Hallucinations and Delusions – Becoming A Family Caregiver

Hallucinations and Delusions Seem Real

Hallucinations and delusions can both occur with mental illness, including dementia (Alzheimer’s.) In fact, some people even hallucinations or delusions with infections, after anesthesia, with serious illnesses, or as a side effect of medications. Therefore, you can’t assume that if your family member doesn’t have a mental illness, you won’t face one of these strange situations. My husband has them whenever he has an infection. It’s one way I know he’s developing pneumonia, and his oxygen saturation is getting compromised.

Tricks of the Brain

So, what are they? Both hallucinations and delusions are tricks of the brain. The brain tells the person something is real that isn’t, and the person honestly believes it is real. To the person experiencing the hallucination, they smell, hear, see, taste, and feel what is before them. It is real to them. As real to them, as any other object is to you. Therefore, you cannot easily persuade them that it is not.

The same is true for a delusion. In the brain of the person having the hallucination, they believe it’s true. If their brain warns them that you are out to harm them, they will not trust you. The sweet and loving history that pre-exists with that person no longer exists in their mind. For them, the current truth told to them by their brain is their only truth.

Creates Difficult Care Situation for Caregivers

Unfortunately, these delusions and hallucinations (i.e., sensory perceptions) falsely by the brain can become dangerous and terrifying to the person experiencing them. For the caregiver, it creates an exceedingly difficult situation for you to handle.

Reference:

What’s the Difference Between Delusions and Hallucinations? U.S. News & World Report

UCLA Health Caregiver Training Video

Tips on Handling Hallucinations or Delusions

Fear of the Hallucinations

Keep in mind that the hallucination is not real. Since it’s not real, it has no power to hurt you because your mind controls it. Therefore, you have total power over it. When you feel like it’s trying to harm you, that’s your mind playing tricks on you.

Increased stress may bring on hallucinations. Stress seems to be a trigger for hallucinations, and it can be good stress or bad stress.

Therefore, if you are hallucinating, check your stress level.

Are you getting enough sleep?
Are you drinking enough water and eating enough food?
Have you been ill or ran a fever?
Have you taken any medicine or used any drugs that could cause hallucinations?
Has there been any emotional family event?

Check to See If its Real

What better way to dispel fear than to face it head-on? Check the hallucination to see if it’s real. Here’s how you can do that.

Visual (sight, vision):

Test (1) Take a few pictures of what you see. If it’s not in the picture, it never was there.

Test (2) If you wear glasses or contacts, look at the image, then remove them. If the image doesn’t blur as everything else does, then it’s not real. All the real things should blur the same amount without your glasses or contacts.

Auditory (Sound, hearing):

Test (1) If you hear the sound while you are on the phone, hit the record button to capture the sound. Then ask someone else to listen to the recording to find out if they hear the sound also.

Test (2) If you hear voices, you can turn the music volume up very loud. If you can still hear the voices clearly through the music as if the music were not there, it’s not a real voice.

Olfactory (Smell):

Test (1) Ask another person if they smell what you smell. If they don’t, it may be a hallucination. However, you may need to ask a couple of people if the smell is subtle.

Taste:

Test (1) Ask someone to take a bite of what you are eating and ask them how it tastes to them. You can use this method to confirm that the food is okay to eat; however, recognize that the “taste” is still present. Therefore, it may still be difficult to force yourself to eat something that may taste nasty to you, even knowing that it’s okay in the real world.

General Rule Test:

Notice how others react to what you think you see, hear, feel, smell, or taste. If others are not having the same reaction as you, the chances are that you may be having a hallucination, especially if most people are behaving the same way. Learning to read other people’s cues and body language can help these situations provided you validate the read by comparing results on several individuals.

