Charles-bonnet Syndrome: Hallucinations are in the Eye of the Beholder

2017 ◽  
Vol 41 (S1) ◽  
pp. S631-S631
Author(s):  
N. De Uribe-viloria ◽  
E. Mayor Toranzo ◽  
S. Cepedello Perez ◽  
I. Sevillano Benito ◽  
M. De Lorenzo Calzon ◽  
...  
Keyword(s):  
Functional Mri ◽  
External Input ◽  
Vision Impairment ◽  
Association Cortex ◽  
Cognitive State ◽  
Visual Hallucinations ◽  
Neural Pathway ◽  
Management Options ◽  
Charles Bonnet Syndrome ◽  
Competing Interest

IntroductionCharles-Bonnet Syndrome (CBS) is a clinical entity characterized for visual hallucinations in patients with severe vision impairment and preserved cognitive state. Its pathogeny is still unknown, limiting management options. For diagnosis neurological and psychiatric disorders must be discarded. Treatment is based in three pillars: explaining to the patient the origin and nature of the symptoms, treating the visual deficit when possible, and pharmacotherapy with anti-psychotics.Objectives and aimsTo outline the main characteristics and etiopathogenic theories of the CBS, so as to improve diagnosis and treatment.MethodsBasing on a case followed in mental health consults, we made a systematic review of the articles published in Medline (PubMed) in the last 5 years, with the following keywords, Charles-Bonnet Syndrome, hallucinations, deafferentation, visual impairment.ResultsWe found that all our case and the reported ones had in common the nature and characteristics of the hallucinations, the presence of a trigger, usually a new medicament, and the functional MRI patrons of activity; those patrons located the loss of input prior to the association cortex, which appeared hyper-excitable in functional MRI.ConclusionsAlthough the aetiology and pathogeny of CBS is still unclear, present data suggests that the key mechanism may be a dysregulation in the homeostatic adaptation of the neural pathway when it is left without external input, traducing a hyper-function of a physiological process, probably mediated by acetylcholine, as opposed with other neuropsychiatric pathologies, in which the cortex is the primary affected area.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A Case Report of Charles Bonnet Syndrome – The Silent Doubt: Am i Crazy?

2016 ◽  
Vol 33 (S1) ◽  
pp. S471-S471
Author(s):  
A. Lopes ◽  
P. Sales
Keyword(s):  
Visual Acuity ◽  
Psychiatric Symptoms ◽  
Correct Diagnosis ◽  
Visual Field Loss ◽  
Antipsychotic Agents ◽  
Psychiatric Disease ◽  
Visual Hallucinations ◽  
Charles Bonnet Syndrome ◽  
Ophthalmologic Examination ◽  
Competing Interest

IntroductionThe Charles Bonnet syndrome refers to symptoms of visual hallucinations that occur in patients with visual acuity or visual field loss. These are often called release hallucinations, reflecting the most widely accepted theory about their pathogenesis. The syndrome is most found in elderly patients, 70–85 years, and this probably reflect the mean age at which the most common underlying conditions are seen. It is probably more common than is thought and because either it is misdiagnosed as psychosis and/or dementia or it is not reported by patients because they fear that the hallucinations represent psychiatric disease.Objective and methodThe authors present the clinical case of a 89-year-old woman, with no previous psychiatric disease, admitted to hospital because of visual hallucinations in form of children and animals. She experienced them during months until she told someone. No psychiatric symptoms were found. The lady had a serious cataract on the left eye with total loss of the visual acuity, as documented by ophthalmologic examination.ResultsThe patient initiated quetiapine 300 mg and will have period appointments with a neurologist. Further future information will be presented.ConclusionsA correct diagnosis is essential to treat these patients and explaining them the meaning of the hallucinations is generally relieving. Many author disagree with antipsychotic agents, while others report benefit.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Charles Bonnet Syndrome (CBS): Successful Treatment of Visual Hallucinations Due to Vision Loss with Agomelatine in Three Cases

