Alucinações: Tipos, Causas e Abordagem Clínica

Hallucinations are perceptions without external stimuli, vivid and indistinguishable from reality.

Sensory Modalities

• Auditory: Voices, noises — most common (schizophrenia, mood disorders).
• Visual: Shapes, people, scenes — Lewy body dementia, Parkinson's, Charles Bonnet syndrome, occipital lesions.
• Tactile: Crawling, burning — substance withdrawal, delirium.
• Olfactory: Burning, rotten — temporal lobe epilepsy, migraine, neurodegenerative.
• Gustatory: Metallic, bitter — temporal lobe, medication side effects.

Etiologies

• Psychiatric: Schizophrenia, bipolar, major depression with psychotic features.
• Neurologic: Epilepsy, Parkinson's, Lewy body, tumors, stroke.
• Substance: Intoxication (stimulants, psychedelics), withdrawal (alcohol, benzos).
• Medical: Delirium (infection, metabolic), hepatic/renal failure, thyroid storm.
• Sensory deprivation: Charles Bonnet (visual loss), musical ear (hearing loss).
• Sleep: Hypnagogic/hypnopompic (normal variants).

Evaluation

History (onset, modality, insight), mental status, neuro exam, labs (CBC, CMP, TSH, B₁₂, tox screen), neuroimaging (MRI), EEG if seizure suspected.

Treatment

Target cause: antipsychotics (dopamine D₂ blockade), antiseizure, treat infection/metabolic, adjust medications, sensory aids. CBT for distress.

Not all hallucinations = psychosis; context determines urgency.