Hallucinations not related to mental illness

[Eydawn]

As usual, I'm trolling the Interwebs trying to stay awake while on my shift and giving myself a break from some microbiology homework. I found this really interesting article on MSNBC titled When The Elephant in the Room Isn't Really There and thought it would be something interesting to bring up, especially for those of us who work with the elderly population with any sort of frequency. I had never heard of of Bonnet syndrome before reading this article; brings up some good food for thought.

So, what if your patient is oriented, totally there mentally, but insisting that the giant pink elephant is in the ambulance with you? Are they really hallucinating? Is there something pathological going on in their brain? Or is it merely their visual cortex substituting imagery in the absence of readable visual input? Will it change how you interact with this patient at all, now that you have read this article?

Wendy

CO EMT-B

[Lone Star]

Interesting article!

While it's never a 'good idea' to play into or on a patient's halucinations (visual or audible), they appear to be 'real' to the patient.

I've seen where EMT's have actually 'killed the invisible spiders' only to be told in no uncertain terms by the patient that they knew they were being made fun of.

I've told patients flat out that while they believe that they're seeing/hearing these things, I just don't see or hear them. I'll go on to tell them that I'll be sure to bring this symptom up to the recieving staff, and see if there's something that they can do for the patient that I cannot.

Prior to reading this article, I most likely would have been thinking along the lines of dementia or drugs. This definately gives me something more to consider when dealing with patients (especially the elderly)!

[DwayneEMTP]

Pretty interesting.

Another example of why the scientific process is so important. We just can't always believe what we discover with our senses...

The patient says, 'I'm seeing kids on the piano.' And they're right.

The docs are saying 'you're not really seeing anything.' And they're right too.

This happened to me a few times...but there were mushrooms involved. I don't think it's exactly the same thing, right?

Thanks for posting Cutie...

Dwayne

[crotchitymedic1986]

About two weeks before Obama won the presidency, a friend of mine shared a story of a mental patient who was being admitted against her will. She had freaked out about the possibility of Obama's election, was seeing apocalyptic visions, started reading her bible 24/7, and had contemplated murdering her kids to save them from the horrific future she saw. You can dedide with the knowledge you have now, whether or not she was crazy or visionary.

Realize the one of the most common causes of hallucinations is medication related, especially the phenothiazines.

[Kaisu]

Interesting that you should bring this up Wendy. In this thread My linkI talk about my mother's recent illness.

Yesterday, when I went to see her, she was hallucinating. Her visuals were vivid and real to her, yet when I told her that no one else could see them she would re-orient herself. She was disturbed by the fact that she was seeing things that others didn't. I discussed it with the ICU nurse, who told me that this was a very common phenomena in ICU. The RN could not tell me exactly why this happened. She said they theorize that it is a combination of medications, post-surgical chemical release, and a lack of visual stimuli.

I immediately gave her her glasses, instinctively thinking that if she could see clearly, then her brain might not need to create so much stuff. It really made no difference. The cool thing is, after I explained that what she was going through was normal and she was not crazy, we actually had a ball laughing about what she was seeing.

(she has no idea of popular culture or internet virals, but she did see ceiling cat)

[chbare]

Pretty interesting.

Another example of why the scientific process is so important. We just can't always believe what we discover with our senses...

The patient says, 'I'm seeing kids on the piano.' And they're right.

The docs are saying 'you're not really seeing anything.' And they're right too.

Ever take any physics or astronomy? When you start covering relativistic effects, you would not believe just how true the essence of your statement really is. Sorry, off topic.

Take care,

chbare.

[Richard B the EMT]

Back when I was working in the EMD, a caller requested an ambulance to take him to a particular psychiatric hospital, as "They have the equipment to block my life signs from the Christal Star Ship there."

On arrival, the NYPD and my field crew advised there was nobody at the scene.

This left three possibilities:

1) The man changed his mind, and left the scene,

2) The call was bogus from jump street, or

3) The Klingons found him prior to our arrival and snatched him!

While admittedly humorous, I actually did field that call!

[joesph]

I do what the voices in my radio tell me to do

[fireflymedic]

Interesting that you should bring this up Wendy. In this thread My linkI talk about my mother's recent illness.

Yesterday, when I went to see her, she was hallucinating. Her visuals were vivid and real to her, yet when I told her that no one else could see them she would re-orient herself. She was disturbed by the fact that she was seeing things that others didn't. I discussed it with the ICU nurse, who told me that this was a very common phenomena in ICU. The RN could not tell me exactly why this happened. She said they theorize that it is a combination of medications, post-surgical chemical release, and a lack of visual stimuli.

I immediately gave her her glasses, instinctively thinking that if she could see clearly, then her brain might not need to create so much stuff. It really made no difference. The cool thing is, after I explained that what she was going through was normal and she was not crazy, we actually had a ball laughing about what she was seeing.

(she has no idea of popular culture or internet virals, but she did see ceiling cat)

I'm guessing from the content she was dealing with ICU psychosis - phenomenon that happens causing hallucinations, temporary irrational behavior, etc. From my reading, the understanding is that occurs due to constant stimulation environment and no distinct sleep/wake cycles. In an ICU it is always daytime, but for some bizarre reason, similar to sundowning in elderly patients, it gets worse at night.

http://www.emedicinehealth.com/script/main/art.asp?articlekey=7769

There are also some physical reasons that are non psychiatric that patients can indeed see visions (temporal lobe epilepsy is known to produce religious visions - such as case of Emily Rose). Dehydration, hypoxia (the general explanation for the visions people see when dying), etc.

Very interesting though - thanks for posting !

[Kaisu]

More on the non-psychotic hallucinations - the following day my mother was worse. Her delusions were fixed and I was unable to orient her as I had been the day before. An amazing ICU nurse added another piece to the puzzle. He stated that something about putting patients on the heart/lung machine results in these symptoms more often than not.

From Oberlin alumni review heart/lung machine side effects

For patients who qualify for bypass surgery, success rates are better than 90 percent. There remain, however, serious side effects that often result from the heart-lung machine itself. Some of the damage is caused by blood clots; patients may experience inflamed kidneys and lungs, and there is a small risk of damage to the retina of the eye.

Furthermore, even a small clot can damage the brain. A third to a half of patients who are put on the heart-lung machine may later exhibit cognitive defects, from memory problems and difficulty concentrating to depression and attention deficiency.

From the university of California More cognitive problems

Patients hooked up to the machine face a two- to four-percent chance of stroke and a 25-percent risk of transitory retinal damage. Post-operative infections may be more of a risk when the machine is used. And cognitive deficits are common. Last June Duke University researchers reported in the New England Journal of Medicine that five years after bypass surgery, 42 percent of patients studied still suffered from a decline in intellectual function. The risk was greatest for the patients who were placed on heart-lung machines.

Heart-lung machines provoke the release of a riot of inflammatory molecules capable of harming organs throughout the body, including the brain.

Microscopic bubbles from the oxygenator or arterial plaque dislodged during placement of the tubes connecting patient and machine can block blood flow to the brain or other organs. Mechanical damage to fragile blood cells can result in clots.

Many elderly and very sick patients have been considered ineligible for coronary bypass surgery simply because they are too weak to withstand the rigors of the heart-lung machine.

I think you get the idea. Fortunately for my mother, she was back to normal today. I think it's interesting that I was never informed of these risks prior to the surgery (not that it would have changed the decision.) It's interesting that retinal damage is something that occurs from being on the heart/lung machine, and as Wendy pointed out, these non-psychotic hallucinations are related to visual problems.

PS.. I love this site! It makes me think and learn.