14, 15 Patients with major depressive disorder or bipolar disorder also may experience visual hallucinations. 13ĭSM-IV-TR lists visual hallucinations as a primary diagnostic criterion for several psychotic disorders, including schizophrenia and schizoaffective disorder, 4 and they occur in 16% to 72% of patients with these conditions. 12 Visual hallucinations occur in numerous ophthalmologic, neurologic, medical, and psychiatric disorders ( Table 2). 11 These false perceptions may consist of formed images (eg, people) or unformed images (eg, flashes of light). Visual hallucinations manifest as visual sensory perceptions in the absence of external stimuli. When they occur, they typically consist of perceived unilateral tinnitus, phonophobia, or hearing loss.Ĭommon causes of auditory hallucinations Peripheral lesions Patients with migraines rarely report auditory hallucinations. The sounds typically are unformed mechanical or seashell-like noises or music. 9 Hemorrhages and arteriovenous malformations in the pontine tegmentum and lower midbrain have been associated with acute onset of auditory hallucinations. 7, 8ĬNS neoplasms can produce auditory hallucinations in 3% to 10% of patients. 1 Patients with alcohol hallucinosis also may experience musical auditory hallucinations. These hallucinations usually are vocal and typically consist of accusatory, threatening, and/or critical voices directed at the patient. 6 These hallucinations typically are brief, stereotyped sensory impressions and, if formed, may be trivial sentences, previously heard phrases, or commands.Īuditory perceptions of music have been associated with partial seizuresĪlcoholic hallucinosis is a hallucinatory syndrome caused by alcohol withdrawal. 5 Curie and colleagues found that 17% of 514 patients with temporal lobe epilepsy had auditory hallucinations as a component of their seizures. Perceptions of music have been associated with partial seizures. Partial seizures may cause auditory hallucinations. These unformed hallucinations consist of buzzing or tones of varying pitch and timbre. Simple (unformed) auditory hallucinations-referred to as tinnitus-can be caused by disease of the middle ear (otosclerosis) or inner ear. 4 Auditory hallucinations also are seen in mood disorders but tend to be milder than their psychosis-induced counterparts. According to DSM-IV-TR, “hearing voices” is sufficient to diagnose schizophrenia if the hallucinations consist of a voice keeping up a running commentary on the person’s behavior or ≥2 voices conversing with each other. Some might hear their own thoughts spoken aloud. The voices may be perceived as coming from inside or outside the patient’s head. A patient might experience 2 voices talking about him in the third person. 3 A common manifestation is hearing ≥1 voices. 1Īuditory hallucinations in psychosis usually are formed and complex. 2 Approximately 60% to 90% of patients with schizophrenia and up to 80% of those with affective psychoses experience auditory hallucinations. 1 A frequent symptom of schizophrenia, auditory hallucinations can cause substantial distress and functional disability.
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This type of hallucination has various causes ( Table 1). Awareness of typical presentations of hallucinations associated with specific disorders can help narrow the diagnosis and provide appropriate treatment.Īlso known as paracusia, auditory hallucinations are perceptions of sounds without identifiable external stimuli. In this article we describe common features and psychiatric and nonpsychiatric causes of auditory, visual, olfactory, gustatory, tactile, and somatic hallucinations. To avoid providing unnecessary or ineffective treatments-and to ensure that patients receive proper care for nonpsychiatric conditions-it is important to accurately diagnose the disorder causing a patient’s hallucinations.
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Many physical and psychiatric disorders can manifest with hallucinations, and some patients have >1 disorder that could cause different types of hallucinations. Not all patients who experience hallucinations have a psychotic disorder.