Delirium : An Acute Mental State

Hari Prasad, aged 72, was sitting in his courtyard sipping morning tea as he did every day. To his family, he appeared completely normal. Just two days prior, he had been admitted to the hospital due to pneumonia. He was on medication, and doctors had noted that his condition was steadily improving. However, on the morning of the third day, everything changed unexpectedly.

Looking at his daughter, he asked, 'How did you get here? You went missing when you were a child.' His daughter was taken aback. A few moments later, pointing toward a corner of the room, he whispered, "There is a person standing there; turn them out." In reality, no one was there. The man who had seemed calm just minutes ago suddenly became agitated, stood up, tried to go home, and refused to accept that he was in a hospital.

Initially, the family assumed this was an effect of old age or an early sign of dementia. Some attributed it to stress, while others suspected a psychological disorder. However, after evaluating him, the doctor explained, 'This is not dementia; it is delirium. A physical infection in his body has temporarily disrupted how his brain functions.'

Once the infection was brought under control, Hari Prasad's condition gradually returned to normal over the next few days. He recognized his daughter, remembered why he had been brought to the hospital, and expressed complete disorientation regarding his unusual behavior from a few days earlier, having no memory of it.

Incidents like this often cause fear and confusion for many families. When an individual who appeared normal a moment ago suddenly becomes confused, incoherent, or acts strangely, people frequently attribute it to psychiatric illness, aging, or psychosis. However, the reality is often quite different. That state may be delirium—an acute brain dysfunction that develops rapidly but can frequently be reversed if the underlying cause is identified and treated in a timely manner.

Delirium is a sudden-onset, severe mental state in which an individual's consciousness, attention, cognition, and perception of reality are temporarily impaired. Both psychology and medicine treat this as a medical emergency, though its primary origin is almost always organic and physical rather than purely psychiatric.

The Psychological Perspective

From a psychological standpoint, delirium is not merely an state where someone "sees things that aren't there." Rather, it represents a profound, acute disruption in the brain's ability to perceive the surrounding environment, maintain focus, and process information appropriately. Unlike neurodegenerative conditions that progress gradually, delirium develops rapidly—often over a few hours or days. This rapid onset makes it a critical condition requiring immediate attention in both psychology and clinical medicine.

The primary deficit in a person experiencing delirium is an impaired ability to focus or sustain attention. Engaging in a standard conversation becomes difficult. When asked a question, their focus may shift within seconds; they cannot hold a train of thought for long, and they struggle to follow simple instructions. Consequently, they may appear disorganized, distant, or uncooperative.

Delirium also impairs spatial, temporal, and personal orientation. Individuals may become confused about where they are, what day or time it is, or who is standing before them. Some may feel they are in an unfamiliar place while sitting in their own homes, whereas hospitalized patients might believe they have already returned home.

Thought processes and speech patterns become fragmented and disorganized. A conversation might begin on one topic and abruptly drift to an unrelated subject within seconds. Sentences may lack logical structure, arguments become incoherent, or answers may be entirely irrelevant to the questions asked. Hallucinations can also occur; patients may claim to see people, animals, or objects that are not present, hear non-existent sounds, or harbor false beliefs that someone intends to harm them. Because these experiences feel entirely real to the patient, their fear and behavioral responses are equally genuine.

Fluctuations in emotional state and behavior are another hallmark of delirium. A person who appears calm one moment can suddenly become highly anxious, angry, or agitated. A short while later, they may swing to the opposite extreme—becoming hypoactive, lethargic, or entirely unresponsive. This unpredictable waxing and waning pattern often leaves family members deeply confused.

Perhaps the most defining clinical feature of delirium is its fluctuating course over a 24-hour period. An individual may seem relatively lucid in the morning, become severely confused by evening, and appear improved again a few hours later. Because of this fluctuating nature, families frequently mistake it for normal forgetfulness, aging, or a psychiatric disorder. In reality, delirium serves as an acute signal of temporary brain dysfunction. When the underlying cause is promptly addressed, the individual can typically return to their baseline cognitive function.

