How to handle hallucinations

Hallucination can be a symptom of different health issues such as schizophrenia. It is a state of sense in which a person can hear and feel things even they are not actually around. The most common type is the auditory hallucinations in which an individual claims hearing voices and sounds. In fact, there are people hallucinating hearing the voices of dead ancestors, old acquaintances and even guardian angels. This serves as reassurance and comfort for them.

However, there are instances when hallucination becomes worse in which it needs intervention. It is said that this symptom can cause disorientation and distress. That is why as early as possible, it is important to know and learn the things coping with hallucinations. Luckily, there are strategies that can be used in alleviating the symptoms.

Hallucinations Coping Strategies

Some people suffering from schizophrenia hallucinations seek medical intervention. Aside from medications, there are other alternative ways coping with hallucinations that include the following:

Fighting back – This strategy of coping up involves talking back or yelling to hallucinations. Fighting back the voice is not a good idea because it may result to depression because the voice would not go away by itself.

Passive acceptance – Accepting hallucination has positive emotional effects, but in the long run passive acceptance can consume your entire life.

Mindfulness techniques – Acknowledging the voices can be agreeable, but accepting guidance from the voices should be spared of.

Distraction – Another way in coping with hallucinations is through distractions. You can focus on tasks, watch television or recite numbers. Using distractions is more effective than the white noise.

Ask for help – People experiencing frequent hallucinations should ask help from family, friends and even support group. Going out with friends can divert the attention and make the mind busy.

Meditative activities – Exercising and engaging in other meditative activities like yoga can help prevent hallucinations. It is because this activity can calm your mind and body.

Hallucination can cause higher level of distress especially if the person does not know how to cope with it. The condition may aggravate to those people using drugs. If the condition persists, the best thing to do is to consult a psychologist for possible intervention. Through the help of psychologist, the symptoms can be intervening. Using the alternative way of dealing with hallucination can be implemented even outside the structured therapy.

The strategies in coping with hallucinations do not challenge the belief of the person where the voice is coming. This means that the techniques would not make a person irritated imposing him or her to oppose his or her belief. The coping strategies can only be effective only if the person hallucinating will acknowledge and practice it. Likewise, practicing the strategies can also help in gaining more control over the voices being heard. Not all the techniques can be effective to many individuals. That is why it is important to choose techniques in coping with hallucinations that would work best for you. After all, it is you alone who can determine which one is working and which one is not.

Auditory hallucinations refer to experiencing hallucinations that make you believe that someone is talking to you. If you often hear voices calling your name or speaking to you, but you are unable to find any real person speaking to you, then you are a victim of auditory hallucinations. Around 70% of the victims of schizophrenia as well as 15% of people suffering from depression, mania and mood disorders experience auditory hallucinations. Continue reading to find out more about auditory hallucination, its causes and the ways you can deal with this problem.

What Is Auditory Hallucinations?

Auditory hallucination, also known as one kind of paracusia wherein the victim perceives sounds without any auditory stimulus. You are able to hear one or even multiple talking voices in this condition. It is normally caused by psychotic disorders like mania or schizophrenia and is an important symptom of these problems. However, victims of auditory hallucinations can hear voices even if they aren’t suffering from any mental illness.

Hearing different talking voices is divided into 3 major categories: hearing any voice that is speaking your thoughts, hearing just one or multiple voice fighting and arguing with one another, and hearing voices that narrate your actions. However, these categories don’t encompass all the kinds of auditory hallucinations.

Other kinds of paracusia include the musical ear syndrome and exploding hear syndrome. In the former, you hear one or many musical tones and songs playing in your mind. Research suggests that listening to music for long period of time can result in musical ear syndrome. It can also be a result of lesions developing on your brain stem, tumors, abscesses, epileptic activity, encephalitis, hearing loss and sleep disorders like narcolepsy.

What Causes Auditory Hallucination?

Brain-Related Factors

If you have experienced brain damage due to any medical condition or accident, it could result in auditory hallucination. Mostly, people who have experienced severe accidents report hearing spiritual and holy voices.

Also, many people hear different voices right after they go to sleep, or when they just wake up from a dream. This too, has a connection with different parts of your brain. The brain waves alter to a slower range of theta when you sleep and results in the occurrence of random dreams. Many people who hear voices during their dreams hear people calling out their name.

