Review Article

Malingering of Psychotic Symptoms in Psychiatric Settings: Theoretical Aspects and Clinical Considerations

Table 2

Differential diagnosis of visual hallucinations.

Visual hallucination characteristicsPossible causeReferences

VH are usually simple, with appropriate insight
Valsalva-like maneuvers can trigger VH
Retinal pathology and/or retinal traction[53]
Release hallucinations, simple, and complex in nature, with intact insight and a history of visual acuity lossCharles Bonnet syndrome[54]
Simple VH/disturbances such as flickering, uncolored, unilateral zigzag linear changes in the center of the visual field that gradually progress toward the periphery, often leaving a scotomaMigraine with aura[55]
Simple, brief, and consistent for each patient; usually consist of small, brightly colored spots or shapes that flashEpilepsy or seizure disorder[56, 57]
Seeing objects move when they are actually still and seeing complex scenarios of people and items that are not presentDementia with Lewy bodies[58]
Simple and complex VH with acute disturbance of consciousness and diminished ability to sustain attentionDelirium[59, 60]
VH of crawling insectsCocaine and methamphetamine intoxication/withdrawal[6163]
Shadows, flashing lights, and moving objectsCocaine intoxication/withdrawal[62, 63]
VH with some type of animal life such as “animals on the walls”Alcohol-induced hallucinations[64]
VH of colored patterns, geometric shapes, and figures of animals and people; size distortion and the feeling of fantasy; hypnagogic hallucinationsHallucinogens[65]
VH including trailing of moving images, geometric hallucinations, flashes of color, and halos around objectsHallucinogen-persisting perception disorder[66, 67]