Key Clinical Perspectives on Delirium

Modern medical and psychological frameworks for understanding delirium have been shaped by several globally recognized experts. Their work urges clinicians and the public to view delirium not as trivial confusion, but as a critical, fluctuating, and largely reversible state of acute brain failure.

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|                           PROMINENT DELIRIUM RESEARCHERS                          |

+------------------------------------+----------------------------------------------+

| Expert & Affiliation               | Core Contributions                           |

+------------------------------------+----------------------------------------------+

| Dr. Sharon K. Inouye               | • Developed Confusion Assessment Method (CAM)|

| Harvard Medical School             | • Frame delirium as a reversible medical     |

|                                    |   emergency rather than normal aging         |

+------------------------------------+----------------------------------------------+

| Dr. Zbigniew J. Lipowski           | • Defined delirium as an acute, temporary    |

| Psychiatrist & Author              |   global cognitive disruption                |

|                                    | • Emphasized delirium as a symptom of        |

|                                    |   underlying physical illness                |

+------------------------------------+----------------------------------------------+

| Dr. E. Wesley Ely                  | • Pioneered ICU delirium screening & research|

| Critical Care Specialist           | • Highlighted long-term cognitive impacts    |

|                                    |   of untreated delirium                      |

+------------------------------------+----------------------------------------------+

Dr. Sharon K. Inouye

A specialist in geriatric medicine affiliated with Harvard Medical School, Dr. Sharon K. Inouye developed the Confusion Assessment Method (CAM) in 1990, which remains the most widely used diagnostic tool for identifying delirium globally.

In her landmark 2006 review article titled "Delirium in Older Persons" published in the New England Journal of Medicine, she highlighted delirium as one of the most common yet frequently missed complications among hospitalized older adults. Her core message was clear: delirium is not an inevitable consequence of aging, but an acute condition with underlying causes that can be identified and treated. Later, in her 2020 article "Joining Forces against Delirium" in the same journal, she urged clinicians to monitor brain function with the same clinical vigilance accorded to other major organ systems.

Dr. Zbigniew J. Lipowski

Dr. Zbigniew J. Lipowski, a psychiatrist and scholar, contributed significantly to the formalization of delirium research. In his influential 1987 publication in JAMA, "Delirium (Acute Confusional States)," and subsequent clinical writings, he defined delirium as an acute, temporary brain syndrome characterized by simultaneous disturbances in attention, consciousness, and global cognition.

His conceptual framework continues to inform textbook definitions across psychiatry and neurology. Lipowski emphasized that delirium is not an independent disease in itself, but rather an acute cerebral reflection of a severe underlying physical or systemic disturbance.

Dr. E. Wesley Ely

Dr. E. Wesley Ely, an American critical care physician and researcher, has devoted decades to investigating delirium in intensive care unit (ICU) settings.

Dr. Ely asserts that dismissing delirium as minor confusion or simple sedation in critical care is a serious error, as it can lead to long-term cognitive impairment, persistent memory deficits, and a reduced quality of life. His co-authored work, Delirium in Critical Care, along with extensive clinical trials, has driven hospitals worldwide to implement routine delirium screening and preventative protocols in ICUs.

The collective consensus among these experts is unified: delirium should never be written off as "normal aging" or an untreatable psychiatric event. It represents an urgent physiological signal that something is malfunctioning within the body. With early detection, targeted diagnostic workups, and prompt intervention, most patients can regain their baseline cognitive state.

Causes and Risk Factors

Delirium occurs when the brain's baseline neural processing is suddenly disrupted. It is frequently multifactorial, arising from a combination of physiological stressors rather than a single isolated trigger.

                           +------------------------+

                           |  TRIGGERS OF DELIRIUM  |

                           +-----------+------------+

                                       |

     +-----------------+---------------+---------------+-----------------+

     |                 |                               |                 |

+----+----+     +------+-----+                   +-----+------+    +-----+-----+

| Severe  |     | Metabolic  |                   | Medications|    |  Surgical |

| Infection|    | Imbalance  |                   | & Toxins   |    |  Trauma   |

+---------+     +------------+                   +------------+    +-----------+

| • Fever |     | • Low O2   |                   | • Side-    |    | • Post-op |

| • Pneumonia   | • Dehydration                  |   effects  |      stress    |

| • UTI   |     | • Electrolyte                  | • Substance|    | • Severe  |

|         |     |   disruption                   |   withdrawal|     pain      |

+---------+     +------------+                   +------------+    +-----------+

Primary Causes

Infections: High fever, pneumonia, urinary tract infections (UTIs), or systemic sepsis.