Bully or Abuse

Often, people who are bullied in their childhood end up having mental issues like anxiety, insecurities and depression, which consequently results in auditory hallucinations anxiety. Mostly, children without any siblings and suffered from bullying are prone to auditory hallucinations as they don’t have the essential coping mechanism to handle bullying.

Moreover, physical and sexual abuse can result in this problem as well. If you were abused at a tender age, then you are likely to hear numerous voices later on. You can hear your abuser’s voice as well and you won’t be able to control it.

Mental Stress

Stress is also one of the auditory hallucinations causes. Huge amounts of stress accumulated over a long time period can make you hear voices in your head. Besides, loss of a loved one can also trigger auditory hallucinations anxiety . Some people find auditory hallucinations as a way to cope with this loss during the initial bereavement days. Moreover, isolation can activate this problem too. When you become isolated from people for a long time period, you begin hearing different voices. This is commonly experienced by sailors and castaways, and is a kind of compensation for their lack of social interaction.

Effect of Drugs

Different drugs can also affect the neurotransmitters in your brain, resulting in auditory hallucination. You can hear a voice after you take a drug, or when you withdraw from it. People suffering from Adderall-induced psychosis often go through paracusia.

Lack of Sleep

Not sleeping properly for a prolonged time can often induce hallucinations. Research suggests that intense sleep deprivation is associated with the neurons that compose the ‘I-function’ in your brain, which pressurizes the neurons and results in symptoms of psychosis such as auditory hallucinations.

Starvation

Starvation result in a malnourished brain. When your brain burns out, it can't function well and can result in strange behavior such as auditory hallucinations.

Other Illness

Mental illnesses such as schizophrenia, psychosis, major depression, dissociative identity disorder and bipolar disorder can make you hear threatening voices.

In addition to that, physical illnesses can also result in delirium that can make you disengage from your surroundings and result in

Moreover, post-traumatic stress disorder can also activate auditory hallucinations. Soldiers, victims of crimes and natural disasters often experience this issue.

How to Deal With Auditory Hallucination

Antipsychotic Medications

Antipsychotic medications are mostly employed for treating auditory hallucinations. They affect the dopamine metabolism that fixes the problem. If you are diagnosed with mood disorders, then you will be prescribed with adjunctive medicines such as mood stabilizers or antidepressants.

Cognitive-Behavioral Therapies

Cognitive behavioral therapy is an effective treatment for decreasing the intensity and frequency of paracusia. Enhances supportive therapy can also help fix this problem. You can also mix other behavioral therapies with CBT for treating your condition.

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) can help in reducing the symptoms of schizophrenia, depression and mania. Repetitive transcranial magnetic stimulation (RTMS) is a biological treatment procedure that can cure auditory hallucinations. It alters the neural activity of your brain and can be used along with antipsychotic medications for curing paracusia.

Reframing

Reframing the voices you hear is a good technique of managing them. This is executed by bringing those voices to your conscious awareness, so you recognize that they aren’t real. Once, you become comfortable with these voices, you are able to decrease their intensity and frequency.

An Ongoing Research for You

Ongoing research studies have shown that around 14% of children experience auditory hallucinations without experiencing any paranoia or delusions. Hallucinations and talking voices they hear can affect their well-being.

A hallucination is a perception of something that is not really there. It can involve sight, hearing, taste, smell, and/or touch. For example, you may hear voices that nobody else hears or see something that nobody else sees.

You probably will know if a person is having a hallucination. It may scare you, because you can’t see why the person is behaving as he or she is. The person also may be very scared.

Remain calm, and try to help the person:

  • Approach the person quietly while calling his or her name.
  • Ask the person to tell you what is happening. Ask whether he or she is afraid or confused.
  • Tell the person that he or she is having a hallucination and that you do not see or hear what he or she does. But don’t argue with the person if he or she can’t understand you or doesn’t believe you. The person needs to feel that it’s okay to talk to you about his or her symptoms.
  • Talk with the person about the experience, and ask whether there is anything you can do to help.
  • Suggest that the person tell the voices to go away. Involving the person in other activities may help.
  • Help the person find ways to handle the hallucinations, such as listening to music or watching TV.
  • Do not hurry the person.