Participate in an Activity You Know is Real

Focusing on activities that you know are real will help keep you grounded and connected to reality.
If you have a hobby, enjoy playing with a pet, or play a favorite game, use them as your “go-to” activities when you are uncertain about what your senses are telling you. Items and activities that are familiar establish a long-term memory image in your brain that will give you a sense of comfort and help you figure out what is normal for your world and what is not.
If one of your senses participates in a hallucination, use another to engage in an activity that takes concentration. If you see something you know is not real, sing a song using sound to divert your sensory stimulation.
On the other hand, sometimes, you can block out the hallucination using the same sense. For example, if you feel like you have ants crawling on your skin, a hot shower or cold compress might soothe the hypersensitive area and stop the sensation.

Treat your hallucinations as fictional characters or friends.

If the voices in your head are scaring you, give them a name. Talk to them as if they are friends when you’re alone, and they may seem less scary. If you give them a silly name or character that sounds non-threatening, the voice may take on some of those characteristics too.

Pretend They Are Rude Bullies

If the voices sound like a bully or tell you to do bad things, think of them as pathetic teenagers who are being rude and want attention. Just ignore them to keep them from getting their way.

Talk To the Voices Out Loud

If you’re in a private area, you can talk out loud to the voices. If they insult you, insult them right back. Mock them or be sarcastic. However, if you’re in public, you might want to talk into a phone to do this, so people don’t look at you oddly.

Do what helps you to feel safe.

Dealing with hallucinations is a scary business. Most people feel very insecure during the episodes since it’s difficult to know what is real and reliable. Therefore, whatever you use to give you a sense of security should be available to you during this time as well, even if it might seem “silly” to someone else. If it calms you and makes you feel better, then use it.

If you have a special comfortable place where you feel safe, consider visiting it, or a special chair, you find helps you to feel safe.
Use any comfort objects, like a favorite blanket or a book that you like to re-read.
Turn on the lights, and open or close curtains (whichever you prefer).
Play your favorite, most relaxing music.
Spend time with people who help you feel safe.

Take your medication, as directed, every day.

Don’t forget to take your medicine every day. If you need to set the alarm on your phone, or write a reminder, do it. Also, ask your doctor or pharmacist what you should do if you forget to take a dose. Should you skip it, take it when you remember, or double it the next time.

Let Your Pet Help

Get your pet in on helping you remember to take your medication. If you have a pet, give your pet a treat every time you take your meds. You may forget when it’s time to take your meds, but your pet won’t.

Use a Pill Organizer Tray

If you forget if you have taken your medication, keep your medicine in a scheduled tray. I’m referring to one of those trays marked with the days of the week and four boxes at least under each day. At the beginning of the week, organize your medication for the week. As you take medicine, the slot for that dose empties, which serves as a reminder that you took it. It’s a good way to help prevent taking the medication twice.

Know your warning signs.

After you have a few episodes, you may notice a pattern of events leading to hallucinations. The pattern can serve as your warning sign that hallucinations may becoming. If you can recognize what causes them, sometimes you can prevent them from occurring. Other times, you can just be prepared for them when they happen. Some common warning signs include, but are not limited to, the following:

Changes in sleep routines
Wanting to be alone, isolating yourself away from others
Feeling annoyed more easily.
Wondering if it’s time to stop taking your meds

If you keep a diary of your hallucinations, it can help you notice the patterns as they develop and make it easier for you to determine what might be a trigger for hallucinations. A diary is also a helpful tool to show to your doctor or therapist when discussing your hallucinations’ impact on your life.

Find ways to reduce stress in your daily life.

A lower-stress lifestyle can help reduce hallucinations. Doing something relaxing or enjoyable helps to reduce your exposure to stress.

Below are some stress-reduction strategies you can try if you need some ideas.

Spend time with people you enjoy.
Participate in sports or exercises you enjoy.
Spend time with hobbies you find relaxing.
Give your pets a little extra love and attention.
Get advice on how to tackle the most stressful areas of your life.
Turn off all news, talk shows, commentaries, and social media—anything with controversy.
Cut out (or at least reduce exposure to) toxic people, places, and habits.
Use caller ID to avoid talking to persons who will share negative viewpoints only.

Try Focusing on Your Breathing.