Metabolic Disruptions: Hypoxia (lack of oxygen), severe dehydration, hepatic or renal dysfunction, or electrolyte imbalances (such as sudden shifts in sodium or potassium levels).

Medications & Substances: Adverse drug reactions, polypharmacy, toxicity, or sudden withdrawal from alcohol or sedatives.

Physical Trauma & Surgery: Brain injury, acute physiological stress following major surgery, or unmanaged post-operative pain.

High-Risk Populations

Individuals aged 65 and older.

People living with underlying neurodegenerative conditions, such as dementia.

Patients admitted to Intensive Care Units (ICUs).

Individuals recovering from major surgical procedures.

Patients taking multiple prescription medications (polypharmacy).

Individuals undergoing substance or alcohol withdrawal.

Patients experiencing severe, systemic bodily infections.

Clinical Symptoms and Presentation

Because delirium manifests differently across individuals, its early indicators can be subtle. Families sometimes misinterpret early signs as simple fatigue, normal aging, stress, or mild memory lapse. However, the defining characteristic of delirium remains its rapid onset and fluctuating intensity over hours or days.

Attentional Deficits: Difficulty sustaining attention during conversation, getting easily distracted, losing track of thought mid-sentence, or struggling to follow basic instructions.

Disorientation: Confusion regarding time, current physical location, or identity. A patient may believe an ICU room is their home or fail to recognize close family members.

Perceptual Distortions & Hallucinations: Seeing or hearing things that are not present, or holding paranoid beliefs (e.g., suspecting caregivers or family members of intending harm). These experiences feel completely real to the patient, driving real fear and distress.

Behavioral and Emotional Volatility: Rapid shifts from agitation, anger, or restless vocalization to extreme lethargy, drowsiness, or unresponsiveness.

Fluctuating Course: Symptoms typically wax and wane throughout the day—often worsening during late afternoon or night (sometimes referred to as "sundowning")—making continuous assessment necessary.

Dr. E. Wesley Ely describes delirium as "an emergency alarm sent by the brain warning that something severe is occurring in the body." Sudden confusion, failure to recognize familiar faces, unusual behavior, or rapid shifts in consciousness are not minor events. Treating them as purely psychiatric issues or expecting them to resolve without medical intervention carries significant clinical risk. Prompt evaluation by a physician or specialist is essential to address the root physical cause.

Understanding Delirium Subtypes

Delirium presents in distinct motor subtypes based on psychomotor activity levels:

Hyperactive Delirium: The most easily recognized form. The patient exhibits marked restlessness, agitation, hypervigilance, loud speech, hallucinations, or paranoia. Because the behavior is overt, families and medical staff usually identify it immediately.

Hypoactive Delirium: Often underdiagnosed and carrying a higher mortality risk due to delayed recognition. The patient appears unusually quiet, lethargic, slow to respond, or excessively sleepy. Families may mistake this for simple exhaustion, depression, or old age.

Mixed Delirium: The patient alternates between hyperactive and hypoactive states within the same day—displaying agitation at one hour and severe lethargy a few hours later. This variability makes clinical diagnosis challenging.

