Are Hallucinations Ever Normal?

Hallucinating

Hallucinations are unreal sensory experiences. For example, seeing, hearing, or feeling something that isn’t there.

We often associate hallucinations with psychosis, e.g., schizophrenia. Those hallucinations are usually auditory, that is, hearing voices telling the individual something even though there is no one else there.

Visual hallucinations are more commonly due to a general medical illness such as serious alcohol withdrawal (delirium tremens).

People with viral infections of the retinas of their eyes may hallucinate, e.g., seeing small animals and people playing and running around the room. In this case, the retinas send false signals to the brain, which interprets them in this way.

These are all examples of hallucinations due to a medical or psychiatric illness. But do people who are not medically or psychiatrically ill ever hallucinate?

The answer is “Yes!” Here are some examples.

When people are falling asleep, they may experience hallucinations, which are often visual. These are called hypnagogic hallucinations, which occur during the transition between wakefulness and the dream phase of sleep (Rapid Eye Movement or REM sleep).

At the other end, as someone is waking up, there also can be hallucinations. These are called hypnopompic hallucinations. They can be quite vivid and seem real at times.

On rare occasions such hallucinations can be so detailed and extensive that the person believes something unusual has happened to them.

For example, they may hallucinate being experimented on by aliens in a spaceship. These hallucinations can be so powerful that the person is convinced it really happened.

These sleep-related hallucinations are not the result of medical or psychiatric illness. They can occur in normal people. However, they may be more likely if someone is sleep deprived, stressed, or overusing drugs or alcohol.

Another example of hallucinations in a normal person is “seeing” a loved one who has recently died standing at the foot of their bed. This is not unusual and is a normal experience.

These are just examples of hallucinations in normal people. If you experience hallucinations and they are worrisome to you, it would be prudent to seek an evaluation from your doctor to find out if it is normal or due to an illness.

Aren’t people interesting?

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Smoking Cessation

Nicotine Addiction

Knowing that smoking cigarettes is typically harmful for your health, a number of smokers try to stop. This is not always easy, so it has been a real help for many people to take a medication to help them stop smoking

Nicotine is the primary ingredient in tobacco that stimulates a pleasure center in the brain. As a result, some people become addicted to nicotine.

Two common treatment approaches to stop cigarette smoking involves two different medications along with counseling.

Neither medication eliminates cigarette smoking in everyone who takes one of them. Cinciripini and colleagues wanted to find out what the best strategy is when smoking cessation attempts with one of these medications doesn’t work.

They studied 490 smokers who were given one of two medication treatments: varenicline (2 mg per day) or a combination of oral nicotine (2 mg lozenges) and nicotine patches (21 mg patches).

They took their medication for 6 weeks. Participants who failed to stop smoking were randomly assigned to one of 3 treatment options: 1. Continue the same medication at the same dose; 2. Increase the dose of the medication they were on; or 3. Switch to whichever medication they were not on.

The researchers wrote about the results in JAMA Online on May 2, 2024. “Increasing the dosage led to the greatest benefit for those originally taking varenicline, whereas those receiving nicotine replacement therapy benefitted similarly from the dosage increase and switching to varenicline …”

The researchers also noted that there was an indication that increasing the dose of the nicotine replacement may “provide longer-term benefit” than switching to varenicline.

Varenicline is a medication that blocks a receptor in the brain that lights up the pleasure center when stimulated by nicotine. As a result, nicotine does not stimulate the pleasure center when smoking.

One thing I took from this research is that there are helpful things you can do if your initial treatment for cigarette smoking is not working.

If you are interested in reading the research paper itself, type this in a search bar:

doi:101001/jama.2024.4183

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Counterfeit Botox Harmful Reactions

Dry Mouth and Slurred Speech

The CDC reported that several Health Departments and the FDA “are investigating reports of harmful reactions among people who receive injections of counterfeit or mishandled botulinum toxin (commonly called “Botox”).”

These “harmful reactions” happened “after receiving botulinum toxin injections from unlicensed or untrained individuals or in non-healthcare settings, such as homes and spas.”

