Diagnostic Tests for Hallucination
Hallucination Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Hallucination:
- Child Behavior: Home Testing
- Mental Health (Adults): Home Testing
- Mental Health: Home Testing:
- Brain & Neurological Disorders: Related Home Testing:
Hallucination Diagnosis: Book Excerpts
Diagnosis of Hallucination: medical news summaries:
The following medical news items
are relevant to diagnosis of Hallucination:
Diagnostic Tests for Hallucination: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Hallucination.
DELIRIUM:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine laboratory tests include a CBC, sedimentation rate, ANA, chemistry panel including electrolytes and BUN and VDRL tests, a blood alcohol level, urinalysis, and urine drug screen. A CT scan of the brain and EEG is usually indicated also. Acute delirium may be an indication to administer intravenous glucose and thiamine. If there is fever, blood cultures and a spinal tap for analysis and culture need to be done. Arterial blood gases and carboxyhemoglobin should be determined. Generally, a neurologist or neurosurgeon should be consulted early.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
HALLUCINATIONS:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
A blood alcohol level and urine drug screen are essential at the outset. Most physicians will want to refer the patient to a psychiatrist if these studies are negative. However, the interested physician may proceed further with a wake-and-sleep EEG to identify psychomotor epilepsy, or a CT scan and MRI to identify brain tumors and other causes of organic brain syndrome. Remember, the MRI costs twice as much as a CT scan. A spinal tap will be helpful in diagnosing central nervous system lues. A sleep study will help diagnose narcolepsy. Psychometric testing will help identify schizophrenia and other psychiatric disorders.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Halo vision:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
First, ask the patient how long he has been seeing halos around lights and when he usually sees them. The patient with glaucoma usually sees halos in the morning, when IOP is most elevated. Ask the patient if light bothers his eyes. Does he have eye pain? If so, have him describe it. Remember that halos associated with excruciating eye pain or a severe headache may point to acute angle-closure glaucoma, an ocular emergency. Note a history of glaucoma or cataracts.
Next, examine the patient’s eyes, noting conjunctival injection, excessive tearing, and lens changes. Examine pupil size, shape, and response to light. Then test visual acuity by performing an ophthalmoscopic examination.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Psychotic behavior:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Because the patient’s behavior can
make it difficult — or potentially dangerous — to obtain pertinent information, conduct the interview in a calm, safe, and well-lit room. Provide enough personal space to avoid threatening or agitating the patient. Ask him to describe his problem and circumstances that may have precipitated it. Obtain a drug history, noting especially the use of an antipsychotic, and explore his use of alcohol and other drugs, such as cocaine, indicating duration of use and amount. Ask about recent illnesses or accidents.
As the patient talks, watch for cognitive, linguistic, or perceptual abnormalities such as delusions. Do thoughts and actions seem to match? Look for unusual gestures, posture, gait, tone of voice, and mannerisms. Does the patient appear to be responding to stimuli? For example, is he looking around the room?
Interview the patient’s family. Which family members does he seem closest to? How does the family describe the patient’s relationships, communication patterns, and role? Has a family member ever been hospitalized for psychiatric or emotional illness? Ask about the patient’s compliance with his drug regimen.
Finally, evaluate the patient’s environment, educational and employment history, and socioeconomic status. Are community services available? How does the patient spend his leisure time? Does he have friends? Has he ever had a close emotional relationship?
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Halo vision:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
First, ask the patient how long he has been seeing halos around lights and when he usually sees them. Patients with glaucoma usually see halos in the morning, when IOP is most elevated. Ask the patient if light bothers his eyes. Does he have eye pain? If so, have him describe it. Remember that halos associated with excruciating eye pain or a severe headache may point to acute angle-closure glaucoma, an ocular emergency. Note a history of glaucoma or cataracts.
Next, examine the patient’s eyes, noting conjunctival injection, excessive tearing, and lens changes. Examine pupil size, shape, and response to light. Then test visual acuity by performing an ophthalmoscopic examination.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Psychotic behavior:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Because the patient’s behavior can make it difficult—or potentially dangerous—to obtain pertinent information, conduct the interview in a calm, safe, and well-lit room. Provide enough personal space to avoid threatening or agitating the patient. Ask him to describe his problem and any circumstances that may have precipitated it. Obtain a drug history, noting especially use of an antipsychotic, and explore his use of alcohol and other drugs such as cocaine, indicating duration of use and amount. Ask about any recent illnesses or accidents.
