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, hum, light flashes, luminous figures, smells. Simple - complete images: static animals, household items. Complex - dynamic phenomena, for example, voices commenting on what is happening. Diagnosis is performed through observation, conversation, analysis of the overall clinical picture. During therapy, antipsychotic drugs are prescribed.
general characteristics
There are true and false hallucinations. True hallucinatory images have the qualities of objectivity, integrity, structure, constancy. They are assimilated with the real situation, that is, they interact with existing objects, for example, an ax lies on a table. Pseudohallucinations are present in a conditional, imaginary space, often do not have a clear structure. Common options 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 of hallucinations are elementary, simple, complex. Elementary ones have incomplete objectivity, unimodal, are represented by separate non-speech sounds and simple images like causeless flashes. Simple hallucinatory phenomena are objective, static, sometimes moving, but do not change shape. They are unimodal - they use one analyzer. Complex hallucinations are formed with the participation of several analyzers, the images are dynamic, often have a 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 frightening, 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, the common characteristic is that the images are always perceived by the patient as real.
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 poisoning with psychoactive substances.
extreme conditions
Hallucinatory sensations appear in extreme situations for the body, which are often accompanied by the risk of death, are associated with a pronounced deficit or excess of chemicals, information, and 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:
- Overheat. Unrealistic images, sounds, voices occur when the body temperature rises to 41-42 ° C. This condition is observed with fever, a severe form of heat stroke. Characterized by psychomotor agitation, delirium, confusion.
- Hypothermia. Extremely low temperatures can also provoke a delusional-hallucinatory state. Symptoms unfold already at a mild stage of hypothermia, when the body temperature drops below 35 ° C. A person feels chills, the functions of internal organs are inhibited, coordination of movements is disturbed, and perception is distorted.
- Lack of food. Lack of nutrients creates a lack of energy, which is necessary for the functioning of the brain and other organs. Hallucinosis manifests itself on the 7th-9th day of fasting, when ketone bodies become the main energy source. The person looks detached, indifferent, does not show interest in close people, ongoing events.
- Lack of air. Oxygen is essential for the normal functioning of the brain. When the air flow stops, the brain tissues use the oxygen reserves for 4-5 minutes, after which hypoxic changes gradually increase, hallucinatory images are formed. The reasons for the lack of oxygen are deliberate suffocation, being in an unventilated room, ischemic brain damage.
- Strong fatigue. Prolonged physical and mental overload can cause hallucinatory experiences. Distortion of perception occurs as a result of the 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, serious illness, forced wakefulness due to work overload. Sometimes the state of sleep deprivation is formed purposefully in order to achieve an altered consciousness. Regardless of the cause, a person experiences vivid hallucinations, an aggravation of the perception of the senses, a feeling of unreality of what is happening.
- Sensory deficiency. The nervous system functions normally with constant exposure to a variety of stimuli. If the volume of incoming sensory information is significantly reduced or its flow stops altogether, the brain compensates for this by creating its own stimuli - images of various modalities. Cosmonauts experience similar states. For therapeutic purposes, sensory deprivation chambers are used to stimulate the creativity and deepest emotions of patients.
- social isolation. Reduced or inability to interact with other people provokes the loss of personal identity. 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. Often she is represented by the voice of a "friend", the image of one of the relatives. The causes of social deprivation are imprisonment in solitary confinement, a serious illness.
Mental disorders
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 a 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 classified as a symptom of the first rank. Patients hear the sound of their own thoughts, contradictory, mutually exclusive and commentary voices. Somatic pseudo-perceptions (movement, deformation of organs) are noted. Patients are sure that their ideas, feelings and impulses are being influenced, that their thoughts can be read, recognized by others.
- Bipolar disorder. Symptoms of psychosis are observed in severe bipolar affective disorder. A common psychotic manifestation is auditory and visual hallucinatory representations. More often they unfold in the phase of mania along with delusional ideas of greatness, omnipotence. The hallucination can be congruent or incongruent with the mood of the patient, supports manic tendencies or is not associated with them.
- symptomatic psychoses. The causes of exogenous psychotic states are severe somatic diseases, infections, poisonings. They proceed with a temporary stupefaction of consciousness, from twilight to oneiroid. Acute psychosis usually lasts from several hours to 2-3 days, delirium with hallucinations often develops at night, the resulting images frighten patients. In severe cases, delirium turns into amentia, in which confusion, incoherence of speech, and chaotic movements predominate.
