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ed11563


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Quiz: Hallucinations
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Quiz: Are You Familiar With Conditions Associated With Hallucinations?

Stephen Soreff, MD; Selim Benbadis, MD; Amy Kao, MD

|October 26, 2015

Halloween is a time for having fun with frightening costumes and decorations. But some visuals are frightening in a much more serious way. Hallucinations can be associated with any of the five senses and are related to a wide variety of underlying causes. These sensory distortions can indicate a serious malady or may simply be a normal manifestation of a nondangerous cause. Do you know what to look for in a patient with hallucinations? Test your knowledge with our quick quiz.

Visual hallucinations during alcohol-withdrawal delirium, also known as "delirium tremens," are seen in individuals with which of the following?
Polymorphisms of genes coding for dopamine transporter and catechol-O-methyltransferase
Excess levels of cortisol
Melatonin disturbance
Increased central nervous system gamma-aminobutyric acid levels
853109-Figure1.jpg

Visuoperceptual deficits in delirium, such as hallucinations and delusions, are not due to the underlying cognitive impairment. Visual hallucinations during alcohol-withdrawal delirium are seen in persons with polymorphisms of genes coding for dopamine transporter and catechol-O-methyltransferase. Decreases in central nervous system gamma-aminobutyric acid levels are observed in patients with delirium resulting from benzodiazepine and alcohol withdrawal. Delirium has been associated with the disruption of cortisol and beta-endorphin circadian rhythms. This mechanism has been suggested as a possible explanation for delirium caused by exogenous glucocorticoids.

For more on hallucinations associated with delirium, read here.

In a patient with hallucinations, which of the following would allow diagnosis of schizophrenia, according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)?
Memory loss
Vocal outbursts
Problems understanding interpersonal cues
Catatonic behavior
853109-Figure2.jpg

According to the DSM-5, the presence of two or more of the following is required, each present for a significant portion of time during a 1-month period (or less if successfully treated), with at least one of them being (1), (2), or (3):

  1. Delusions

  2. Hallucinations

  3. Disorganized speech

  4. Grossly disorganized or catatonic behavior

  5. Negative symptoms (eg, decrease in emotional range, poverty of speech, loss of interests and drive)

For more on the diagnosis of schizophrenia, read here.

Which of the causes of temporal lobe epilepsy is more commonly associated with olfactory hallucinations?
Infection
Vascular malformations
Trauma
Temporal lobe tumor
853109-Figure3.jpg

Olfactory and gustatory illusions and hallucinations may occur. Acharya and colleagues found that olfactory auras are more commonly associated with temporal lobe tumors than with other causes of temporal lobe epilepsy.

For more on temporal lobe epilepsy, read here.

In addition to sleep paralysis, excessive daytime sleepiness (EDS), and hypnagogic hallucinations, which of the following makes up the classic tetrad in narcolepsy?
Nocturnal compulsive behaviors
Cataplexy
Difficulty falling asleep
Obesity
853109-Figure4.jpg

The classic tetrad of narcolepsy consists of EDS, cataplexy, hypnagogic hallucinations, and sleep paralysis. Children rarely manifest all four symptoms. EDS is the primary symptom of narcolepsy and must be present for at least 3 months to justify the diagnosis.

For more on narcolepsy, read here.

Although no medical treatment may be necessary in patients with hallucinations associated with dementia with Lewy bodies (DLB) if symptoms are mild, which of the following should be tried first when medication is used?
Standard neuroleptics
Antiepileptic drugs
Selective serotonin reuptake inhibitors (SSRIs)
Acetylcholinesterase inhibitors
853109-Figure5.jpg

Hallucinations and agitation are especially troublesome in DLB. When these symptoms are mild, no medical treatment may be necessary.

When medication is used, acetylcholinesterase inhibitors should usually be tried first. For example, double-blind, placebo-controlled studies have demonstrated that the cholinesterase inhibitor rivastigmine may decrease psychiatric symptoms associated with DLB, particularly apathy, anxiety, hallucinations, and delusions.