2017 ◽  
Vol 41 (S1) ◽  
pp. S172-S172 ◽  
Author(s):  
H.C. Hsu ◽  
Y.S. Huang ◽  
W.X. Fan ◽  
T.C. Chen
Keyword(s):  
Visual Impairment ◽  
Vision Loss ◽  
Psychiatric Symptoms ◽  
Elderly Person ◽  
The Elderly ◽  
Visual Hallucinations ◽  
Charles Bonnet Syndrome ◽  
Competing Interest ◽  
Guilty Feeling ◽  
The Individual

BackgroundCBS becomes more prevalent as the population ages. CBS is characterized by the triad of impairment of vision, complex visual hallucinations with insight, mentally normal people. Although visual hallucinations in the elderly are often associated with dementia with Lewy body, Alzheimer's disease and delirium, they are excluded from the diagnosis of typical CBS. Here, we describe three typical CBS patients whose visual hallucinations developed after bilateral severe visual impairment due to diabetic retinopathy. The effectiveness of agomelatine adds to evidence implicating serotonergic and melatoninergic pathways in the pathogenesis of visual hallucinations.Case reportThe average age of these three patients (2 males and 1 female) is 71. Except for the visual hallucinations, all patients showed no psychiatric symptoms or cognitive decline or neurological focal signs. They were frequently upset by the fact of hallucinating, fearing that they are losing their minds. They lived in fear of impending insanity, guilty feeling, unhappy mood, insomnia. The frequency of visual hallucinations stopped with agomelatine 25 mg/day for 3 weeks in these cases.DiscussionTo our knowledge, this is the first report describing the effectiveness of agomelatine in treating typical CBS patients and indicates that agomelatine is an safer option for the treatment of CBS, especially in the elderly, diabetic population. Therapeutic options for CBS still remain poor and of uncertain benefit for the individual patient. CBS has a high prevalence rate (0.4%–30%) among the visually impaired. Clinicians must ask elderly people with visual impairment whether they have hallucinations. Firm reassurance that the syndrome is not related to mental illness is a major relief to an elderly person burdened already with failing vision.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Charles Bonnet syndrome in patients with Stargardt disease: prevalence and risk factors

2021 ◽  
pp. bjophthalmol-2021-319525
Author(s):  
Patty P A Dhooge ◽  
Rob J Teunisse ◽  
Bart Liefers ◽  
Stanley Lambertus ◽  
Nathalie M Bax ◽  
...  
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Social Functioning ◽  
Social Isolation ◽  
Short Form ◽  
Retinal Pigment ◽  
Vision Impairment ◽  
Visual Hallucinations ◽  
Stargardt Disease ◽  
Charles Bonnet Syndrome

AimsTo describe the prevalence of the Charles Bonnet syndrome (CBS) and search for potential CBS risk factors in a Dutch Stargardt disease (STGD1) cohort.MethodsEighty-three patients with STGD1 were screened for CBS. They underwent a full eye examination. All patients completed the social functioning domain of the 36-Item Short Form Health Survey questionnaire. Participants suspected of CBS were interviewed to further evaluate their visual hallucinations.ResultsCBS prevalence was 8.4%. Six out of seven patients with CBS were women. CBS was not associated with age (p=0.279, Mann-Whitney). Patients with CBS had a significant lower social functioning score (p<0.05, Mann-Whitney). All seven patients with CBS were in the category of vision impairment (visual acuity <6/12, but ≥3/60). Moreover, first hallucinations manifested after a drop in visual acuity. The retinal atrophic area of the worst eye tended to be lower in the CBS group (range 0.11–9.86 mm2) as compared with controls (range 0–180 mm2). There was no relation between the position of the scotoma and the location of the visual hallucinations.ConclusionThe relative high CBS prevalence in STGD1 suggests that CBS may be more prevalent in younger ophthalmic patients than currently presumed. In this specific group of patients, we established social isolation and acquired vision impairment as risk factors for CBS. There was a female preponderance among patients with CBS. Age and retinal pigment epithelium atrophy were not identified as significant risk factors. We should actively diagnose CBS in patients of any age who fulfil the criteria for the category vision impairment, especially in cases where social isolation is suspected.

