Overview
Hallucinosis caused by drugs refers to the development of sensory perceptions without external stimuli, often involving complex visual or auditory experiences, triggered by certain medications, particularly sedatives and anesthetics like midazolam and propofol 2.Diagnosis
Presence of persistent hallucinations despite external stimuli removal
History of recent exposure to hallucinogenic drugs (e.g., midazolam, propofol) 2
Exclusion of other causes of hallucinations such as psychiatric disorders or metabolic disturbances
No specific diagnostic tests; clinical assessment and medication review are crucialManagement
Withdrawal or adjustment of causative drugs: Gradual tapering of sedatives or anesthetics under close monitoring 2
Supportive care: Addressing patient comfort and safety, possibly involving psychiatric consultation for severe cases 2
Monitoring: Frequent reassessment for resolution of symptoms and potential withdrawal effects 2Special Populations
Elderly: Increased risk of drug-induced hallucinations; careful deprescribing of antipsychotics and sedatives recommended 1
Comorbidities: Patients with cognitive impairments may require heightened vigilance and multidisciplinary care 1Key Recommendations
Exercise caution with sedatives and anesthetics prone to hallucinogenic effects to prevent sexual hallucinations and other adverse psychological symptoms (Evidence: Expert opinion 2)
Implement gradual deprescribing strategies for older inpatients on long-term sedatives and antipsychotics to reduce hallucinosis risk (Evidence: Moderate 1)
Provide comprehensive patient and caregiver education on potential drug side effects, especially in elderly populations (Evidence: Expert opinion 1)References
1 Jokanovic N, Aslani P, Carter S, Duong M, Gnjidic D, Jansen J et al.. Development of consumer information leaflets for deprescribing in older hospital inpatients: a mixed-methods study. BMJ open 2019. link
2 Balasubramaniam B, Park GR. Sexual hallucinations during and after sedation and anaesthesia. Anaesthesia 2003. link