The CDC provided this list of harmful reactions:

• Blurry vision

• Droopy eyelids

• Difficulty swallowing

• Dry mouth

• Slurred speech

• Difficulty breathing

• Fatigue

• Generalized weakness

Some affected people were hospitalized.

(CDC April 19, 2024)

So, if you are considering Botox treatment, you would be wise to seek treatment by a medical professional with proper training in how to administer it.

The Mayo Clinic points out that only purified botulinum toxin that meets the FDA requirements should be administered.

It works by “blocking chemical signals from nerves to muscles.” Botox has a number of indications for its use including treatment of “wrinkles, frown lines, neck muscle spasm, sweating, overactive bladder, preventing frequent migraine headaches, lazy eye, and other conditions.”

Done correctly, it can be a valuable treatment for a number of conditions.

Mayo Clinic 2024 https://www.mayoclinic.org

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Psilocybin for Anxiety & Depression

Anxious and Depressed

Psilocybin is a psychedelic that affects the serotonin system in the brain. This is the same system that is targeted by many medications prescribed by health care practitioners for anxiety and/or depression

For that reason (and others) researchers have investigated whether psilocybin could be used successfully to treat anxiety and depression. International research has shown that psilocybin can be very helpful to treat these two categories of mental illnesses.

Unlike recreational use of psilocybin , researchers use purified psilocybin, and the dose given is precise. Also, controlled studies use either a placebo or much lower doses for comparison purposes.

Also, most formal research includes having a therapist present to help the research subject discuss what they are experiencing and to process it in a way that is therapeutic. This approach is called “psilocybin-assisted therapy.”

In Germany, psychiatrists can legally provide treatment for anxiety and depression using psilocybin during a psychotherapy session. The psychiatrists have to demonstrate competency providing appropriate psychotherapy with these patients.

Yerubandi and colleagues wanted to find out about possible side-effects from psilocybin-assisted treatment. They published results from an analysis of 6 clinical trials with a total of 528 patients in JAMA Network Open on April 10, 2024.

The patients were mostly white, middle-aged adults. The doses of psilocybin used in the studies were: low dose 1-3 mg, moderate dose 10-20 mg, and high dose 20-30 mg.

The research showed that “… headaches, nausea, anxiety, dizziness, and elevated blood pressure occurred significantly more frequently with psilocybin vs comparators,” i.e., placebo, low-dose psilocybin, niacin, or escitalopram (Lexapro is the common Brand name). Headache and nausea were the two most common side-effects.

They did not find any association “with risk of paranoia and transient thought disorder” even though researchers thought they might occur.

The side-effects they did identify “resolved within 48 hours” and were found to be “tolerable.” The authors acknowledged that the studies did not look into the possibility of rare long-term adverse effects; additional studies will need to be done to find out if that occurs.

To me, the bottom line is that purified psilocybin given at precise doses during a therapy session can provide meaningful benefit to patients with depression and anxiety disorders such as PTSD.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

What To Do With The “Stomach Flu”

Stomach Cramps and Diarrhea

According to an excellent article by Sara Berg, MS from the AMA Association, the “stomach flu” is not a type of flu. It is caused by a different type of virus (the norovirus) that attacks the stomach and intestines rather than the respiratory tract. (This article is based on the above reference by Berg).

Norovirus is the most common cause of “acute gastroenteritis,” which means an inflammation of the stomach and intestines.

People with a norovirus infection typically have the sudden onset of nausea, vomiting, stomach cramps, and diarrhea. Unfortunately, it is becoming more common in the U.S.

It is spread by the “fecal-oral route” meaning that billions of the viruses are found in infected peoples’ stool. If that stool gets into a water supply or on food, the virus is taken in by mouth.

The virus can continue to shed for “up to two weeks after … symptoms are gone.” The virus can live on surfaces such as tables and hand rails “for days to weeks.”

Noroviruses cannot be treated with an antibiotic. Also, even though many people refer to it as the “stomach flu,” medicines for the flu such as decongestants are ineffective and may even cause harm since they dry out tissues.

