Hallucinations are falsely perceived objects or sensory images that occur in the absence of a real external stimulus, but are accompanied by confidence in its existence. Elementary hallucinations are represented by ringing, buzzing, light flashes, glowing figures, smells. Simple – complete images: static animals, household items. Complex – dynamic phenomena, for example, voices commenting on what is happening. Diagnosis is performed by observation, conversation, analysis of the general clinical picture. During therapy, antipsychotic drugs are prescribed.
Distinguish between true and false hallucinations. True hallucinatory images have the qualities of objectivity, integrity, structurality, constancy. They are assimilated with the real situation, that is, they interact with existing objects, for example, an axe is lying on the table. Pseudo-hallucinations are present in a conditional, imaginary space, often do not have a clear structure. Common variants are voices in the patient’s head or visual images hanging in the air. The origin of pseudohallucinations is interpreted by the patient as artificially caused by another person.
According to the content, hallucinations can be elementary, simple, complex. Elementary have an incomplete objectivity, single-modal, are represented by separate non-verbal sounds and simple images like causeless flashes. Simple hallucinatory phenomena are objective, static, sometimes move, but do not change shape. They are single-modal – they use one analyzer. Complex hallucinations are formed with the participation of several analyzers, the images are dynamic, often have semantic content. Example: the smell of poisons combined with voices behind the wall, deciding to poison the patient.
Hallucinations are diverse – single and multiple images, randomly arising or connected by a common plot, neutral in relation to the patient or intimidating, commanding, commenting, amusing. According to the key analyzer involved, they are divided into visual, olfactory, auditory, tactile, gustatory, visceral, motor, complex. Regardless of the cause and modality, a common characteristic is that images are always perceived by the patient as actually existing.
Causes of hallucinations
Hallucinations can completely change behavior, emotions, feelings and thoughts. The brighter the images, the more they control a person, “obscuring” reality. Their content and frequency vary depending on the etiological factor. The causes of hallucinations can be divided into four large groups: states of physiological or psychological stress, mental illness, neurological pathologies and substance poisoning.
Hallucinatory sensations appear in extreme situations for the body, which are often accompanied by the risk of death, are associated with a pronounced deficiency or excess of chemicals, information, physical influences. Such phenomena cause a state of acute mental or physiological stress, and hallucinations are formed on the basis of changes in biochemical processes in the brain. Their possible causes:
- Overheating. Unreal images, sounds, voices arise when the body temperature rises to 41-42 ° C. This condition is observed with fever, a severe form of heat stroke. Psychomotor agitation, delirium, confusion are characteristic.
- Hypothermia. Extremely low temperatures can also provoke a delusional hallucinatory state. Symptoms unfold already at the mild stage of hypothermia, when the body temperature drops below 35 ° C. A person feels chills, the functions of internal organs are suppressed, coordination of movements is disrupted, perception is distorted.
- Lack of food. Lack of nutrients creates a shortage of energy, which is necessary for the work of the brain and other organs. Hallucinosis manifests itself on the 7-9 day of fasting, when ketone bodies become the main energy source. The person looks detached, indifferent, does not show interest in close people, events taking place.
- Lack of air. Oxygen is necessary for the normal functioning of the brain. When the air supply stops, the brain tissues use oxygen reserves for 4-5 minutes, after which hypoxic changes gradually increase, hallucinatory images are formed. The reasons for the lack of oxygen are intentional suffocation, being in an unventilated room, ischemic brain damage.
- Severe fatigue. Prolonged physical and mental overload can cause hallucinatory experiences. Distortion of perception occurs as a result of exhaustion of the nervous system, or rather, a violation of its selective function, the ability to distinguish the real from the imaginary.
- Sleep deprivation. Lack of sleep can be the result of insomnia, severe illnesses, forced wakefulness due to overloads at work. Sometimes the state of sleep deprivation is formed purposefully in order to achieve an altered consciousness. Regardless of the reason, a person experiences vivid hallucinations, an aggravation of the perception of the senses, a feeling of unreality of what is happening.
- Sensory insufficiency. The nervous system functions normally with constant exposure to a variety of stimuli. If the volume of incoming sensory information decreases significantly or its flow stops altogether, the brain compensates for this by creating its own stimuli – images of various modalities. Astronauts experience similar states. Sensory deprivation chambers are used for therapeutic purposes, stimulating the creativity and deep emotions of patients.