Some people find it helpful to focus on their breathing when trying to manage a hallucination. It’s like meditation in that you concentrate on thinking about how you breathe as you’re doing it. You focus all your attention on your lungs and chest wall as you breathe in and hold your breath for four seconds. Then you concentrate on a slow controlled exhale through your lips. You repeat this over and over so that you focus only on breathing in and out. The purpose is to take your mind away from the hallucination until it’s gone.

Talk to your loved ones about how they can help you when you’re hallucinating.

Your family wants to help you when you are distressed, but they don’t always know what to do. You know best what you need. Tell them. They want to understand and help. If they say the wrong thing now, it’s just because they don’t understand, and they’re worried. By telling them what you want and how you want it, you can make life better for yourself and them.

Here are some examples of things you can say:

“Sometimes I forget what to do when I hallucinate because I’m so scared that I forget how to help myself. It would be helpful for you to gently remind me of the strategies I can use.”
“There’s not much you can do when I hallucinate. But if you stay with me and listen and validate my feelings, it helps me feel better.”
“Please don’t argue with my hallucinations. It doesn’t help me. What I need is someone to listen to me and acknowledge my feelings, even if the hallucinations aren’t real.”

Take Care of Yourself

Avoid self-isolation.

Being alone with your hallucinations can make them worse.Try to spend time seeing friends or family.

Avoid drugs and alcohol.

You may be on prescription medication for hallucinations or your medical condition. If so, prescription medicines and non-prescription medication may clash and make you sick if they are not compatible with one another. Do not mix alcohol and drugs without consulting a doctor. Marijuana might calm you down at the moment, but it makes symptoms worse and increases the risk of a relapse.

Stick with your self-care habits.

Sleep well, get outdoors to exercise, and eat healthy food. Good self-care habits can help you feel healthier and stronger, so you’re better able to cope with difficult situations.

Don’t punish yourself

If you have a bad day and cannot take good care of yourself. Tomorrow is a new day. Just keep doing your best.

Offer Reassurance

Speak calmly and with a caring voice. Show support with your words first before you attempt to touch your family member (remember you may be a stranger to her).
Tell her who you are-“Hi, Mom, it’s Donna.”
Let her know you are there to help her—”Are you okay? I heard you call out, and I came to see if I could help.”
If she recognizes you or seems to welcome your presence, you can pat her shoulder or touch her hand reassuringly to provide comfort.
Acknowledge that she seems upset and try to describe how you think she feels. Ask her to validate that you are correct in your interpretation of her feelings. “It sounds like you are afraid. Did something scare you?”

Use Distractions

Suggest a walk somewhere.
Play a game.
Increase the lighting in the room.
Turn on music or encourage them to play an instrument if they know how to play one.
Look through old photo albums.

Respond Honestly

If your family member asks you if what they are seeing is real, be honest but sensitive to the fact that they believe it’s real. For example. If they ask you if you see the man sitting on the sofa and no one is there, say, “Do you mean the green sofa? I’m sorry, but I don’t see anyone there, although I believe you see something when you look over there.”

Make Changes in the Environment

Sometimes the trigger for the hallucination is something in the environment that can be corrected, such as noise or flashing light. Ask your family member to tell you about what they are experiencing. Based on the details they provide, look for anything that might mimic that description in the environment. If you find it, try to remove or alter it somehow and see if it makes a difference. You might find that you can “cure” the hallucination yourself.

Check for (1) sounds from radios left on stations that are not coming in clearly or that someone forgot to turn off, (2) equipment hums or noises that are confusing, (3) building or street noises that regularly occur that might also come across as a whisper or voice.
Change burned-out light bulbs to remove shadows and brighten up the room. Check the light fixtures’ position related to mirrors or windows to determine if reflections or distortions occur at certain times from the sun or moon bouncing off their surface.
Remove clutter from rooms that could appear as shapes representing scary forms such as intruders.
Cover or remove mirrors that may appear to be someone watching when the person passes by them.
If using agency attendants, ask if the same individuals can be assigned to provide consistency and familiarity.
Place familiar personal belongings around the room from several years ago. Long-term memory is stronger than short-term memory, and they may be able to recall memories better.

