Delusions or Hallucinations

Delusions and hallucinations are symptoms of altered perception that can be frightening for both the person experiencing them and their loved ones. Hallucinations involve sensing things that aren't there—hearing voices, seeing visions, or feeling sensations with no external source. Delusions are fixed false beliefs that persist despite evidence to the contrary, such as believing one is being persecuted or has special powers. While often associated with mental health conditions like schizophrenia, these symptoms can also result from medical conditions, medications, substance use, or extreme stress. Understanding that these experiences feel very real to the person having them is crucial for providing appropriate support and seeking proper treatment.

⚠️ Seek Immediate Help For:

  • Threats to harm self or others
  • Aggressive or violent behavior
  • Sudden onset of symptoms
  • Confusion or disorientation
  • High fever with hallucinations
  • Recent head injury
  • Substance intoxication/withdrawal
  • Inability to care for self
  • Severe distress or fear
  • Command hallucinations

Types of Hallucinations

Auditory

  • Most common type
  • Hearing voices
  • Music or sounds
  • Commentary on actions
  • Commands
  • Conversations

Visual

  • Seeing people
  • Objects or shapes
  • Lights or colors
  • Animals
  • Complex scenes
  • Distortions

Tactile

  • Feeling touched
  • Insects crawling
  • Electric sensations
  • Temperature changes
  • Pain sensations
  • Movement on skin

Other Types

  • Olfactory (smells)
  • Gustatory (tastes)
  • Proprioceptive (body position)
  • Vestibular (movement)
  • Mixed types
  • Complex hallucinations

Types of Delusions

Persecutory

  • Being followed or spied on
  • Conspiracy beliefs
  • Being poisoned
  • Targeted harassment
  • Most common type

Grandiose

  • Special powers or abilities
  • Fame or importance
  • Religious significance
  • Exceptional talent
  • Secret knowledge

Referential

  • Special messages in media
  • Events have personal meaning
  • Others' actions directed at them
  • Signs and coincidences

Other Types

  • Somatic (body-focused)
  • Jealousy
  • Erotomania (being loved)
  • Control (thoughts controlled)
  • Nihilistic (world ending)

Common Causes

Mental Health Conditions

  • Schizophrenia
  • Bipolar disorder (mania/depression)
  • Major depression with psychotic features
  • Schizoaffective disorder
  • Brief psychotic disorder
  • PTSD

Medical Conditions

  • Dementia/Alzheimer's
  • Delirium
  • Brain tumors
  • Epilepsy
  • Parkinson's disease
  • Huntington's disease
  • Infections (UTI in elderly)
  • Autoimmune disorders

Substances

  • Alcohol withdrawal
  • Drug intoxication
  • Stimulants (meth, cocaine)
  • Hallucinogens
  • Cannabis (high THC)
  • Prescription medications
  • Steroid psychosis

Other Causes

  • Sleep deprivation
  • Sensory deprivation
  • Extreme stress
  • Grief/bereavement
  • Isolation
  • High fever
  • Nutritional deficiencies

Associated Symptoms

May occur with:

  • Disorganized thinking: Confused thoughts, speech
  • Paranoia: Excessive suspicion
  • Mood changes: Depression, mania
  • Anxiety: Fear, panic
  • Social withdrawal: Isolation
  • Sleep disturbances: Insomnia
  • Cognitive changes: Memory, concentration
  • Behavioral changes: Agitation, catatonia
  • Self-care decline: Hygiene, eating

Medical Evaluation

Initial Assessment

  • Safety evaluation
  • Mental status exam
  • Medical history
  • Medication review
  • Substance use screening
  • Family history

Diagnostic Tests

  • Blood tests: Rule out medical causes
  • Drug screening: Substance use
  • Brain imaging: CT/MRI if indicated
  • EEG: If seizures suspected
  • Neurological exam: Brain function

Psychiatric Evaluation

  • Detailed symptom history
  • Functional assessment
  • Risk assessment
  • Cognitive testing
  • Diagnostic criteria review

Treatment Options

Medications

  • Antipsychotics
  • Mood stabilizers
  • Antidepressants
  • Anti-anxiety medications
  • Sleep aids
  • Medication adjustments

Therapy

  • Cognitive behavioral therapy
  • Family therapy
  • Group therapy
  • Psychoeducation
  • Social skills training
  • Vocational rehabilitation

Hospitalization

  • Safety concerns
  • Stabilization
  • Medication management
  • 24-hour monitoring
  • Crisis intervention
  • Discharge planning

Support Services

  • Case management
  • Peer support
  • Housing assistance
  • Day programs
  • Crisis hotlines
  • Community resources

Living with Psychotic Symptoms

Coping Strategies

  • Take medications as prescribed
  • Maintain routine
  • Stress management
  • Adequate sleep
  • Avoid drugs and alcohol
  • Reality testing techniques
  • Grounding exercises
  • Support network

For Family/Friends

  • Stay calm and supportive
  • Don't argue with delusions
  • Acknowledge their experience
  • Encourage treatment
  • Learn about the condition
  • Set boundaries
  • Seek support for yourself

Recovery and Prognosis

  • Early treatment: Better outcomes
  • Medication compliance: Crucial for stability
  • Ongoing support: Reduces relapses
  • Substance avoidance: Prevents triggers
  • Stress reduction: Maintains wellness
  • Regular monitoring: Catches early signs
  • Hope: Recovery is possible
  • Individual variation: Different paths

Crisis Resources

  • 988: Suicide & Crisis Lifeline
  • 911: Immediate danger
  • Crisis text line: Text HOME to 741741
  • NAMI Helpline: 1-800-950-NAMI
  • Local crisis teams: Mobile response
  • Emergency departments: 24/7 help
  • Warmlines: Peer support

Related Symptoms

Confusion

Often accompanies psychosis.

Paranoia

Common with delusions.

Anxiety

Frequently co-occurs.

Mood Changes

May indicate bipolar disorder.