Related Information

Credits

Current as of: September 23, 2020

Author: Healthwise Staff
Medical Review:
Kathleen Romito MD – Family Medicine
Donald Sproule MDCM, CCFP – Family Medicine
Lisa S. Weinstock MD – Psychiatry
Christine R. Maldonado PhD – Behavioral Health

How to handle hallucinations

The Difference Between Hallucinations and Delusions

  • Hallucinations are defined as false perceptions. They are very real to the person experiencing them. One example is seeing bugs crawling on the floor, though they are not there. Nothing you say to the person having that experience will convince him/her otherwise.
  • Delusions, per the National Institute of Health, are strongly held fixed beliefs or opinions not based on evidence. These false beliefs and opinions can be about people or things. They can also be about the person with dementia. Some common types of delusions include stealing, believing there is an intruder, and infidelity. Paranoia is a form of delusion.

When This Happens, What Do We Do?

If you are a caregiver and your loved one is seeing bugs that you do not see, or accusing you of stealing something, it is human nature to respond with “What bugs?” or “I didn’t steal anything.” Remember though, that your loved one’s behaviors are likely coming from changes in the brain related to the Alzheimer’s or dementia. Becoming dismissive, defensive or arguing your point will not be effective.

Top 5 Tips for Managing Hallucinations and Delusions

The following five tips are more effective ways to manage a person with Alzheimer’s or other forms of dementia when they are experiencing hallucinations and delusions:

  1. Remain calm and resist any urge to argue.
  2. Provide reassurance, understanding, and concern. Underlying your loved one’s reactions are feelings of fear. Look beyond their words for the emotion, and provide validation by acknowledging their fear. An example of a validating statement might be, “That must be scary to think someone is in the house with you.” With this response, you acknowledge your loved one’s fear.
  3. Investigate the immediate environment. Sometimes the cause is in the immediate environment. Having acknowledged their fear with your reassurance, determine the cause. Are they seeing something that you just do not see? Find out where and what it is. Are they seeing it at a certain time of day? Perhaps the lighting through the window at a certain time of day creates a shadow, which can be eliminated by closing the drapes at that time of day, or spending that time in a different room.
  4. Use distraction. Are the people on a favorite TV show now in their bedroom? Have there been violent or upsetting shows on TV when your loved one is in the room? Keep the TV off, and plan another activity for that time of day. What other activities do they like? Some common distractions include taking a walk, doing puzzles, playing cards, and looking at photos.
  5. Evaluate for other medical causes. Consult with your loved one’s physician, as there could be other medical reasons. While your response to the immediate hallucination or delusion would remain the same, follow up with your loved one’s physician to rule out any underlying medical issues. Some other medical causes that can cause hallucinations or delusions include dehydration, urinary tract infections, kidney or bladder infections, or pain. If your loved one recently started a new medication, report any changes in their behavior to the doctor.

No Matter Who We Are, We Just Want to Feel Understood

Whether the cause of the hallucination or delusion is related to one’s Alzheimer’s or dementia, or to another medical issue, the way to respond remains the same—respond to the feeling, and acknowledge what they are experiencing. It is always true that we just want to feel understood.

Nicholas R. Metrus, MD, is a board-certified neurologist and neuro-oncologist. He currently serves at the Glasser Brain Tumor Center in Summit, New Jersey.

Hallucinations are a common symptom of dementia. They can be frightening for those who experience them and challenging for caregivers. If you live with or care for someone with dementia who sees or hears things that appear not to be based in reality, you probably know this all too well.

There are a number of effective ways for dealing with dementia-related hallucinations. These include knowing how best to respond to someone who is frightened or concerned about what they're experiencing, practical ways to help prevent hallucinations, and medication.

How to handle hallucinations

Hallucinations in Dementia

Hallucinations are sensory experiences that seem real but actually are created in the mind in the absence of an external source or event. Most are visual, but about half of people who see things that aren't there also may hear nonexistent noises or voices (auditory hallucinations). Multisensory hallucinations are rare.

Hallucinations should not be confused with delusions, which also are common in dementia. A delusion is a strongly held belief that has no supporting evidence. For example, a person with dementia may believe a loved one is having an affair or stealing their money.

For people with Alzheimer’s disease, hallucinations tend to occur during relatively brief and distinct periods of time, typically just a few weeks. For those with Lewy body dementia (LBD), however, hallucinations are persistent and long-term.

A 2013 review found that 82% of people with dementia living in senior care facilities had at least one neuropsychiatric symptom.  

Causes

Hallucinations are experienced by people with dementia largely due to changes in the brain caused by the disease. This may be compounded by memory loss and other cognitive issues typical of dementia, such as the inability to remember certain objects or to recognize faces.

In Lewy body dementia, impairment of visuospatial ability is believed to contribute to hallucinations. Visuospatial ability refers to correctly interpreting what we see as well as the size and location of our surroundings.