- Social isolation. The decrease or lack of opportunity to interact with other people provokes the loss of identity of the individual. A person ceases to understand who he is and what he is, feels the loss of himself as a representative of society. Hallucination becomes a protective mechanism that helps to maintain mental balance, self-identification. She is often represented by the voice of a “friend”, the image of someone from relatives. The reasons for social deprivation are imprisonment in a solitary prison cell, serious illness.
In psychiatric practice, hallucinations often manifest themselves as part of a hallucinatory delusional syndrome. They are characteristic of psychoses – disorders accompanied by emotional and behavioral inadequacy, lack of critical attitude towards oneself. As a rule, patients develop pseudohallucinations – visual, auditory, olfactory, gustatory, kinesthetic images that are formed without reference to real space, often accompanied by a feeling of imposition, suggestion by someone else. Causes of hallucinatory delusional phenomena:
- Schizophrenia. In schizophrenia, the development of hallucinations is attributed to the symptoms of the first rank. Patients hear the sound of their own thoughts, contradictory, mutually exclusive and commenting voices. Somatic pseudo-perceptions (movement, deformation of organs) are noted. Patients are sure that their ideas, feelings and motives are being influenced, that their thoughts can be read and recognized by others.
- Bipolar disorder. Symptoms of psychosis are observed in severe bipolar affective disorder. A common psychotic manifestation is sound and visual hallucinatory representations. More often they unfold in the phase of mania together with delusional ideas of greatness, omnipotence. Hallucination can be congruent or incongruent with the patient’s mood, supports manic tendencies or is not related to them.
- Symptomatic psychoses. The causes of exogenous psychotic states are severe somatic diseases, infections, poisoning. They occur with temporary confusion of consciousness, from twilight to oneiroid. Acute psychosis usually lasts from several hours to 2-3 days, delirium with hallucinations develops more often at night, emerging images frighten patients. In severe cases, delirium passes into amentia, in which confusion, incoherent speech, chaotic movements prevail.
- Organic delusional disorder. With schizophrenic disorder, hallucinatory delusional attacks are possible, accompanied by unmotivated actions, loss of control over behavior, manifestations of aggression. Hallucinations are more often visual, have religious, magical content, and call for action. The causes of organic delusional disorder are epilepsy, focal brain damage.
- Organic hallucinosis. A distinctive feature of organic hallucinations is continuous hallucination caused by the influence of an organic factor. Images are stable, appear with clear consciousness, during periods of wakefulness. The most common is alcoholic hallucinosis, in which patients hear pointing or threatening voices.
Another reason for hallucinatory images is organic lesions of the parts of the brain responsible for processing perceived information. There is a pathological irritation of the cortical parts of the analyzer, patients begin to see flashes, simple glowing objects, hear music, smell, taste in the mouth in the absence of real stimuli. Another neurological cause of hallucinations is the loss of the analyzer or its functions. Common factors of the development of hallucinatory symptoms in neurological pathologies include:
- Neurodegenerative processes. Degeneration of nervous tissue leads to the development of dementia, a chronic progressive disease characterized by a violation of higher cortical functions, including memory, speech, intelligence. Hallucinations are not a mandatory symptom. They are most often diagnosed with dementia with Lewy bodies, less often with Alzheimer’s disease, Huntington’s chorea.
- Local brain lesions. Hallucinatory visions and sensations are provoked by focal lesions of the temporal, occipital or parietal lobes of the brain, hyperstimulation of the midbrain or trunk. The immediate causes are tumors, strokes, vascular malformations, traumatic brain injuries, focal variants of epilepsy. True elementary and simple hallucinations are typical: flashes, noises, tactile sensations.
- Neuroinfections. In neuroinfections, the pathogen penetrates into the tissues of nerve cells, causing both general somatic symptoms and damage to the central nervous system. Convulsions, disturbances of consciousness, a state of overexcitation, delusional hallucinatory syndrome can occur in the acute course of purulent encephalitis and meningitis.