Resources

https://www.wikihow.com/Handle-Hallucinations.

https://alz.org/help-support/caregiving/stages-behaviors/hallucinations

Hallucinations Caregiver Training Video

Caregiver Training: Hallucinations

The above video link connects to the UCLA Alzheimer’s and Dementia Care Video series which provides practical tools in a variety of settings to create a safe, comfortable environment both for the person with dementia and the caregiver. They have several other videos you might find useful on that site in addition to this one.

Wife is having hallucinations hearing children playing in the backyard. She wants to see them. Husband tries to explain no one is there but she gets angry and tries to see for herself.

Looking in the mirror only to find someone else there who is telling you what to do because they have been sent by witch to cast a spell on you incorporates both hallucinations and delusions concerns. — Looking in the mirror only to find someone else there who is telling you what to do because they have been sent by witch to cast a spell on you incorporates both hallucinations and delusions.

Hallucinations and delusions are seen in Mental Illness and with Chronic Health conditions

Hallucinations

As a caregiver, you may need to deal with hallucinations from two different perspectives. How you approach your family member depends on why the hallucination is occurring. Is it the result of a chronic mental illness under treatment that requires management with honesty or an intervention? Is this hallucination related to Alzheimer’s and causing no harm to anyone?

Mental Health Hallucinations

With mental health conditions, the individual often has a chronic health condition requiring counseling and treatment protocols. Chances are a healthcare provider has previously shared with them ways to approach dealing with hallucinations and delusions they also experience them. As their caregiver, they should share that process with you. With therapy, people who have hallucinations often can learn to recognize if what they see is real or fake.

Am I Having a Hallucination?

Hallucinations Seem Real

Hallucinations are a common symptom of many mental health conditions. They emerge using the senses – sight, hearing, smell, or touch – seemingly real though they are not. It’s difficult for anyone who has not experienced hallucinations to understand how real the encounter feels. There is no difference between the real tree and the hallucination tree; both are the same. They look, smell, sound, and feel the same. The hallucination tree is real to them, and if it’s about to fall on them, they feel the terror they would feel if a real tree is about to fall. Therefore, it is important not to dismiss their hallucination as a dream. Dreams are not real to them, but hallucinations are.

Can’t Tell the Difference

If they experience hallucinations but can’t always tell when they are having one, they must get very frustrated. Furthermore, they may be afraid to move with not knowing if they can trust what they see.

Hallucinations Seem Real No Matter What Their Cause

Whether hallucinations stem from a mental health condition, result as a side effect of a medication, or show up as a warning of a urinary tract infection, the impact is the same for the person having them. They seem real. The individual sees, hears, feels, smells something that is not there, but it’s as real as the earth beneath their feet. To tell them it’s not going to cause conflict because either you’re lying to them, you’re trying to play a trick on them, or you’re going to hurt them. Any way you look at it, you become someone they can’t trust. Unless the person with the hallucination is aware that they are hallucinating and that you are trying to help them, they will not believe what you say. Why? Because the hallucination is so real.

What May Be the Cause?

When individuals with memory disorders hallucinate, the cause is often something other than the underlying medical condition. Therefore, it is important to attempt to determine why they have hallucinations. (Refer to the section under mental health hallucination about possible causes.) Elderly patients often have dementia hallucinations when they have an infection or become dehydrated. Caregivers consider hallucinations a warning sign that a more serious problem may be developing, and they should contact the doctor just in case.

How to Help Family Members Cope with Memory Loss, Hallucinations, and Delusions

Your Approach

Between the forgetfulness, confusion, and hallucinations, your family member may be living in a terrifying world at times. Keep in mind as you approach that she may not recognize you. Depending on the nature of the hallucination, you may even pose a threat to her. If you become argumentative, condescending, or dismissive, she might become defensive, argumentative, and possibly combative. To avoid those situations from developing, keep in mind that the hallucination or delusion she is experiencing is real to her.

Hallucinations and Delusions both seem real

Delusions Seem Real

Like hallucinations, delusions are difficult for both the caregiver and the family member to handle because they seem real. The person experiencing the delusion believes the story they tell about a situation. If your family member tells you she had dinner last night in Paris with your dead Aunt who works for the CIA, understand that in her mind, it happened. If you ask her questions about how she got there and returned home before morning, she will have an answer that makes sense to her.