Furthermore, hallucinations in LBD and Parkinson’s dementia may be linked to underlying abnormalities in the brain's processing of alpha-synuclein, a protein in the brain believed to be compromised in people with dementia.

There are other potential causes of hallucinations in dementia, some of which can easily be managed in order to eliminate hallucinations altogether:

  • Medications
  • An overly stimulating environment

Management and Treatment

Seeing things that aren't there can be unsettling and even frightening, even if what is being imagined isn't scary. For that reason, an important aspect of helping someone with dementia who is having hallucinations is to reassure them that what is happening is not unusual and that it may stop occurring over time.

It also can be helpful to explain that hallucinations can be controlled and that there is nothing to be afraid of. Don't argue with someone who insists that what they're seeing or hearing is real.

To them what they're experiencing is real; by trying to convince them otherwise you may create frustration and anxiety that could make things worse and cause them to feel their concerns are being dismissed.

Practical guidelines for helping someone deal with hallucinations include:

  • Verify the truth. Make sure the hallucination really isn’t based in reality. If someone with dementia insists they saw a man at the window, make sure no one actually happened to be outside.
  • Offer reassurance. Let someone with dementia-related hallucinations know you will check in on them frequently. If they live in a care facility, explain to staff and caregivers that the person sometimes has hallucinations that upset or scare them.
  • Alter the environment. Make adjustments related to what the person imagines. If they “see” strangers looking through an outside window, show them the window is locked or keep the shades or curtains closed. Rearrange furniture, install night lights, and make any other changes you can that might interrupt hallucinations.
  • Maintain routines. The more normal and reliable a person’s day-to-day experiences are, the less likely they are to stray from reality. If the person is living in a facility, try to arrange for daily consistency in staff and other caregivers. It may also help to keep a record of when hallucinations tend to occur and under what circumstances.
  • Use distractions. Soothing music or even something as simple as walking into a brightly lit room can help defuse a hallucination.

Medications

When hallucinations are scary or distressing for the person who has them, or they have a negative impact on quality of life, it may be necessary to turn to medication. There are several prescription drugs for treating hallucinations.

Antipsychotic medications often are effective for treating hallucinations, either by eliminating or reducing the frequency with which they occur or by having a calming effect that makes them less distressing.

Cholinesterase inhibitors, which treat Alzheimer’s disease and other dementias, work by increasing the levels of certain neurotransmitters in the brain—chemical messengers important for memory, thinking, and judgment. As such, they help boost alertness and cognition as well as potentially reduce hallucinations and other behavioral problems.

Examples of cholinesterase inhibitors include Aricept (donepezil), Exelon (revastigmine), and Razadyne (galantamine).

Nuplazid (pimavanserin) is the first drug approved to treat hallucinations and delusions associated with psychosis experienced with Parkinson’s disease dementia.

In June 2021, the Food and Drug Administration approved Aduhelm (aducanumab) as another option to treat Alzheimer’s disease. Aduhelm is the first new drug approved for the disease since 2003 as well as the first to specifically target amyloid-beta, the protein researchers widely believe to play a role in the development of Alzheimer's.

Medication Precautions

Some medications have serious side effects and are associated with a higher rate of death in people with dementia; these include certain antipsychotic medications, which should be closely managed.

In addition, carbidopa/levodopa, a drug commonly prescribed for patients with Lewy body dementia, can cause or worsen hallucinations in these patients. Rytary (carbidopa/levadopa)—a drug prescribed to treat the movement-related symptoms—can cause or worsen hallucinations caused by Lewy body dementia.

Simple and practical advice on the day-to-day management of schizophrenia.

How to handle hallucinations

[Article revised on 4 May 2020.]

The symptoms of schizophrenia are manifold, and present in such a variety of combinations and severities that it is impossible to describe a “typical case” of schizophrenia.

Positive symptoms

The so-called “positive symptoms” of schizophrenia consist of psychotic phenomena (hallucinations and delusions), which are usually as real to the schizophrenia sufferer as they are unreal to everybody else.

Positive symptoms are usually considered to be the hallmark of schizophrenia and are often most prominent in the early stages of the illness. They can be provoked or aggravated by stressful situations, such as succumbing to a physical illness, breaking off a relationship, or leaving home to go to university.

Hallucinations

Psychiatrists define a hallucination as “a sense perception that arises in the absence of a stimulus.” Hallucinations involve hearing, seeing, smelling, tasting, or feeling things that are not actually there.