Treatment consists primarily of maintaining good hydration by drinking lots of fluids with electrolytes. Example include Gatorade, Powerade, and Pedialyte (this last one is to be used in children but can also be used in adults).

Adults may want to try Kaopectate, Pepto Bismol or Lomotil to reduce diarrhea. Avoid caffeine products. Kids can be placed on a BRAT Diet (bananas, rice, applesauce, and toast).

Prevention is better than treatment. Good handwashing is key. Rinse all fruit and vegetables before eating them. Cook shellfish thoroughly with a goal of an internal temperature of 145 degrees.

Stay home if you are sick from acute gastroenteritis.

Symptoms usually last 24-48 hours, but remember, the virus can be present in the stool for up to two weeks after symptoms are gone. If symptoms persist for 72 hours or more, it would be prudent to see your doctor.

Some people notice a return of some symptoms when they begin to eat normally after the initial symptoms have resolved.

Most often, this is due to temporary lactose intolerance caused by diarrhea. This typically lasts only 48 hours. So, you may want to avoid milk products for a couple of days after norovirus symptoms have stopped.

While most people recover from norovirus infections, young children (ages 6-18 months) and adults over age 65 can get seriously ill and a few may even die. These individuals need to be monitored closely.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Ashamed of Your Appearance?

Ashamed About Her Appearance

Sometimes people are so ashamed how they look, they avoid social situations. At the extreme, some people think they have physical defects that are actually not visible to anyone else.

This is called, Body Dysmorphic Disorder (BDD). The Mayo Clinic defines it as “a mental health condition in which you can’t stop thinking about one or more perceived defects or flaws in your appearance – a flaw that appears minor or can’t be seen by others. But you may feel so embarrassed, ashamed and anxious that you may avoid many social situations.”

An example would be a 14-year-old girl who is certain that her nose is too large and misshapen that she begs her parents to let her get a “nose job.” However, her parents can see that her nose is normal, even attractive.

To help her feel better, her parents take her to a plastic surgeon. He tells her and her parents that her nose is 100% normal, and he will not operate on it.

A study in England of children and adolescents age 5-19, showed that body dysmorphic disorder (BDD) and preoccupation with appearance were more common than realized.

BDD was more common in adolescents and girls than children and boys. Preoccupation with appearance was more common than full-blown BDD.

However, preoccupation with appearance had the same rate and type of negative effects and associated impairment seen with BDD (Krebs G and colleagues Journal of Child and Adolescent Psychiatry, March 17, 2024).

The most common associated mental health conditions were anxiety and depression. Also, the children & adolescents and their parents reported “psychosocial impairment, self-harm and suicide attempts.”

Clearly, BDD and appearance preoccupation in children and adolescents are worrisome and warrent an evaluation by a mental health professional.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Vinegar for Obesity?

Trying To Lose Weight

Is there an effective, inexpensive, non-prescription treatment for overweight and obese teens and young adults? There may be at least one available.

Researchers in Lebanon studied teen and young adult research subjects with obesity or being overweight. The research subjects were given either apple cider vinegar (5, 10, or 15 ml) or a liquid placebo three times a day for 4-12 weeks.

Vinegar has acetic acid. Prior research showed that it may reduce fat and improve metabolism.

The results of the research were encouraging. The research showed that “… daily consumption of the three doses of ACV (apple cider vinegar) for a duration of between 4 and 12 weeks is associated with significant reductions in … weight, body mass index, waist/hip circumferences and body fat ratio, blood glucose, triglyceride and cholesterol levels.”

Despite these good results, it is challenging to recommend using apple cider vinegar three times daily to lose weight based on just one study.

Also, the research only included teens and young adults so we can’t be sure these results would benefit other age groups.

Small doses of apple cider vinegar three times a day should be tolerated by most adults. However, there are exceptions. For example people with acid reflux may get worse.

The research was published by Abou-Khalil and colleagues in the BMJ Nutrition, Prevention and Health 2024; e000823.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Leprosy in the U.S.?!

Patch of Leprosy on Chest Skin

Who knew? Leprosy is still found throughout the world including the U.S. The states most affected are Arkansas, California, Florida, Hawaii, Louisiana, New York, and Texas.