- Loss of analyzer function. When the analyzer loses the ability to receive external information, a state of forced sensitive deprivation is formed. Hallucinatory sensation develops according to compensatory mechanisms, recreating images of a certain modality. A well-known example is Charles Bonnet syndrome – the vision of images by patients with acquired severe visual disorders.
- Narcolepsy. In patients with narcolepsy, there are no reason for drowsiness, attacks of decreased muscle tone while maintaining consciousness. When falling asleep, hypnagogic hallucinations unfold, which do not allow you to fall asleep completely, and when you wake up, hypnopompic ones that prevent you from correctly assessing the situation around you.
Hallucinations can be provoked by taking narcotic drugs, alcohol, and some medications. Following the use of a psychoactive substance, acute intoxication develops, accompanied by a disorder of consciousness, cognitive functions, perception, emotions. The severity of psychotic symptoms depends on the type and dose of surfactants. The disorder of the mental sphere is characterized by vivid hallucinatory images, false recognitions, delusions of attitude. Such conditions are provoked by the use of a number of substances:
- Hallucinogens. When using psychotomimetics, such as LSD, mescaline, ecstasy, mental and behavioral abnormalities develop. In the acute period of intoxication, uncontrolled laughter, crying, euphoria, depersonalization, derealization are observed. Hallucinatory experience is usually vivid, dynamic, polymodal. The tendency to hallucinosis may persist, manifesting itself in the future when taking alcohol, sleeping pills.
- Cannabinoids. Crushed flowers and leaves of cannabis, preparations from them lead to narcotic intoxication. Hallucinogenic, stimulating and sedative effects are noted. Hallucinatory visions are the result of acute intoxication, simultaneous use of high doses of the substance. Speech becomes slurred, complex motor functions are disrupted, coordination deteriorates.
- Amphetamines. These synthetic substances cause mental arousal, a sense of well-being, emotional closeness to other people. The introduction of large doses provokes the development of panic attacks, hallucinosis, paranoia. Irascibility, impulsivity, aggressiveness are aggravated without any reason. Prolonged drug use increases the risk of amphetamine psychosis, symptomatically similar to schizophrenia.
- Substance abuse. The group of toxic substances includes paint solvents, adhesives, varnishes. Intoxication is accompanied by a loss of the ability to critically assess what is happening. Hallucinatory sounds and visions, confusion, vomiting may occur. When removing substances from the body, headache increases, weakness appears.
The subjective nature of experiences with perception disorders complicates the diagnostic process. The pathopsychological assessment of the condition of patients is based on the clinical experience of a psychiatrist. The assumption of the presence of hallucinations is possible when observing the behavior of the patient, analyzing the general picture of the disease (anamnestic, catamnestic information). The standard diagnostic process includes three procedures:
- Clinical survey. The peculiarity of hallucinations is that they are perceived by patients as part of reality, a critical attitude is possible only in rare cases. Therefore, direct questions about the symptom are ineffective. Hallucinatory-delusional syndrome is revealed in the process of communicating with patients when they begin to talk about unlikely or improbable events – “wave exposure”, “mind reading”, “suggestion by sight”. The doctor receives more objective clinical information from family members.
- Observation. The behavior and emotional state of the patient reflect the content and nature of hallucinations. He can peer into the space in front of him, into an empty wall, while experiencing fear, surprise, joy. With auditory hallucinations, patients often listen to voices and sounds, can engage in dialogue, swear, laugh, joke. Tactile sensations make them scratch, rub their skin, ask a doctor to examine them, remove “insects”.
- Provocative tests. There are a number of tests to identify hidden perception disorders and predisposition to them. During the Aschaffenburg test, the patient is asked to talk on the phone turned off, if a conversation is started or the patient hears something, it is assumed that there are hallucinations of the auditory modality. To detect visual hallucinations, the Reichardt test is used (examining a blank sheet of paper), the Lipman test with pressure on the eyelids.
To eliminate hallucinations caused by taking psychoactive drugs, it is enough to stop using drugs. In case of deprivation of vital substances and conditions, it is necessary to return them to their previous level: normalize body temperature, restore proper nutrition, sleep and rest, resume social contacts. Hallucinatory symptoms in mental and neurological diseases are stopped with the help of neuroleptics. They reduce mental and motor arousal, prevent the formation of productive psychotic symptoms.