The most common hallucinations in schizophrenia are auditory hallucinations—hallucinations of sounds and voices. Voices can either speak to the schizophrenia sufferer (second-person, “you” voices) or about him (third-person, “he” voices).

Voices can be highly distressing, especially if they involve threats or abuse, or if they are loud and incessant. (Carers might begin to experience something of the distress of hearing voices by turning on both the radio and the television at the same time, both at full volume, and then trying to hold a normal conversation.)

On the other hand, some voices—such as the voices of old acquaintances, dead ancestors, or “guardian angels”—can be a source of comfort and reassurance rather than of distress.

Delusions

Delusions are defined as “strongly held beliefs that are not amenable to logic or persuasion and that are out of keeping with their holder’s background. Although delusions need not necessarily be false, the process by which they are arrived at is usually bizarre and illogical. In schizophrenia, delusions are most often of being persecuted or controlled, although they can also follow a number of other themes.

Positive symptoms correspond to the general public’s idea of “madness,” and people with prominent hallucinations or delusions may evoke fear and anxiety in others. Such feelings are often reinforced by selective reporting by the media of the rare headline tragedies involving people with (usually untreated) mental illness.

The reality is that the vast majority of schizophrenia sufferers are no more likely than the average person to pose a risk to others, but far more likely than the average person to pose a risk to themselves. For example, they may neglect their safety and personal care, or they may leave themselves open to emotional, physical, or financial exploitation.

How to deal with positive symptoms

For obvious reasons, there is little in the way of self-help that sufferers can do to address their delusions—other than, of course, engaging with their carers, care team, and treatment plan.

But there are some simple things that anyone can do to dampen, and maybe even banish, auditory hallucinations.

If you’re assailed by voices, try out some or all of the following:

  • Keep a diary of the voices to help identify and avoid the situations in which they arise.
  • Identify a trusted person with whom to discuss the voices.
  • Focus your attention on a distracting activity such as reading, singing, listening to music, gardening, or exercising.
  • Talk back to the voices: Challenge them and insist that they go away.
  • Manage your levels of stress and anxiety.
  • Ensure that you are getting enough sleep.
  • Avoid alcohol and recreational drugs.
  • Take your medication as prescribed. If necessary, ask for a review of your medication.

Advice for carers

Psychotic symptoms can also be extremely distressing to carers.

Carers typically find themselves challenging their loved one’s delusions and hallucinations, partly out of a desire to relieve their suffering, and partly out of understandable feelings of fear and helplessness. Unfortunately, this can be counterproductive, insofar as it can alienate the depression sufferer at the very time when they are most in need of care.

Difficult though this is, carers should remind themselves that their loved one’s experiences are as real to them as they are unreal to everyone else.

A much more constructive/less confrontational approach for carers is to recognize that their loved one’s psychotic symptoms are meaningful to them while making it clear that they themselves do not personally share in them.

“The devil told me that I’m to blame for everything that’s happened.”

“Are you hearing him now?”

“No, he’s just stopped talking.”

“What else did he say?”

“That I’m a very bad person and don’t deserve to be looked after.”

“Has he been telling you to harm yourself?”

“No, he hasn’t, although I sometimes feel as though I should.”

“Would you actually harm yourself?”

“No, no, of course not.”

“Gosh, this all sounds terrifying. How are you feeling?”

“I’ve never felt so frightened in all my life.”

“I feel your pain, although I myself have never heard the devil you speak of.”

“Didn’t you hear him earlier on?”

“No, not at all. I’ve never heard or seen him.”

“What about all the evil spirits?”

“No, I haven’t heard them either, not at all. Have you tried ignoring all these voices?”

“If I listen to my iPod they don’t seem so loud, and I can actually hear myself think.”

“What about when we talk together, like now?”

“Yes, that’s very helpful too. I feel much less frightened now.”

Neel Burton is the author of The Meaning of Madness and other books.

Auditory hallucinations are being viewed in different contexts. Some believe that is a sign of mental illness while others view it as a proof of communication with divine powers. Regardless of how people perceive this condition, striving to find and develop the most effective coping skills for auditory hallucinations is of vital importance.

There are several types of hallucinations, with auditory hallucination as one of the most common. Individuals who are suffering from auditory hallucinations tend to hear someone speaking to them or asking them to perform certain things. There are also those who might hear sounds such as tapping noises or walking in some parts of the house especially the attic.