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|                              SUBTYPES OF DELIRIUM                               |

+-------------------+------------------------------------+------------------------+

| Subtype           | Key Behavioral Features            | Clinical Challenge     |

+-------------------+------------------------------------+------------------------+

| Hyperactive       | Agitation, restlessness, overt     | Readily identified;    |

|                   | hallucinations, paranoia           | high injury risk       |

+-------------------+------------------------------------+------------------------+

| Hypoactive        | Lethargy, excessive sleepiness,    | Easily overlooked;     |

|                   | withdrawal, reduced responsiveness | higher clinical risk   |

+-------------------+------------------------------------+------------------------+

| Mixed             | Rapid shifts between hyperactive   | Highly unpredictable;  |

|                   | and hypoactive symptoms            | fluctuating assessment |

+-------------------+------------------------------------+------------------------+

Delirium vs. Other Mental Health Conditions

Delirium is frequently confused with primary psychiatric illnesses or chronic neurodegenerative diseases, but key diagnostic distinctions separate them:

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|                              DIAGNOSTIC COMPARISON                               |

+---------------+------------------------+-------------------+---------------------+

| Feature       | Delirium               | Dementia          | Schizophrenia       |

+---------------+------------------------+-------------------+---------------------+

| Onset         | Acute (hours to days)  | Insidious (months | Gradual (weeks to   |

|               |                        | to years)         | months)             |

+---------------+------------------------+-------------------+---------------------+

| Course        | Fluctuating            | Progressive       | Chronic/Relapsing   |

+---------------+------------------------+-------------------+---------------------+

| Consciousness | Impaired/Fluctuating   | Clear until late  | Typically intact    |

|               |                        | stages            |                     |

+---------------+------------------------+-------------------+---------------------+

| Primary Cause | Underlying physiological| Neurodegenerative | Neurodevelopmental/ |

|               | illness                | pathology         | psychiatric         |

+---------------+------------------------+-------------------+---------------------+

Classification Terminology

Rather than labeling delirium simply as a general "mental illness," it is accurately categorized in medical classifications (such as DSM-5) as a Neurocognitive Disorder. Its management requires a collaborative approach involving primary care physicians, geriatricians, neurologists, and psychiatrists to address both the underlying physiological disturbance and behavioral symptoms.

Prevention, Management, and Caregiving Strategies

Reducing the risk of delirium—especially in hospitalized or elderly individuals—involves basic non-pharmacological preventative measures:

Hydration & Nutrition: Ensure adequate fluid intake to prevent dehydration and electrolyte imbalance.

Sleep Hygiene: Maintain regular sleep-wake cycles and minimize nighttime disruptions in care settings.

Early Infection Management: Promptly evaluate and treat fevers, respiratory symptoms, or urinary tract issues.

Medication Reviews: Avoid unnecessary medications or high-risk drugs (e.g., strong anticholinergics or sedatives) where possible.

Sensory Supports: Ensure patients have access to their eyeglasses and hearing aids to prevent sensory deprivation and confusion.

Familiar Presence: Keep familiar family members or reassuring objects nearby, particularly in hospital settings.

How Families Should Respond

When a relative develops delirium, panic is counterproductive; locating the underlying trigger is the primary objective. Clinicians will perform blood tests, check oxygenation, evaluate organ function, and review drug interactions to identify the physical cause. Treatment focuses on fixing the root physiological issue (e.g., administering antibiotics for an infection or correcting dehydration) rather than solely sedating the patient.

When communicating with a delirious patient:

Maintain a calm, gentle, and reassuring tone rather than arguing or forcefully correcting their hallucinations.

Frequently and gently remind them of where they are, what time it is, and who is present.

Keep the environment well-lit during daytime hours to reinforce night-and-day orientation.

Provide necessary sensory aids (glasses, hearing devices) immediately.

As Dr. Sharon K. Inouye emphasizes, delirium is a condition that can be recognized, largely prevented, and frequently reversed. It does not permanently alter an individual's core personality; rather, it represents a temporary disruption in brain function triggered by physical strain. Recognizing these signs early and seeking medical evaluation ensures that patients receive the care required for a full recovery.

It Could Be Hallucination !

Are you experiencing sensations where you seem to hear someone calling your name even when you are alone in a room? Do you see strange shapes or shadows that others cannot? Or do you feel unexplainable sensations like insects crawling on your body? If these experiences occur frequently, it may not be a simple trick of the mind but rather a state of Hallucination.

A hallucination is a perception created by the brain in the absence of any external physical stimulus or basis. Crucially, for the person experiencing it, the sensation feels 100 percent real. It is not limited merely to sight (seeing things that aren’t there); hallucinations can occur across all five of our senses: hearing (Auditory), smell (Olfactory), taste (Gustatory), and touch (Tactile).