Believe Without Proof

That’s the nature of a delusion. The person with the delusion exists in a different reality from everyone around them. They strongly believe in what they know to be true even though no evidence or facts supports their belief. When confronted with something they cannot prove, they create a reasonable explanation based on facts they create or divert attention to another subject. Unless a person knows they have a medical condition that is causing them to have a delusion, they usually refuse to believe that what they think is happening is not real.

Person Seems Absolutely Normal

Although some delusions are bizarre (i.e., based on events that could never happen or are unrealistic, like an alien abduction into a wristwatch), most themes could happen and be real; however, no evidence supports that it’s true. Individuals with delusions disorders often maintain the delusion for a month or longer and carry-on their daily activities without difficulty. Apart from the delusion, nothing about the individual seems unusual.

Types of Delusions

Some of the types of delusional disorders include the following:

Erotomanic: The person thinks someone higher in social standing than they are is in love with them. Usually, that person does not know them.
Grandiose: The individual believes he has some greater but unappreciated or unrecognized talent, power, insight, knowledge, self-worth, or relationship with someone famous or with God.
Jealous: The person thinks his partner has been unfaithful.
Persecutory: He believes that he is the victim of cheating, spying; was drugged, followed, slandered, or somehow mistreated.
Somatic: The individual believes he is experiencing physical sensations or bodily dysfunctions, such as foul odors or crawling insects under his skin, or is suffering from a disease.
Mixed: The person has delusions characterized by more than one of the above delusional types with one theme dominating.
Unspecified: An individual’s delusions do not fall into the described categories or cannot be clearly determined.

delusions alter how a person thinks of themselves — Delusions can blind our views and limit perspective – pictured as word Delusions on eyes to symbolize that Delusions can distort perception of the world, 3d illustration

Ideas on How to Handle Delusions – It’s similar to Hallucinations, Isn’t it?

Try not to Argue.

Dealing with someone trying to convince you to believe something that you know is not true without losing your patience is difficult. As they attempt to persuade you that what they believe is true, you naturally want to correct their way of thinking. However, to do so will only lead to an argument or a breakdown in communication. Unless the person is at risk of danger, it’s best to go along with them. If they are potentially at risk and need to move them in another direction, try the following techniques.

Do not try to talk them out of what they believe. If you do, your family member will stop trusting you, and it will only start an argument.
Reassure them that they are safe and not in danger. Do not leave the person experiencing the delusion alone if they are afraid. Try to maintain an open and honest behavior with them during all your interactions.
Try to get them to talk about how they are feeling or whatever is bothering them at that time; offer to help keep them safe and explain what you can do to protect or help them.
Accept that they feel the need to believe what they believe, for example. If the person with the delusion believes someone is out to harm them, they probably feel the need to find safety. Therefore, they have a sincere need to find a safe haven.
Focus on building a trusting relationship rather than correcting their false belief.

Attempt to calm them, listen to understand their concern, and determine why the delusion is occurring.

Many times, fear is the cause of the delusion. Your family member may have overheard a conversation, misinterpreted a sound as a threat, or seen a shadow figure believing it to be an intruder. When you actively listen, not just to the words but to the emotion associated with the words, you can often get to the root of their distress and help eliminate the need for the delusion. By listening and supporting them, you build trust.

To show you understand and to help resolve the problem, consider saying something like, “I can see that hat rack is throwing a shadow. It certainly could appear to be a man in your room. It’s no wonder you were frightened. What if we move it away from the light so that the shadow is no longer there?”

Show empathy and try to understand the purpose behind the delusion.
Paraphrase what they said, try to clarify any confusion about what they describe.
Without agreeing or arguing with them, question the logic or reason behind the delusion. Keep the tone of your voice calm and your inflections non-condescending. For example, I checked the locks on the doors, and the house is locked uptight. No one can get in the doors, and all the windows are locked as well. So if you see something that you think looks like someone, let’s check it out together because it’s likely to be a shadow.
Avoid, however, arguing your point or arguing over the reality of a situation. Rather, focus on the emotions of the person rather than the “facts” they present. If you argue facts with them, they will shut down. For example: “It’s very scary to think that someone has entered your home without permission and that your life might be in danger. You must have been very frightened. Tell me about it.”
Identify the theme of the delusion, the main feeling behind it, and its tone.