As the patient talks, watch for cognitive, linguistic, or perceptual abnormalities such as delusions. Do thoughts and actions seem to match? Look for unusual gestures, posture, gait, tone of voice, and mannerisms. Does the patient appear to be responding to stimuli? For example, is he looking around the room?
Interview the patient’s family. Which family members does he seem closest to? How does the family describe the patient’s relationships, communication patterns, and role? Has any family member ever been hospitalized for psychiatric or emotional illness? Ask about the patient’s compliance with his drug regimen.
Finally, evaluate the patient’s environment, educational and employment history, and socioeconomic status. Are community services available? How does the patient spend his leisure time? Does he have friends? Has he ever had a close emotional relationship?
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Seizures, complex partial:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If you witness a complex partial seizure, never attempt to restrain the patient. Instead, lead him gently to a safe area. (Exception: Don’t approach him if he’s angry or violent.) Calmly encourage him to sit down, and remain with him until he’s fully alert. After the seizure, ask him if he experienced an aura. Record all observations and findings.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Delirium:
Physical examination.
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
Because of the fluctuating nature of delirium, serial examinations are valuable.
A. Mental status. Observe the patient and take note of changes of level of consciousness, orientation, agitation, combativeness, hallucinations, or inability to concentrate. Evaluate the mental status by using the Mini Mental Status Examination (4) or a similar tool to standardize the findings (Chapter 4.5).
B. Physical status. Obtain vital signs and evaluate for clinical signs of dehydration, malnutrition, urinary retention, or fecal impaction. The physical examination should be guided by the history, keeping in mind the multifactorial nature of delirium. Evaluate for signs of infection, look for cardiopulmonary decompensation, and complete a thorough neurologic examination with special attention to identifying any focal neurologic deficit.
Testing
A. Laboratory. All patients should have a complete blood count, serum chemistries including electrolytes, hepatic and renal function, albumin and calcium, and a urinalysis. Additional studies will be directed by clinical suspicions based on the history and the physical examination. These may include thyroid studies, serum medication levels, serum and urine drug screens, lumbar puncture with spinal fluid studies, HIV status, syphilis test, vitamin B12 and folate levels, or serum markers of cardiac damage such as creatine kinase-MB or troponin.
B. Additional studies. All patients should have an electrocardiogram and a chest roentgenogram as well as arterial blood gases or oxygen saturation level tests. With no history of trauma or focal neurologic deficit, a computed tomography scan is of limited value. An electroencephalogram is also of limited value unless the diagnosis of seizure is being considered.
Diagnostic assessment.
Delirium can be a medical emergency, and a high index of suspicion must be maintained to accurately diagnose and treat the condition. Diagnosis is complicated by the similarity of presentation of depression, dementia and delirium, and by overlapping signs and symptoms. It is essential to rule out an underlying dementia or depression before the diagnosis of delirium can be made. This has particular impact on the treatment and prognosis of the illness.
A. Dementia is characterized by a gradual onset of decreased functioning in the areas of memory, execution of the activities of daily living, and social functioning. It is less likely for delirium to cause changes in sensorium, cognition, attention; it is also less likely for delirium to fluctuate from hour to hour. Delirium can coexist with an underlying dementia and should always be considered when a previously diagnosed dementia patient exhibits an acute change in mental status.
B. Depression is characterized by a depressed mood with psychomotor retardation or agitation. Look for a gradual onset of anhedonia, sleep disturbances, fatigue, feelings of guilt or worthlessness, or a previous history of depression (Chapter 3.3).
C. Other diagnoses. Consider in the differential diagnosis functional psychosis and bipolar disease, especially the manic phase. Both can produce hallucinations, although those of delirium tend to be visual or tactile, whereas those of psychosis tend to be auditory in nature. Epilepsy, especially temporal lobe seizures, can mimic delirium. Multi-infarct dementia, with its characteristic labile emotional state, must be considered. Remember that delirium is a complex, multifactorial condition and can present superimposed on a variety of other medical psychiatric conditions. A careful history and physical examination will help clarify the diagnosis and guide the physician and patient toward the correct treatments.
References
1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association, 1994:129–133.
2. Johnson JC. Delirium in the elderly. Emerg Med Clin North Am 1990;8:255–265.
3. American Psychiatric Association Practice Guidelines. Am J Psychiatry 1999;
156:S1–S20.