The Unheard Voice in a Silent Room

Ram Bahadur, 45, worked the night shift at a newspaper in Kathmandu. Constant exertion of 50-60 hours a week, a heavy cigarette addiction, and chronic sleeplessness had become his close companions.

One night, around 2 AM, while editing news at his desk, he clearly heard his name being called -'Ram Bahadur... look here.'

He looked around, but the workstation was deserted. All his colleagues had gone home. He dismissed it as a trick of the mind. However, from the next day, that voice began to appear continuously. It would whisper right by his ear - 'Someone is following you, be alert.'

He started searching behind walls, doors, and windows in his room. He felt as though a person was standing just a few inches away from him, speaking. But no one was there. This was a severe example of Auditory Hallucination, created in his brain due to extreme mental stress and lack of sleep.

The Strange Midnight Visitor

Sixty-eight-year-old Sushila Devi was living life at her own pace. With age, she had begun showing early symptoms of Parkinson’s disease and had been taking regular medication for the past few months.

One evening, before turning on the lights, she saw an elderly man sitting on the sofa in her living room. He was in white clothes and was looking at Sushila Devi calmly. She asked, 'Who are you?' But the old man gave no answer, only continued smiling.

Terrified, she ran to the kitchen and called her son. But when her son looked, the sofa was empty. Sushila Devi, however, had clearly seen the color of the old man's clothes and even the wrinkles on his face. This was Visual Hallucination, arising due to age-related neurological illness and the side effects of its medication.

Mental Illness or Just a Symptom?

In simple terms, hallucination itself is not a distinct mental illness; it is a complex symptom. Just as a fever is a symptom when a virus enters the body, hallucinations appear when there is a disruption in the brain's information processing system. It can manifest in various mental and physical conditions.

• Severe Mental Illness: Conditions like Schizophrenia, Bipolar Disorder, or Severe Depression. In these serious disorders, an imbalance of neurotransmitters like dopamine and serotonin causes a break between a person's thinking and reality. In Schizophrenia, auditory hallucinations and delusions are primary, while in Bipolar and Psychotic Depression, visual or auditory sensations outside of reality accompany extreme despair or mania. Proper medicinal treatment and psychosocial counseling can keep these conditions under control.

• Neurological Issues: Dementia, Parkinson’s, Alzheimer’s, or Brain Tumors. When brain tissues or nerves are damaged in neurological problems, the communication system is disrupted. In Dementia and Alzheimer’s, the brain creates confused messages as memory and thinking ability decline. Parkinson’s medication or a brain tumor pressuring the brain's visual and auditory centers leads to the patient experiencing hallucinations like seeing non-existent figures or hearing voices.

• Physical and Environmental Factors: High fever (Delirium), Epilepsy, extreme sleeplessness, severe drug or alcohol addiction, or withdrawal effects. Physical and environmental adversities temporarily disorganize the brain's chemical environment and electrical waves. High fever or infection causes brain swelling leading to delirium, while quitting drugs or alcohol over-excites the brain, causing terrifying visual or tactile hallucinations. Similarly, sleep deprivation and epileptic seizures disrupt neurological balance, causing the brain to perceive things that aren't there.

Psychological Explanations and Historical Context

It is fascinating to know how hallucinations were viewed and explained throughout scientific history.

Emil Kraepelin, a German psychiatrist, classified hallucination as a primary and core symptom of serious mental illness (specifically Schizophrenia, known then as Dementia Praecox). He clarified the difference between hallucination and illusion. This explanation is found in his famous book Psychiatrie: Ein Lehrbuch für Studirende und Aerzte (6th Edition), published in 1896. His work is a cornerstone of modern Psychiatry. It can still be studied in classic texts on Mental Health Literacy and Psychiatry, such as research papers on the Kraepelinian Dichotomy or Dementia Praecox and Paraphrenia (Transl. 1919). According to Kraepelin, a hallucination is not a misunderstanding of an external object (Illusion) but the result of an entirely internal mental process. He stated that the inhuman or threatening voices patients hear are signs that their internal thought system is broken. According to him, such hallucinations play a decisive role in rapidly deteriorating the mental state by pulling the patient’s consciousness away from reality.

