD, flashbacks may occur for years
• CNS insults generally require neurologic and multisystem intensive care
• Schizophrenia is generally treated with antipsychotics; compliance is frequently problematic
• Narcolepsy is treated with daytime stimulants and nighttime sleep aids or tricyclic antidepressants
• Medications: Discontinue the causative drug

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: DELIRIUM (Differential Diagnosis in Primary Care)

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