This type of condition can be caused by various factors including lack of sleep, substance abuse, and mental illness such as delirium, schizophrenia, and dementia. This can also be experienced by those who are taking medications particularly medications used for treating psychosis, depression, epilepsy, and Parkinson’s disease. Due to the negative effects that auditory hallucinations provide, a lot of people are already seeking for ways to cope with this problem. Among the most suggested ways are:

• Vocalization: Most individuals find auditory hallucinations less troublesome when they are the ones who are doing the talking. It is believed that talking and other activities that involve the use of voice including reading, humming, and singing can somehow help in preventing or controlling the voices. In this regard, experienced advised that individuals with this condition should try to read out loud or sing a song several times.

• Mistrust the Voices: Coping skills for auditory hallucinations include learning to distrust the voices that individuals hear. Although there are therapists who suggest that individuals learnt to make friend with the voices, this often deliver unproductive results. The best thing that you can do is to question the voices that you hear and eventually control them.

• Take Note of Incidents When Auditory Hallucinations Happen: The best way to cope with hallucination is to determine when it usually occurs and the reasons behind its occurrence. By keeping a diary of all the incidents can help you to easily identify the possible ways to manage this condition and effectively deal with them.

Aside from these, auditory hallucinations will also be treated efficiently if you seek the help of the experts. Cognitive behavioral therapy is often recommended to help in reshaping the delusional beliefs of patients in an effort to minimize the incidents when they hear the voices. This process generally involves normalizing the hallucination, explaining the neurology behind the condition, suggesting different coping strategies, and engaging patients.

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How to handle hallucinations

Bugs in the bed: How to handle hallucinations

by VANESSA MILNE

There are bugs on the bed. Someone broke into the house. Animals are in the kitchen.

Except that they’re not.

Seeing or hearing things that aren’t there is a common symptom of Alzheimer’s disease. And while it can be distressing to those with the disease — and their caregivers — it is possible to prevent hallucinations or minimize their effects.

Hallucinations are more common as people approach the middle stage of Alzheimer’s, the same phase where they may have trouble understanding what people are saying to them. They’re related to delusions, which center around a false belief, such as the idea that people are conspiring against you, and to misperceptions, such as believing people on the TV are real.

If someone has a hallucination, it’s best to go along with it. Trying to prove it’s not true is likely to make the person angry or upset, rather than reassured.

“It’s unlikely that they have the insight to understand that there’s anything wrong with them, so more than likely the response would be anger,” says Kathy Hickman, knowledge mobilization expert at the Alzheimer Society of Ontario.

Think of how you would react if someone told you something you saw wasn’t there, she says. You would probably hold firm to your position and get frustrated that they didn’t believe you.

Instead, she advises caregivers to stay calm, acknowledge what the person is feeling and try to distract them.

“You might say, ‘I can see that you’re really upset right now. How about we go have a nice cup of tea, or let’s put on some music,’” Hickman says.

At the same time, a little detective work is in order. “Ask a couple of questions to understand what’s upsetting the person, and get some clues,” Hickman says.

That’s important because hallucinations are often pegged to real things.

“The person might have a bedspread with a pattern on it, and their brain is telling them there are bugs crawling on their bed,” Hickman says.

In turn, you can remove the trigger by changing the bedspread to something without a pattern. Good lighting can also help minimize confusing shadows.

People are also more likely to hallucinate when they’re under stress, caused by an unfamiliar environment, being overwhelmed by too many people or noises, or not sleeping well. Sundowning — where people with Alzheimer’s are disoriented in the late afternoon — can also contribute.

Keeping a regular routine and ensuring the person is eating well and is not dehydrated can also help prevent hallucinations.

More serious causes include: hearing loss or vision problems, medication interaction issues, a fall, or an infection. So it’s important to report any hallucinations to a physician as well.

If your loved one can’t be distracted, or is extremely upset and can’t be calmed down, urgent medical attention is warranted. And it’s worth thinking about whether the hallucinations mean the person poses a safety risk to themselves or others — how they might act if they believe they’re defending themselves, for example.

And, Hickman notes, people also have positive hallucinations. “They might say there’s animals in the house, and they have a pet, or people are coming to visit,” she says. “But if they’re not upset about that — and you’ve made sure there aren’t safety concerns — there’s not harm in it.”

That doesn’t mean it’s not distressing. “Even if it’s not upsetting to the person, caregivers can be upset,” Hickman says. Knowing how to respond — and keeping in mind to not take hallucinations personally — can help.