Visual hallucinations

• Charles Bonnet Syndrome: Visual hallucinations in cognitively intact individuals, usually with significant visual impairment
• Lewy Body Dementia: Recurrent, well-formed visual hallucinations, often associated with cognitive fluctuations and parkinsonism
• Parkinson’s Disease: Visual hallucinations, particularly in advanced stages, often linked to dopaminergic treatment
• Migraine with Aura: Transient visual disturbances, such as scintillating scotomas, occurring before or during a headache
• Epilepsy (Occipital Lobe Seizures): Simple visual hallucinations (e.g., flashing lights) during or following a seizure

• Schizophrenia: Visual hallucinations, often with auditory hallucinations and delusions
• Delirium: Acute onset visual hallucinations with fluctuating consciousness, often in the context of an underlying medical condition
• Major Depressive Disorder with Psychotic Features: Severe depression with mood-congruent or mood-incongruent visual hallucinations
• Bipolar Disorder (Manic Phase): Visual hallucinations during manic episodes, often accompanied by grandiosity and hyperactivity

• Alcohol Withdrawal (Delirium Tremens): Visual hallucinations, often alongside tremors, agitation, and autonomic instability
• Substance Intoxication (e.g., LSD, cannabis): Visual distortions or hallucinations depending on the substance used
• Substance Withdrawal (e.g., benzodiazepines): Visual hallucinations may occur during withdrawal, particularly from sedatives
• Medications (e.g., anticholinergics, dopaminergic drugs): Drug-induced visual hallucinations, dose-related, reversible with cessation

Assess the specific symptoms presented by the patient:

• Description of Hallucinations: Nature, frequency, duration, and content of the hallucinations (e.g., simple vs. complex, animals, people)
• Onset and Triggers: Sudden vs. gradual onset, any precipitating factors (e.g., stress, substance use, visual impairment)
• Associated Symptoms: Presence of cognitive changes, motor symptoms, or mood disturbances
• Impact on Function: Effect on daily activities, insight into hallucinations, any distress or safety concerns

Gather a detailed background including:

• Past Medical History: Previous psychiatric diagnoses, history of neurological disorders (e.g., Parkinson’s, epilepsy), or known visual impairment
• Drug History: Review current medications for potential side effects, recent changes in drug regimen, or use of recreational substances
• Family History: Any family history of psychiatric or neurological conditions
• Social History: Alcohol and drug use, recent significant life events, social support, and living conditions

• General Physical Examination: Assess for signs of systemic illness (e.g., infection, organ failure) that could contribute to delirium
• Neurological Examination: Check for focal neurological deficits, signs of Parkinsonism, or features suggestive of epilepsy
• Mental Status Examination: Assess orientation, attention, memory, and thought processes for signs of delirium, dementia, or psychosis
• Ophthalmological Examination: If visual impairment or Charles Bonnet syndrome is suspected, assess visual acuity and fields

• Brain Imaging (e.g., MRI, CT): To identify structural abnormalities (e.g., stroke, tumor) or neurodegenerative changes
• Electroencephalogram (EEG): To assess for epileptiform activity, especially if seizures are suspected
• Blood Tests: To rule out metabolic causes (e.g., glucose, electrolytes, liver and kidney function tests), and screen for infection or substance levels
• Toxicology Screen: Particularly if substance misuse or overdose is suspected
• Cognitive Testing: Formal assessment for dementia, particularly if Lewy Body Dementia is suspected