Hallucinations: auditory, visual, what diseases are involved?

Hallucinations can affect one or more senses. This is most oftenauditory hallucinations (feeling like hearing voices or noises) or visual (impression of seeing unreal images). Of the olfactory and/or tactile hallucinations can also be observed. Their duration and complexity may vary. “Hallucinations are very often hidden by the patient or their loved ones. He sees it as a shame from a societal point of view, this is still due to a broad stigmatization of psychiatric symptoms“, notes Dr. Paul Malekpour, psychiatrist at Rouen University Hospital.

What is the definition of a hallucination?

A hallucination East a wrong perception of a stimulus that does not exist. More concretely, the individual perceives information that is not real. This information can be intrapsychic or sensitive, that is to say linked to each of the 5 senses and therefore be auditory or visual, more rarely gustatory, tactile or olfactory, and sometimes combine several senses. We also talk aboutcenesthetic hallucinations when a person perceives caresses, touches or strange bodily sensations.

A sign of illness?

These hallucinations can be chronic or dailyas in certain psychiatric or neurological illnesses, but also occur suddenly and isolated during an epileptic attack or after consuming toxic substances or medications. “Hallucinations should never be trivialized since they can correspond to serious illnesses”would like to clarify Dr Paul Malekpour.

Hallucinations usually result from the expression of mental disorders:

• decompensated bipolar disorder,
• severe depression called melancholic,
• emotional shock,
• schizophrenia.

The person may or may not be aware that they are experiencing a hallucination. Certain chronic diseases (epilepsy, dementia), infectious (encephalitis), or metabolic, alcohol and drug abuse, sleep disorders are also among the diseases at risk of hallucinations. A family genetic background can also be considered. “Psychiatric illnesses represent the most common causes of chronic hallucinations; schizophrenia must first be ruled out, due to the better prognosis of the illness in the event of early detection in young adults.“, underlines Dr Malekpour.

Auditory hallucination

These are the most common hallucinations. We call “auditory hallucinations” the perception of noises or sounds that do not actually exist. Auditory hallucinations can be distinguished from hearing voices (acoustic-verbal hallucinations). Between 5 and 25% of the population are affected by this type of hallucinations, particularly people suffering from uncorrected hearing loss, and this symptom is present in more than half of people with schizophrenia. These hallucinations may have a biological origin (brain injury) or in rare cases have a psychoanalytic origin (linked to a neurotic defense mechanism). They involve the perception of a sound, a voice or music. These can be simple sounds (clicking, tapping, etc.) or complex sounds (voice, music, etc.). Auditory hallucinations can be linked to an acute or chronic mental disorder (schizophrenia for example), the use of certain substances or significant stress. In the case of mental disorders, those around you can be alerted by a listening attitude, a conversation without an interlocutor, or by counter-hallucinatory maneuvers (headphones on the head, earplugs).

Visual hallucination

These can be simple appearances (color spots or shapes) or complex ones (people or characters). These hallucinations may be linked to the subject’s drug addiction, or to neurological disorders linked to alcoholism. They can also be caused by neurodegenerative diseaseby Alzheimer’s diseaseParkinson’s disease, by sleep paralysis or by an ophthalmological disorder (Charles Bonnet syndrome)

Olfactory and gustatory hallucination

They can be associated with pleasant or unpleasant smells or tastes. They remain less precise than visual and auditory hallucinations, and can be caused by damage to the olfactory and taste systems (viral infection, brain or ENT tract tumors, exposure to certain drugs, epilepsy, etc.).

Tactile and cenesthetic hallucination

They cause sensations of hot or cold, feelings of burning, stinging or itching. For example, they can lead the patient to scratch their arm until it bleeds (Ekbom syndrome). “Cenesthetic or bodily hallucinations affect internal sensitivity. The patient may, for example, have the sensation that a part of his body is transforming“, specifies the psychiatrist.

Intrapsychic hallucination

“Intrapsychic hallucinations are experienced by the patient as an intrusion into one’s own consciousness. The feeling is then that ofhaving an automaton in your head with a feeling of external influence and a loss of control over your thinking. Strictly speaking, we speak of “mental automatism” to describe this distressing sensation. This type is found mainly in schizophrenia.“, observes the specialist.

The diagnosis is essentially clinicalthat is to say it is based on questioning and physical examination of the patient. “Rather than an illness, hallucinations are more a symptom of potentially serious disorders (brain tumor, psychosis, toxic substances, side effects of medications, etc.) requiring first and foremost the urgent advice of a doctor in order to clarify the cause.“, notes Dr. Malekpour. It is necessary to first identify the cause of these hallucinations by a blood sample, a brain MRI, an electroencephalogram to find the best treatment.

“Failing to treat hallucinations of psychiatric origin will lead, in an insidious but certain way, to marginalization of the patient, global desocialization (emotional, family and professional), and ultimately in a more dramatic way when the person dies by suicide or neglect“, warns the psychiatrist. Treatment depends on the cause of the hallucinations.

► In the case of mental pathology problems, antipsychotics (neuroleptics)possibly temporarily associated with anxiolytics and psychological care are the most effective treatment. “Currently, benign and painless repeated transcranial magnetic stimulation solutions are being developed.“, specifies the psychiatrist.

► In the case of organic disordersit is necessary to take care of the disease responsible for the hallucinations. Detoxification and medical monitoring are essential during hallucinations linked to drug or alcohol consumption.

► If the hallucinations are caused by medicationsit will be necessary to notify the prescriber in order to modify the treatment.

Thanks to Dr Paul Malekpour, psychiatrist at Rouen University Hospital.