Most cases arise in people who have lived overseas where leprosy is more common. The highest number of cases in the world are in India.

The proper name for leprosy is Hansen’s Disease. The name comes from the scientist in Norway who discovered the bacteria that causes it (Mycobacterium leprae).

Florida currently has the highest rate in the U.S. There were 15 new cases in 2023. The nine-banded armadillo is a natural host, and the new cases were in locations where these animals are more common.

Hansen’s Disease (leprosy) is most often identified by finding a discolored patch or patches of skin that are often numb. This is due to the bacteria damaging nerves to the skin patches.

Infected individuals may also have enlarged nerves visible under the skin. Also, their skin tends to be thick, stiff, and/or dry.

In more advanced cases, they may have painless ulcers on the bottom of their feet. Other signs may include loss of eyebrows or eyelashes or painless swelling or lumps on their face.

It usually takes a long time (years) after being infected before signs of the illness appear.

Diagnosis is made by a biopsy of the involved skin. Treatment is very effective. It requires 2 or 3 different antibiotics given for one or two years.

The CDC also points out that “ancient leprosy,” such as is mentioned in religious texts, is not the same as modern leprosy. For example, the Greek word translated into English as leprosy actually just means any skin disorder or may refer to “mildew on clothes, possessions, or living quarters.”

Once treatment begins, in just a few days the patients are no longer contagious and can safely go to school or jobs. In reality, Hansen’s Disease is not very contagious; it usually requires prolonged exposure to an infected individual before someone else can get it from them.

Also, according to the CDC, “95% of adults are immune” due to a vigorous immune response to the bacteria.

We often imagine Hansen’s Disease as causing fingers, toes, and noses to be missing. This is because the bacteria attacks the nerves to these areas so that cuts and trauma can go unrecognized.

Over time, these untreated wounds lead to destruction and resorption of those structures. It is a very late finding so it is now rare.

Hansen’s Disease is frightening to many people. This is mainly based on stories from past centuries. We now have highly effective treatments.

If you or someone you know may have been exposed, e.g., touched an armadillo, and now have one or more numb, discolored skin patches, it is a good idea to see a physician.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Non-prescription Oral Birth Control Pill Available

Taking a Daily Pill

The over-the-counter (no prescription needed) oral birth control pill is now available online. The pill’s name is Opill and is manufactured by Parrigo.

It is a progestin-only pill (norgestrel). It does not contain any estrogen. It should be taken every day at the same time.

The pill is 98% effective at preventing pregnancy when taken as directed. It begins working 48 hours after the first dose.

The pill can be ordered online at Opill.com and Amazon. It is likely that other sites will soon be available.

Current pricing:

One month supply $19.99

Three month supply $49.99

Six month supply $89.99

To learn more including contraindications, potential side-effects, and other important information, see my blog on this topic from March 5, 2024 on this site.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

New Indications for a Weight Loss Medication (WEGOVY)

Wanting to Lose Weight Safely

The Food and Drug Administration (FDA) granted a new indication for the weight loss medication, Wegovy (semaglutide). The FDA pointed out that “obesity or overweight affects approximately 70% of American adults.”

They state that these are “serious health issues that increase the risk for premature death and a variety of health problems, including heart attack and stroke.”

A high quality, multinational research study showed that Wegovy was superior to a placebo in its ability to reduce the risk of heart disease and stroke.

In addition to receiving either Wegovy or placebo, the research included standard medical treatment (e.g., blood pressure control), and “healthy lifestyle counseling, including diet and physical activity.”

The FDA noted that “Wegovy is also approved to reduce excess weight and maintain weight reduction long-term in certain adults with obesity or overweight and children with obesity, for use in addition to a reduced calorie diet and increased physical activity.”

Demonstration that Wegovy can reduce the risk of cardiovascular disease and stroke increases its value as part of the treatment of obesity or overweight individuals. It should be given along with a reduced calorie diet and increased physical activity.

Peter M. Hartmann, MD

Family Medicine & Psychiatry