- Organic delusional disorder. With a schizophrenia-like disorder, hallucinatory-delusional seizures are possible, accompanied by unmotivated actions, loss of control over behavior, manifestations of aggression. Hallucinations are often visual, have a religious, magical content, call to action. The causes of organic delusional disorder are epilepsy, focal brain damage, and surfactant poisoning.
- organic hallucinosis. A distinctive feature of organic hallucinosis is continuous hallucination due to 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.
Neurological diseases
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 sections of the analyzer, patients begin to see flashes, simple luminous 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 in the development of hallucinatory symptoms in neurological pathologies include:
- neurodegenerative processes. Degeneration of the nervous tissue leads to the development of dementia, a chronic progressive disease, which is characterized by a violation of higher cortical functions, including memory, speech, and intelligence. Hallucinations are not a mandatory symptom. Most often they are diagnosed in dementia with Lewy bodies, less often in Alzheimer's disease, Huntington's chorea.
- Local lesions of the brain. Hallucinatory visions and sensations are provoked by a focal lesion of the temporal, occipital or parietal lobes of the brain, hyperstimulation of the midbrain or brainstem. Immediate causes - tumors, strokes, vascular malformations, craniocerebral 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, impaired 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. A hallucinatory sensation develops according to compensatory mechanisms, recreating images of a certain modality. A well-known example is the Charles Bonnet syndrome - the vision of images by patients with acquired severe visual impairment.
- Narcolepsy. In patients with narcolepsy, for no reason, there are influxes of drowsiness, attacks of decreased muscle tone with the preservation of consciousness. When falling asleep, hypnagogic hallucinations unfold, which do not allow you to fall asleep completely, and when you wake up, hypnopompic hallucinations, which prevent you from correctly assessing the situation around you.
Substance use
Hallucinations can be triggered by taking drugs, alcohol, and certain medications. Following the use of a psychoactive substance, acute intoxication develops, accompanied by a disorder of consciousness, cognitive functions, perception, and emotions. The severity of psychotic symptoms depends on the type and dose of PAS. 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. With the use of 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. The hallucinatory experience is usually vivid, dynamic, and polymodal. The tendency to hallucinosis may persist, manifesting itself in the future when taking alcohol, sleeping pills.
- Cannabinoids. Crushed flowers and leaves of hemp, drugs from them lead to drug intoxication. Hallucinogenic, stimulating and sedative effects are noted. Hallucinatory visions are the result of acute intoxication, the simultaneous use of high doses of a substance. Speech becomes slurred, complex motor functions are disturbed, coordination deteriorates.
- Amphetamines. These synthetic substances cause mental arousal, a feeling of well-being, emotional closeness to other people. The introduction of large doses provokes the development of panic attacks, hallucinosis, paranoia. Hot temper, impulsiveness, aggressiveness are aggravated without any reason. Long-term drug use increases the risk of amphetamine psychosis, symptomatically similar to schizophrenia.
- Substance abuse. The group of toxic substances includes paint thinners, glues, varnishes. Intoxication is accompanied by a loss of the ability to critically evaluate what is happening. There may be hallucinatory sounds and visions, confusion, vomiting. With the removal of substances from the body, headache intensifies, weakness appears.
Examination and treatment of patients is carried out under the guidance of a psychiatrist
Diagnostics
The subjective nature of experiences in violation of perception complicates the process of diagnosis. 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 patient's behavior, analyzing the overall picture of the disease (anamnestic, follow-up 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. The hallucinatory-delusional syndrome is revealed in the process of communication with patients, when they begin to talk about unlikely or implausible events - “impact by waves”, “mind reading”, “suggestion with a look”. The doctor receives more objective clinical information from family members.
- observation. Behavior, 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, they can enter into a dialogue, swear, laugh, and joke. Tactile sensations make them scratch, rub the skin, ask the doctor to examine them, remove "insects".
- provocative tests. There are a number of tests that can reveal hidden perceptual disorders and a predisposition to them. When conducting the Aschaffenburg test, the patient is asked to talk on the switched off phone, if a conversation is started or the patient hears something, the presence of auditory modality hallucinations is assumed. To detect visual hallucinations, Reichardt's test (examining a blank sheet of paper), Lipman's test with pressure on the eyelids is used.
Treatment
To eliminate hallucinations caused by taking psychoactive drugs, it may be enough to stop using drugs. In case of deprivation of vital substances and conditions, return them to their previous level: normalize body temperature, restore proper nutrition, sleep and rest, and resume social contacts. Hallucinatory symptoms in mental and neurological diseases are stopped with the help of neuroleptics. They reduce mental and motor excitation, prevent the formation of productive psychotic symptoms.