HALLUCINATIONS

A hallucination is the illusion of perception when there has been no sensory input. Some patients are very distressed by hallucinations, others are not and may only mention them if asked. (“Have you seen anything strange or unusual lately?”) 

Hypnogogic hallucinations occur when falling asleep or waking. These are normal, and occur in about 50% of people in acute grief. They can be visual or auditory.

Morphine can very occasionally cause hallucinations. If the dose of morphine becomes too high, most patients feel drowsy, a few develop nausea, and a small number hallucinate. Hallucinations are most common when morphine is started in too high a dosage. They stop as soon as the dose of morphine is reduced.

Toxic confusional states make patients see things. These are not hallucinations but misperceptions of visual stimuli (patterned wallpaper becomes snakes). The patient is rambling, behaving inappropriately and easily startled. (see Confusion)

Brain secondaries very rarely cause hallucinations. Occasionally temporal lobe seizures can cause hallucinations (of smell, taste or hearing), with stereotyped motor behavior (sucking, grimacing, repeated head movements), and, commonly, a feeling of epigastric discomfort. This can be controlled with carbamazepine.

Psychosis can cause hallucinations- usually voices. (Ask “Do you hear voices? What do they say?”) There may be a history of psychosis. There is disordered thought with delusions (bizarre beliefs) and paranoia. High doses of haloperidol or chlorpromazine may be needed. (see Paranoia)

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