FDG-PET Scanning Shows Distributed Changes in Cortical Activity Associated with Visual Hallucinations in Eye Disease

2019 ◽  
Vol 19 (1) ◽  
pp. 84-89 ◽  
Author(s):  
Lütfü Hanoglu ◽  
Sultan Yildiz ◽  
Tansel Cakir ◽  
Taha Hanoglu ◽  
Burak Yulug
Keyword(s):  
Visual Cortex ◽  
Fdg Pet ◽  
Underlying Mechanism ◽  
Posterior Cingulate Cortex ◽  
Eye Disease ◽  
Visual Hallucinations ◽  
Charles Bonnet Syndrome ◽  
Pet Scanning ◽  
Inferior Parietal Cortex ◽  
Visual Deafferentation

Background and Objective: Charles Bonnet Syndrome (CBS) has been defined as complex visual hallucinations (CVH) due to visual loss. The underlying mechanism of CBS is not clear and the underlying pathophysiology of the visual hallucinations in CBS patients and pure visually impaired patients is still not clear. </P><P> Methods: In our study, we have scanned three patients with eye disease and CBS (VH+) and three patients with eye disease without CBS (VH-) using FDG-PET. Results: Our results showed underactivity in the pons and overactivity in primary right left visual cortex and inferior parietal cortex in VH- patients and underactivity in left Broca, left inf frontal primary visual cortex and anterior and posterior cingulate cortex in VH+ patients relative to the normative 18FFDG PET data that was taken from the database consisting of 50 age-matched healthy adults without neuropsychiatric disorders. Conclusion: From this distributed pattern of activity changes, we conclude that the generation of visual hallucination in CBS is associated with bottom-up and top-down mechanism rather than the generally accepted visual deafferentation-related hyperexcitability theory.

scholarly journals An overview of psychological and social factors in Charles Bonnet syndrome

2021 ◽  
Vol 13 ◽  
pp. 251584142110347
Author(s):  
Lee Jones ◽  
Lara Ditzel-Finn ◽  
Jamie Enoch ◽  
Mariya Moosajee
Keyword(s):  
Emotional Response ◽  
Causal Mechanism ◽  
Visual Hallucinations ◽  
Cognitively Normal ◽  
Charles Bonnet Syndrome ◽  
Raising Awareness ◽  
Normal Individuals ◽  
The Social ◽  
Recent Developments ◽  
Insight Into

Charles Bonnet syndrome (CBS) is a condition where cognitively normal individuals with sight impairment experience simple and/or complex visual hallucinations. The exact pathogenesis of CBS is unknown; however, deafferentation is often recognised as a causal mechanism. Studies have provided insight into the multifaceted impact of CBS on wellbeing. Onset of CBS may cause distress among those believing visual hallucinations are indicative of a neurological condition. Hallucinatory content is often congruent with the emotional response. For example, hallucinations of a macabre nature typically result in a fearful response. Visual hallucinations may be highly disruptive, causing everyday tasks to become challenging. Clinical management relies on forewarning and pre-emptive questioning. Yet, knowledge and awareness of CBS is typically low. In this review, we provide a summary of the social and psychological implications of CBS and explore recent developments aimed at raising awareness and improving patient management.