Look around the immediate environment for the possible cause.

Between changes in eyesight, poor lighting, impaired hearing, and altered mental status, it’s no wonder normal sounds and sights get misinterpreted when they occur unexpectedly around someone with dementia or facing mental health challenges. If you consider statements made within the delusion context, you may identify the trigger behind the event within the environment. If you can, you may remove the trigger for future events or reduce the number of occurrences by removing or altering the trigger. The solution may be as simple as adding light, changing a diet, or encouraging a nap.

Use distraction.

Since objects, sounds, and other activities in the environment can cause delusions, diverting your family member’s attention away from the trigger precipitating the event may help put a stop to the delusion. For example: If your father says that he’s Major Smith and Gomer Pyle reports to him at a Marine Corp base, check to see if he was watching that show recently. If he has developed a pattern of watching the program regularly, maybe changing the channel to the Cooking Channel instead might stop the delusions. Other activities such as exercise, playing cards, doing puzzles, looking at pictures, talking to friends, etc., can also be helpful.

If the person talks to you about the delusional theme, redirect them back to what is going on around them. Ask them if they recall what activity everyone is performing and suggest both of you return to that. If they continue to talk, sit, and listen quietly but not engage in discussion.

Consider whether there could be an underlying medical problem.

A change in how someone behaves, loss of memory, confusion, hallucinations, and delusions can all be signs of declining health.

Many medical conditions affect the brain by accumulating toxins in the blood that enter the brain and affect mental status.
Other conditions affect oxygen intake. As the body’s ability to take in oxygen decreases, mental clarity decreases as well.
Infections, especially urinary tract infections, trigger changes in mental status in many individuals.
High fevers, pain medications, and dehydration also add to the confusion and sometimes cause delusions.

Investigate how the delusion is affecting a person’s life.

Determine if and how the delusion affects a person’s life. For example, are they able to function the same as before, or have changes occurred?
What about relationships? Have any changes occurred in how they relate to family members or close friends as a whole or related to a specific individual?
Determine if your family member has made any specific change based on the delusion.
Identify how often the delusions are occurring, how long they last, and how intense the episode becomes. Regarding intensity – Do they always live their life within the delusion, making it a part of how they react to everything that occurs?
Do the delusions have a pattern? Do they occur on a particular day, at a certain time of day, after a particular activity? How many times per day, per week? What triggers them?
Are the delusions always the same, or do they change?

Express concern and the need for possible assistance.

The time may come that you need to persuade them to see a therapist. Since they believe their delusion is true, suggesting they need help may lead to conflict unless the conversation is nonconfrontational. Usually, it’s best not to focus on the delusion but instead to address their emotions or another physical/mental status. Express that you have observed that they appear to be more anxious, or exhausted, or “fill in the blank with the emotion you see,” and you’re concerned that they might be feeling overwhelmed or need more support than you’ve been able to provide.

Suppose an occasional clash occurred related to a delusion episode. In that case, you might reference that event and use it to say that you feel you could use some assistance on how to help your family member in those situations and you would like them to go with you. Truth-be-told, you probably could use the support on how to deal with them, and it’s a good way often to lead them to help by saying you need it first and they’re helping you.

Resources

https://www.brightfocus.org/alzheimers/article/alzheimers-disease-top-five-tips-managing-hallucinations-and-delusions

https://blogs.psychcentral.com/psychosis/2018/02/coping-skills-for-delusions/

https://www.psychologytoday.com/us/conditions/delusional-disorder

https://www.brightquest.com/delusional-disorder/caring-for-someone-with-delusional-disorder/

https://blogs.psychcentral.com/caregivers/2016/04/10-things-you-should-do-with-someone-who-is-delusional/