Karl Jaspers, a German existentialist philosopher and psychiatrist, explained the 'perceptual validity' of hallucinations. According to him, a hallucination is not imagination or a daydream; it feels as clear and objective to the individual as real objects in the external world. His explanations are in General Psychopathology (Allgemeine Psychopathologie), published in 1913. This theory can still be read in detail in the book General Psychopathology (translated and reprinted by John Wiley & Sons). According to Jaspers, the voices or scenes experienced in a hallucination are beyond the individual’s control and possess direct physical presence (Leibhaftigkeit) just like real objects. Since patients believe it as surely as if they had seen or heard it with their own eyes or ears, they cannot be convinced that it is merely imagination. Consequently, hallucination completely changes an individual’s entire subjective experience and perspective toward reality.

Oliver Sacks, a famous neurologist and author, explained that hallucination is not solely a product of "madness" or mental illness. It is also a neurological reaction that a normal brain shows in specific circumstances (e.g., Charles Bonnet Syndrome when vision is lost, or during severe migraines). He discussed this in his various research articles and his globally famous 2012 book Hallucinations. All these events and psychological/neurological explanations can be read in his book Hallucinations (Knopf Publishing Group). According to Sacks, hallucination is also part of the brain's creative capacity and adaptation effort. When vision or hearing is lost, the corresponding part of the brain (Visual/Auditory Cortex) does not become inactive; instead, it increases its own sensitivity and begins to create internal images or sounds. Therefore, not every hallucination is a sign of mental illness; it is merely a natural neurological mechanism for the brain to keep itself active in the absence of external stimuli.

The Major Stages of Hallucination

Hallucination does not reach its peak suddenly. Psychologically, it is generally viewed as developing through four main stages: 

• Comforting Stage (Non-psychotic)
• Condemning or Frightening Stage
• Uncontrolling Stage (Loss of Control)
• Conquering Stage (Complete Dominance)

Stage 1: Initial or Comforting Stage In this stage, the individual experiences some mild voices or shapes when under stress or in loneliness. The person has a slight inkling that this might be a product of their own brain. The voices may be positive or comforting. In this initial stage, hallucinations are often vague and fleeting, which the individual might ignore, thinking it's the result of their imagination or fatigue. In some cases, these voices or figures seem to provide companionship or encouragement during difficult situations, causing the individual not to express immediate fear or concern, and the issue gradually gets forgotten in their daily life.

Stage 2: Condemning or Frightening Stage By the time it reaches this stage, the hallucination begins to become unpleasant. The voices heard criticize, mock, or say bad things about the individual. The person tries to stop it but is unable to. This leads to increased Anxiety and fear. In this stage, the intensity and frequency of the hallucination increase, disrupting the individual's mental balance. The voices heard hurt the individual’s self-esteem, making them feel like a failure and worthless. Even when the person tries to stop or control it, they fail, causing feelings of frustration and hopelessness. In some cases, these voices may incite the individual to harm themselves or others, making this stage extremely dangerous.

Stage 3: Uncontrolling Stage (Loss of Control) After reaching here, the individual begins to fully believe the commands or scenes appearing in the hallucination. The external voice or scene becomes so strong that the person loses contact with their actual environment. They engage in arguments or counter-arguments with those voices. In this stage, the hallucination completely overshadows the individual's logic and reasoning. The things they see or hear are so realistic that they trust the command of the hallucination more than the words of their family or physician. Consequently, their behavior can become abnormal and sometimes dangerous, as they have come completely under the control of the hallucination.

Stage 4: Conquering Stage (Complete Dominance) This is the most severe condition. Here, the hallucination completely controls the individual's thoughts, feelings, and behavior. The voices heard may order them to harm others or themselves (Command Hallucinations). The individual becomes a complete victim of Psychosis and requires immediate medical intervention. In this stage, the connection between the individual and the real world is completely severed. They get lost in their own internal and imaginary world, where hallucination becomes the only truth. The commands coming from the hallucination are so powerful that the individual is compelled to follow them even against their will, leading to serious incidents of violence or self-harm. In this state, since the patient is unable to go to the hospital or seek help themselves, it is crucial for family and society to intervene immediately and arrange for mandatory treatment.