Pain Management in Context of Emotionally Unstable Personality Disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S500-S500
Author(s):  
E. Dobrzynska ◽  
N. Clementi
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Personality Disorder ◽  
English Language ◽  
Opioid Analgesics ◽  
Management Options ◽  
Cognitive Behavioural ◽  
Keywords Chronic Pain ◽  
Competing Interest ◽  
Emotionally Unstable Personality Disorder

IntroductionEmotionally unstable personality disorder (EUPD) is characterised by Pain Paradox. The response for acute, self-induced pain seems to be attenuated while chronic, endogenous pain is usually intolerable. Pain management of this group of patients poses many difficulties, including discrepancies between subjective and objective pain assessment, patients’ demands for strong analgesics and impact on relationship with other professionals.Objectives and aimsThe purpose of the study was to review pain management options for persons diagnosed with EUPD and complaining of chronic pain.MethodsMEDLINE and PsycINFO databases were searched for all English-language articles containing the keywords “chronic pain”, “pain management”, “borderline personality disorder”, and “emotionally unstable personality disorder”.ResultsSeventeen relevant papers were identified. Suggested first step in pain management was ongoing clarification with EUPD patients that analgesics are unlikely to fully treat their pain and support of non-pharmacological approaches to pain, including cognitive-behavioural strategies. Regarding pharmacology, liberal use of non-addicting analgesics was recommended with highly conservative use of opioid analgesics. Importance of evaluation and treatment of any underlying mood and/or anxiety syndromes was stressed as well as liaison with other professionals (e.g. psychologists, neurologists, orthopaedics, and physiotherapists).ConclusionsPatients with EUPD often report chronic pain, which can only be managed by close collaboration of professionals from different disciplines.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Visual Hallucinations in Charles Bonnet Syndrome Can Be Seen in Fluorodeoxyglucose-PET

2011 ◽  
Vol 23 (4) ◽  
pp. E38-E39 ◽  
Author(s):  
Niklas Garde ◽  
Thomas Skripuletz ◽  
Refik Pul ◽  
Georg Berding ◽  
Karin Weissenborn ◽  
...  
Keyword(s):  
Visual Hallucinations ◽  
Charles Bonnet Syndrome ◽  
Fluorodeoxyglucose Pet

Charles Bonnet syndrome as first manifestation of occipital infarction

2022 ◽  
pp. 112067212110697
Author(s):  
Marta Isabel Martínez-Sánchez ◽  
Gema Bolívar
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Field Tests ◽  
Visual Field Loss ◽  
Visual Hallucinations ◽  
Correct Treatment ◽  
Cerebral Magnetic Resonance Imaging ◽  
Full Field ◽  
Charles Bonnet Syndrome ◽  
The Right

Purpose To describe a case of Charles Bonnet syndrome as the first manifestation of occipital infarction in a patient with preserved visual acuity. Observations We report a 78-year-old man followed in our department with a two-month-long history of visual hallucinations based on the vision of flowers and fruits intermittently, being perceived as unreal images. Best-corrected visual acuity was stable in the follow-up time being 20/20 in the right eye and 20/25 in the left eye. Extraocular muscle function testing, pupillary reflexes, biomicroscopy, fundus and optical coherence tomography examinations did not reveal any interesting findings. In order to rule out occipital pathology, orbital-cerebral magnetic resonance imaging was performed, showing an image compatible with the chronic ischemic right occipital lesion. The patient was diagnosed with Charles Bonnet syndrome secondary to occipital infarction and neurology decided that no treatment was required. 24-2 and 10-2 visual field tests showed no remarkable alterations and Full-field 120 point screening test showed nonspecific peripheral defects. Hallucinations improved over the months, being described as not annoying and increasingly infrequent. Conclusions and Importance Charles Bonnet syndrome is a condition characterized by the presence of recurrent and complex visual hallucinations in patients with visual pathway pathologic defects. Visual acuity or visual field loss is not a requirement for diagnosis. Charles Bonnet syndrome should be suspected in all patients with non-disturbing visual hallucinations, even though they present good visual acuteness. It will be essential to perform complementary explorations to identify the underlying pathology that allows the starting of a correct treatment option.

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