4. Folstein MF, Folstein SE, McHugh PR. Mini-mental status examination: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Delirium/Hallucinations:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Delirium is characterized by gross disorientation in the presence of alertness and vigilance, disorders of perception with vivid illusions, and psychomotor and autonomic hyperactivity. It usually develops over a short time and is associated
with fluctuating mental status, decreased attention, disorganized thinking as indicated by rambling, irrelevant, or incoherent speech, and a decreased level of consciousness. The most sensitive findings are variability in level of arousal, impaired short-term memory (e.g., digit span), and disorientation to time. Relatives or friends are helpful sources of information about the tempo and degree of impairment.
Fever, tachycardia, or hypertension should prompt a careful evaluation for a medical cause. Infection is a common cause in the elderly, especially pneumonia or urinary tract infection. Visual hallucinations are organic in origin, due to factors such as drugs, rather than due to schizophrenia.
Confusion Assessment1) Change in mental state (from baseline) that is acute and fluctuates. 2) Difficulty focusing attention or trouble keeping track of what is said. 3) Disorganized thinking (rambling or irrelevant conversation, unpredictable switching between subjects, illogical flow of ideas). 4) Altered level of consciousness (lethargy, stupor, or hyperalert). A positive test requires 1 and 2 positive, and either 3 or 4.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Halo vision:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Examine the patient’s eyes, noting conjunctival injection, excessive tearing, and lens changes. Examine pupil size, shape, and response to light. Then test visual acuity by performing an ophthalmoscopic examination.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Psychotic behavior:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Assess the patient’s appearance, behavior, mood, thought, coping mechanisms, and potential for self-destructive behavior. As the patient talks, watch for cognitive, linguistic, or perceptual abnormalities such as delusions. Do thoughts and actions seem to match? Look for unusual gestures, posture, gait, tone of voice, and mannerisms. Does the patient appear to be responding to stimuli? For example, is he looking around the room?
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Seizures, complex partial:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient has had a seizure, examine him for injury. Make sure he has a patent airway, and then perform a complete neurologic assessment.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Halo vision:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
First, ask the patient how long he has been seeing halos around lights and when he usually sees them. The patient with glaucoma usually sees halos in the morning, when IOP is most elevated. Ask the patient if light bothers his eyes. Does he have eye pain? If so, have him describe it. Remember that halos associated with excruciating eye pain or a severe headache may point to acute angle-closure glaucoma, an ocular emergency. Note a history of glaucoma or cataracts.
Next, examine the patient's eyes, noting conjunctival injection, excessive tearing, and lens changes. Examine pupil size, shape, and response to light. Then test visual acuity by performing an ophthalmoscopic examination.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Psychotic behavior:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Because the patient's behavior can make it difficult—or potentially dangerous—to obtain pertinent information, conduct the interview in a calm, safe, and well-lit room. Provide enough personal space to avoid threatening or agitating the patient. Ask him to describe his problem and circumstances that may have precipitated it. Obtain a drug history, noting especially the use of an antipsychotic, and explore his use of alcohol and other drugs, such as cocaine, indicating duration of use and amount and when it was last taken. Ask about recent illnesses or accidents.
As the patient talks, watch for cognitive, linguistic, or perceptual abnormalities such as delusions. Do thoughts and actions seem to match? Look for unusual gestures, posture, gait, tone of voice, and mannerisms. Does the patient appear to be responding to stimuli? For example, is he looking around the room?
Interview the patient's family. Which family members does he seem closest to? How does the family describe the patient's relationships, communication patterns, and role? Has a family member ever been hospitalized for psychiatric or emotional illness? Ask about the patient's compliance with his drug regimen.
Finally, evaluate the patient's environment, educational and employment history, and socioeconomic status. Are community services available? How does the patient spend his leisure time? Does he have friends? Has he ever had a close emotional relationship?
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Seizures, complex partial:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If you witness a complex partial seizure, never attempt to restrain the patient. Instead, lead him gently to a safe area. (Exception: Don't approach him if he's angry or violent.) Calmly encourage him to sit down, and remain with him until he's fully alert. After the seizure, ask him if he experienced an aura. Record all observations and findings. Obtain a history. Has the patient experienced a seizure in the past? Has he had a recent head injury? Has he experienced any fever, headaches, or periods of confusion? Obtain a complete drug history. Take his vital signs and perform a complete neurologic examination.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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