Is This Limited to a Specific Age Group?

Hallucination is not limited to any specific age group. It can happen to individuals of any age. However, its cause and nature differ according to age.

• Children and Adolescents: During high fever (Febrile seizures/delirium), deep mental trauma from childhood, or neurodevelopmental disorders. Since physical and mental development is ongoing in children, these factors directly affect their nervous system. At such times, there is a high possibility of them seeing frightening figures or hearing imaginary voices.
• Youth and Adults (18-35 years): Due to Schizophrenia, Bipolar Disorder, extreme mental stress, drug or alcohol use, and sleeplessness. In this age group, there is a higher risk of mental health being affected due to intense social and professional stress and chemical changes occurring in the brain. Drugs or sleeplessness disrupt the brain’s neurotransmitter balance, further increasing the possibility of auditory or visual hallucinations.
• Old Age (Above 60 years): Dementia, Alzheimer’s, Parkinson’s, Charles Bonnet Syndrome (a condition where the brain creates images on its own when visual capacity reduces), or reaction to many types of medication (Polypharmacy). As age advances, brain nerves weaken, and visual or auditory capacity declines. In such a condition, the brain begins to create imaginary scenes or sounds on its own to compensate for external information it cannot receive. Also, the neurochemical interaction resulting from taking many types of medicine at once for various diseases (Polypharmacy) in old age makes the risk of visual and auditory hallucinations high in the elderly.
• 
  

What Does the Latest Research Say?

Scientists are continuously making new discoveries regarding hallucinations. A landmark study conducted by researchers from Stanford University and Cambridge University, published in Nature Neuroscience (2023-2024), has brought new facts about hallucinations to light. According to the study, having hallucinations does not just mean the brain is 'broken' or 'mad'; it is an imbalance in the brain's Predictive Processing ability. Our brain always tries to understand the world based on information coming from the senses and prior experience (Prior Beliefs). The study has shown that in individuals with hallucinations, the brain gives excessive importance (Over-weight) to its own internal expectations and prior beliefs rather than actual data (Sensory Input) coming from the senses. That is, when the brain cannot balance external reality and internal imagination, it sends its own internal imagination as "real scenes or voices" to consciousness, even when there is nothing outside. This study, with the help of neuroimaging (fMRI), has clarified communication disturbances between the brain's Striatum and Auditory/Visual Cortex. This study has brought a revolutionary change in the treatment of hallucinations and the perspective toward it. Traditionally, hallucination was viewed solely as a chemical disturbance of neurotransmitters or 'madness', but the Predictive Processing model has clarified that this is a disruption of a specific information-processing capability of the brain. Research conducted through fMRI technology has shown that excessive flow of dopamine in the Striatum suppresses actual sensations transmitted to the visual and auditory cortex. Consequently, the individual gives higher priority to expectations or messages generated within their own brain rather than the reality of the external world. This conclusion opens an important pathway to developing targeted cognitive therapy and new-generation medicines to re-adjust this 'predictive balance' of the brain for patients with Schizophrenia or other mental illnesses in the coming days.

How to Recognize It in the Beginning?

Early Warning Signs

• Sensations of hearing or seeing things that others do not, but holding a slight doubt in the mind. This is a sign of the initial or comforting stage of hallucination, where the individual experiences something strange but has not yet lost reasoning. Awareness and seeking expert advice in time prevents the problem from escalating.
• Staring blankly, constantly covering ears, or acting as if talking alone while looking at the air. Such behavior indicates that the individual is responding to imaginary voices or scenes in their internal world. This is a stage where the hallucination is getting harsher and immediate medical help is needed.
• Complete disruption of the sleep cycle. Continuous sleeplessness prevents the brain from resting, disorganizing the information processing system. This increases fatigue and stress in the brain, intensifying the risk of hallucinations where non-existent voices or scenes are felt.
• Distancing from people (Social Withdrawal) and having an excessively suspicious nature. This state is a sign toward the serious stage of hallucination. When an individual begins to accept non-existent voices or scenes as truth, they feel that others do not understand their situation or are conspiring against them. Due to this fear and mistrust, the individual completely distances themselves from family and society and becomes confined within their own imaginary world.