Studies have also shown that patients with DLB treated with cholinesterase inhibitors do better on neuropsychological tests than do patients treated with placebo. Cholinesterase inhibitors that may be effective in the treatment of DLB also include donepezil and galantamine. In a small minority of patients, motor features are worsened with cholinesterase inhibitors.

Most experts recommend atypical neuroleptics, such as clozapine, quetiapine, or aripiprazole, when cholinesterase inhibitors are ineffective. Avoid standard neuroleptics, such as haloperidol, because of neuroleptic sensitivity.

Some experts have tried antiepileptic drugs to treat agitation and hallucinations, but clinical data supporting their use is lacking.

For more the treatment of DLB, read here.

Related Resources
 

Medscape © 2015  WebMD, LLC

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this article: Stephen Soreff, Selim R. Benbadis, Amy Kao. Quiz: Are You Familiar With Conditions Associated With Hallucinations? Medscape. Oct 26, 2015.



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lilyofcourse


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I have auditory hallucinations some times.

Happened more when I was taking tramodol frequently.

And when I was taking a blood thinner I had bot visual and auditory hallucinations.

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Charley Harper
ed11563


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I never thought of sleep paralysis as a manifestation of hallucinations.

Spouse has sleep paralysis, and frequently can't move as she wakes up.



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Ohfour


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I have been diagnosed with sleep paralysis. I thought I had a ghost. It happens 2 or 3 times a week...

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lilyofcourse


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It's a ghost O4.

But if you will put down a line of salt all the way around your bed and keep some iron near by, they'll leave you alone.

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Ohfour


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Lol! I wish. I have to go to another sleep study tomorrow night. I am so terrified I forget to breathe. Its really bad. A ghost would be easier to deal with...

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lilyofcourse


My spirit animal is a pink flamingo.

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I had one of those sleep studies once.

I finally went to sleep around 5 in the morning.

I was so uncomfortable and self concious.

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A flock of flirting flamingos is pure, passionate, pink pandemonium-a frenetic flamingle-mangle-a discordant discotheque of delirious dancing, flamboyant feathers, and flamingo lingo.

Charley Harper
Ohfour


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I could sleep in a gravel driveway. Sleeping is not my issue, waking up is...:(

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ed11563


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lilyofcourse wrote:

I had one of those sleep studies once.

I finally went to sleep around 5 in the morning.

I was so uncomfortable and self conscious.

I'd bet they charged full price anyway. 



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The Principle of Least Interest: He who cares least about a relationship, controls it.

Always misinterpret when you can.
lilyofcourse


My spirit animal is a pink flamingo.

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Ohfour wrote:

I could sleep in a gravel driveway. Sleeping is not my issue, waking up is...:(

 The camera made me uncomfortable too.

And where it was conducted. 

I don't know. 

People watching me sleep gives me the willies. 



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A flock of flirting flamingos is pure, passionate, pink pandemonium-a frenetic flamingle-mangle-a discordant discotheque of delirious dancing, flamboyant feathers, and flamingo lingo.

Charley Harper
Ohfour


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If I can get rid of these terrors, its worth it to me. You have no idea the hell this is...

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lilyofcourse


My spirit animal is a pink flamingo.

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I can imagine.

I hope they figure it out quickly.


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A flock of flirting flamingos is pure, passionate, pink pandemonium-a frenetic flamingle-mangle-a discordant discotheque of delirious dancing, flamboyant feathers, and flamingo lingo.

Charley Harper
Ohfour


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I hope so too Lily. This is killing me. I wake up with my BP so high, they are worried about me having a stroke. Its that bad....hopefully this study will give me some comfort.

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Tinydancer


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I'll be sending good thoughts and prayers that they find you some relief Ohfour. I had night terrors as a kid but luckily I outgrew them or something because after about the age of 11 they never happened again. Good luck to you.

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Ohfour


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Thanks y'all. Its bad. The worst my doctor has seen. (I'm sure I'm not the worst, but the worst that has been diagnosed with my dr.) I just want to wake up normally. We are getting better with a dorsal mouth piece. We just have to set it right. ..

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