- Etiology may be from underlying psychiatric disorder or organic cause.
- The perception of auditory, visual, tactile, or gustatory sensations without an actual stimulus
- Lysergic acid diethylamide (LSD)
- Psilocybin ("magic mushrooms")
- N,N-Dimethyltryptamine (DMT)
- 5-methoxy- dimethyltryptamine (5-MeO-DMT)
- Isoxazole Mushrooms
- Hawaiian baby woodrose (Argyreia nervosa)
- Hawaiian woodrose (Merremia tuberosa)
- Morning glory (Ipomoea violacea)
- Olili- uqui (Rivea corymbosa)
- Intracranial mass to occipital or temporal lobes
- Encephalitis, limbic encephalitis, anti-NMDA receptor encephalitis
- Rift valley fever
- Vitamin B7 deficiency
Other Toxicologic Causes
- Alcohol withdrawal
- Anticholinergic Toxicity
- Tricyclic (TCA) Toxicity
- Synthetic cannabinoids
- Inhalant abuse
- Nitrogen narcosis
- GHB withdrawal
- Hydrocarbon toxicity
- Heavy metal toxicity
- Multiple medications: montelukast, doxapram, hyoscyamine, tizanidine, peramivir, amantadine, rimantadine, bromocriptine, methylergonovine, benztropine, doxepin, voriconazole, acyclovir, valacyclovir, ganciclovir, cimetidine, penicillin G Procaine, clarithromycin, metoclopramide
- Inhalant abuse
- Workup should be targeted toward specific diagnosis.
- In non-auditory hallucinations, assume organic pathology until proven otherwise.
- New diagnosis of psychiatric disease as cause of hallucinations should generally not be made in ED without first ruling out organic pathology
- If concern for suicidal or unknown toxic ingestion:
- Acetaminophen level
- Salicylate level
- Treat the underlying pathology.
- If hallucinations distressing, can trial dose of PO antipsychotic
- In the case of alcohol withdrawal hallucinosis, no standard therapy has been established, although treatment with neuroleptics (e.g. Haldol) has shown some benefit. Also continue to treat the alcohol withdrawal.
- General psychiatric approach