Measures to Protect and Manage

• Adequate Sleep and Routine : 7-8 hours of quality sleep daily helps 'reset' the brain. A regular schedule of sleeping and waking maintains the brain's 'predictive balance'. This prevents neurochemical disturbances and makes the information processing system healthy, minimizing the risk of hallucinations.
• Away from Stress and Substance Use : Marijuana, alcohol, or other Psychoactive substances multiply the risk of hallucinations. These substances directly affect the balance of brain neurotransmitters like dopamine and serotonin. This hinders the brain's information processing capacity and can turn normal stress into severe hallucination and psychosis.
• Taking Care of Physical Health : Treating high fever, dehydration, and severe infections in time. Serious physical problems or infections increase toxins in the body and hinder the supply of oxygen and nutrients to the brain. Especially in the elderly and children, this affects the nervous system, quickly creating a state of confusion or Delirium, which can cause visual or auditory hallucinations. Therefore, treating physical health in time is equally necessary for mental balance.
• Social Connection : Loneliness makes hallucinatory voices even more pronounced. Positive social interaction keeps the brain connected to external reality. Continuous conversation with family and friends causes the brain to shift attention from internal delusions and focus on the external environment. When an individual remains socially active, they receive real sensations (Sensory Inputs), which dim internal imaginary voices or scenes. Strong social support plays a major role in making the patient feel mentally secure and safe by reducing loneliness and fear.
• Professional Help : If this symptom begins to recur, do not delay in showing a psychiatrist or neurologist. Antipsychotic medication and therapy (CBT) can bring it under complete control. Identifying mental or neurological problems in time and seeking expert consultation is the most effective step in treatment. Antipsychotic medication helps balance brain neurotransmitters, while cognitive therapy (CBT) enables patients to recognize and manage their negative thoughts and hallucinatory symptoms. The correct combination of both completely helps the patient return to a normal and active life.

Should One Be Afraid of This?

Do not be afraid, but do be alert and serious.

In our society, various superstitions and fears are still prevalent regarding hallucination. Some consider it a divine wrath, the effect of ghosts, spirits, or witchcraft, while others look at it as an individual's mental weakness or 'madness'. But modern neuroscience has already proved this thinking completely wrong.

Experiencing hallucination is not something mysterious or terrifying. It is merely a clear Biological Signal that the neurochemical, physical, or psychological balance in the body or brain is disturbed. Just as when our vision blurs or becomes weak, we go to a physician for testing without any hesitation, similarly, when the brain cannot balance external reality and internal imagination, seeking expert help is a very normal and necessary process.

Key Points to Understand:

• It is a Symptom, Not a Permanent State: Hallucination itself is only a symptom. Extreme mental stress, continuous sleeplessness, drug or alcohol use, severe infection in the body, or neurological conditions (e.g., Schizophrenia, Dementia) can be its causal factors. Identifying and treating the correct cause brings this problem under complete control.
• Treatment and Prevention in Time: Hiding symptoms due to fear of society makes the problem even more complex. If attention can be given in the early stages, Cognitive Behavioral Therapy (CBT), lifestyle improvements, and the use of necessary medication can bring the brain's 'predictive balance' back to its original state.
• Familial and Social Support: Never criticize or mock the person experiencing hallucination. For them, this experience is 100 percent real. Therefore, the main responsibility of family and society is to guide them to an expert while giving them love, empathy, and a safe environment.

Finally, hallucination is a signal from the brain asking for rest and treatment. Rather than binding it within the confines of superstition, it is wise to accept it as a health problem and seek correct medical and psychological consultation.

If given timely treatment, medication, and positive support from the family, an individual affected by hallucinations can fully recover and return to their normal, active, and happy life. Therefore, let's not hide in fear, let's become alert and take the right steps.