This page was last updated on
September 19, 2013
Causes of hallucinations
- Perceptual distortions arising from any of the five senses.
- "A false perception, which is not a sensory distortion or misinterpretations but which occurs as the same time as real perceptions" - (Jaspers)
- Dreams and mental images differ from hallucinations and are often Incomplete, dependent on will, can be recreated.
- Pseudo-hallucinations - an involuntary sensory experience vivid enough to be regarded as a hallucination, but recognised by the patient not to be the result of external stimuli.
- Intense emotions.
- Words or short phrases-”kill yourself”
- Motivating instructions
- Disorders of sense organs.
- Geriatric clients
- Sensory deprivations.
- Repetitive words and phrases.
- Black patch disease.
- Disorders of CNS.
Lesions on diencephalon and cortex
- Hypnogogic and Hypnopompic
- Organic hallucinations
- Auditory or visual .
- Elementary or partially or completely organized voices.
- Stimulation of temporal areas.
- Vary in quality ,content.
- Thought echo, second person or third person.
- May be imperative.
- Elementary or partially or completely organized
- Most common in acute organic states
- Extremely rare in schizophrenia.
- sees small animals most often in delirium.
- Often isolated from auditory hallucinations.
- In temporal lobe epilepsy may be experiential.
- Lilliputian hallucinations frequently occur.
- Schizophrenics, organic states, temporal lobe epilepsy.
- Uncommon in depressives.
- finds in schizophrenics, organic states.
- can be experienced in Parietal cortex stimulation.
Special kinds of hallucinations
- finds in Organic states.
- “Cocaine bug.”
- Wind, heat, electrical or sexual sensations.
- Reflex hallucinations
- Extracampine hallucinations
- Autoscopy or phantom mirror image
- Epilepsy ,focal lesions, toxic infective stages
- Parietal lobe disorders
- Negative autoscopy
- Internal autoscopy
- False unshakable belief which is out of keeping with the patients social and cultural background.
- Primary delusions.
- Secondary delusions.
- A new meaning arises not in connection with other psychopathological event and is not understandable.
- Delusional mood: has knowledge of something going on around him but do not know what it is.
- Delusional perception: attribution of new meaning to a normally perceived object.
- Delusional idea: delusion appears fully formed in the mind.
Content of delusions
- A delusion which is understandable in terms of persons cultural background or emotional state.
Delusions of persecution
- Persons or groups.
- About to be killed or being tortured.
- Being robbed of property or knowledge.
- Of being poisoned or infected.
- Delusions of reference.
- Delusions of influence.
- Delusions of jealousy.
- Infidelity- seen in brain disease, alcohol addiction, affective psychoses and can be dangerous, may attempt murder.
- Delusions of love.
- Erotomania: may try to follow, contact or persuade.
- Grandiose delusions.
- Schizophrenia, drug dependence ,organic brain syndromes, mania (jocular and haughty).
- Regarding worth, talent, knowledge or power.
- Delusions of ill health
- Depressive illness, schizophrenia.
- Could be extended to cover persecutory delusions.
- Hypochondriacal delusions.
- Some physical defect, disorder or incurable diseases.
- Infestations, ugly or dysfunctional body parts
- May include spouse or children.
- Result of somatic hallucinations in schizophrenia.
- Delusions of guilt
- Unpardonable sin.
- Can give rise to persecutory delusions.
- Lead to suicide.
- Nihilistic delusions .
- Denies the existence of body, mind, loved ones or the whole world.
- Very agitated depression, delirium, schizophrenia.
- Delusions of poverty- Destitution is facing him and family.
- Delusional misidentification.
- Capgras syndrome.
- Religious delusions- Can be grandiose in nature.
- Delusions of control.
Understanding levels of intensity Stage 1
- Sedatives / hypnotics
- Moderate anxiety.
- Usually pleasant.
- Inappropriate grinning, moving lips, silent and preoccupied.
- Repulsive content.
- Autonomic signs.
- Poor attention span.
- Lose ability to differentiate from reality.
- Severe anxiety.
- Directions will be followed.
- Physical symptoms of severe anxiety.
- Panic stage.
- Terror stricken behaviors.
- Potential for homicide or suicide.
- Physical activity reflects content of hallucination.
Goal of Management
- Help to increase awareness of the symptoms to distinguish the reality.
- Facilitative communication.
- Observation and listening.
- Can talk about hallucination to know about the level of symptoms.
- Talking about hallucination is reassuring and self validating for the patient.
- If left alone, it will overwhelm coping resources.
- Interactive discussions are very helpful.
- Communicate right at the time of hallucination.
- Modulation of sensory stimulation.
- Eye contact.
- Speak simply but slightly louder.
- Call by name.
- Use touch.
- Establish trusting IPR.
- Calm, patient, acceptance, active listening.
- Asses for symptoms duration, intensity and frequency.
- Observe for behavioral clues.
- Help to record number of hallucinations.
- Focus on symptoms and help to describe the happening.
- Empower by helping to understand.
- Help to control over hallucinations.
- Identify whether drugs or alcohol have been used.
- If asked, point out that you are not experiencing same stimuli.
- Do not argue.
- Suggest and reinforce use of interpersonal relationships as a symptom management technique.
- Encourage to talk.
- Help to mobilize social support.
- Help to describe and compare current and past hallucinations.
- Determine the pattern if any.
- Encourage to remember when it began first.
- Pay attention to the content may helpful in predicting the behavior.
- Alert for commanding hallucinations.
- Determine the impact of the patients symptoms on ADL.
- Provide feedback on coping responses.
- Help to recognize symptom triggers and management strategies.
- Place delusion in a time frame and identify triggers.
- Identify all the components , triggers related to stress or anxiety.
- If related with anxiety, teach anxiety management skills.
- Develop symptom management program.
- Assess intensity frequency and duration
- Fleeting delusions can be worked out in a short time frame.
- Listen quietly until need to discuss.
- Identify emotional components.
- Respond to the underlying feeling.
- Encourage discussions with out assuming right or wrong.
- Observe for evidence of concrete thinking.
- Is patient and nurse using language in the same way.
- Is patient takes you literally.
- Observe speech for symptoms of a thought disorder.
- May not be a time for discrepancy.
- Observe ability to use cause and effect relationship.
- Is patient making logical predictions based on past experiences.
- Is patient conceptualizes time.
- Is patient using recent or remote memory meaning fully.
- Distinguish between description and facts of the situation.
- Identify false situations.
- Promote the ability to test reality.
- Determine hallucinations.
- Carefully question the facts as they are presented and their meaning.
- To be done after previous steps.
- Discuss consequences when the person is ready.
- Allow to take responsibility of own action.
- Encourage personal responsibility in wellness and recovery.
- Promote distraction as a way to stop focusing on delusions.
- Promote physical activities.
- Recognize and reinforce healthy and positive aspects of personality.
- Don’t argue or reject.
- Try to keep them engaged.
- Encourage to practice some relaxation techniques.
- Use distractions, exercising, hobbies, saying stop.
- Calming by a glass of water or counting.
- Be tactful in approach.
- Do not express approval.
- Acknowledge feelings or fear.
- Reassure and encourage.
- Explain clearly what you are doing and why.
- Maintain consistency.
- Keep communication open and non judgmental.
- Listen understand and respect their feelings.
- Stuart GW, Lararia MT. Principles and practices of psychiatric nursing (8th edn) Mosby publications; Missouri, 2005.
- Hamilton M. Fish's clinical psychopathology (2nd edn) Varghese Publications; Bombay ,1994.