Charles Bonnet Syndrome with Major Depression in a Chinese Middle-Aged Man

Objective: To describe a middle-aged patient with Charles Bonnet syndrome (CBS) suffering from concurrent major depression. Clinical picture: A 41-year-old Chinese man with retinitis pigmentosa developed complex and vivid visual hallucinations. This was followed by the onset of major depressive illness. His visual hallucinations were greatly influenced by his cultural background and changed during the course of his depression. Treatment: The patient was treated with imipramine. Outcome: The patient had a relapse of depression due to his non-compliance. He recovered after the resumption of imipramine but the visual hallucinations persisted. Conclusions: Patients suffering from CBS can have another concurrent psychiatric illness. The content and form of this patient's visual hallucinations were modified by his cultural background and depressive illness. Sensory deprivation is suggested to be the pathogenic mechanism of his visual hallucination.

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Complex visual hallucinations (Charles Bonnet syndrome) in visual field defects following cerebral surgery

Journal of Neurosurgery ◽

10.3171/jns.2004.101.5.0846 ◽

2004 ◽

Vol 101 (5) ◽

pp. 846-853 ◽

Cited By ~ 21

Author(s):

Thomas M. Freiman ◽

Rainer Surges ◽

Vassilios I. Vougioukas ◽

Ulrich Hubbe ◽

Jochen Talazko ◽

...

Keyword(s):

Visual Field ◽

Visual Hallucination ◽

The Other ◽

Visual Field Defects ◽

Neurosurgical Procedures ◽

Visual Hallucinations ◽

Content Type ◽

Charles Bonnet Syndrome ◽

Fine Print ◽

Field Defects

✓ The development of visual hallucinations after loss of vision is known as the Charles Bonnet syndrome. This phenomenon was first described in 1760 by Charles Bonnet and others during their observations of elderly patients with degeneration of the retina or cornea. To date a clear association between visual hallucinations and neurosurgical procedures has not been reported. Because of their clear demarcation, however, surgical lesions in the cerebrum offer a unique opportunity to determine the pathoanatomical aspects of visual hallucinations. During a 3-year period, 41 consecutive patients who acquired visual field defects after neurosurgery were examined for the occurrence of visual hallucination. Postoperatively, four of these patients experienced visual hallucinations. In two of them an upper quadrantanopia developed after the patients had undergone selective amygdalohippocampectomy. In the other two patients a complete hemianopia developed, in one case after resection of a parietal astrocytoma and in the other after resection of an occipital glioblastoma multiforme. The visual hallucinations were transient and gradually disappeared between 4 days and 6 months postoperatively. The patients were aware of the fact that their hallucinations were fictitious and displayed no psychosis. Electroencephalographic recordings were obtained in only two patients and epileptic discharges were found. Deafferentiation of cortical association areas may lead to the spontaneous generation of complex visual phenomena. In the present series this phenomenon occurred in approximately 10% of patients with postoperative visual field defects. In all four cases the central optic radiation was damaged between the lateral geniculate nucleus and the primary visual cortex. The complex nature of the visual hallucination indicates that they were generated in visual association areas.

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Lockdown and visual hallucinations in older people: a community perspective

BJPsych Open ◽

10.1192/bjo.2021.348 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S119-S120

Author(s):

Rim Roufael

Keyword(s):

Mental Health ◽

Community Mental Health ◽

Older People ◽

Social Isolation ◽

Sensory Deprivation ◽

Community Support ◽

Cognitive Stimulation ◽

Visual Hallucinations ◽

Negative Effects ◽

Charles Bonnet Syndrome

ObjectiveAfter COVID-19 was declared as a pandemic, different countries have enforced lockdowns, and shielding to mitigate the spread of the virus as preventing loss of lives was the priority.Our aim is to look for possible explanations for increased rates of visual hallucinations presented to Community Mental Health Teams for Older People during the period of lockdown.Case reportA review of clinical cases presenting with new onset visual hallucinations to the Community Mental Health Teams for Older People during the lockdown period in 2020 was summarised in two case scenarios. One scenario represents cases with known background of dementia, while the other scenario represents new referrals during the lockdown period with no known psychiatric background. In those cases, the visual hallucinations started during lockdown with no clear cause, did not respond to psychotropic medications, physical health investigations were all normal and hallucinations improved markedly with the end of the lockdown and social isolation.DiscussionFrom clinical practice point of view, during the period of lockdown in the COVID-19 pandemic, visual hallucinations has been one of the commonest presentations reported to the Community Mental Health Teams for Older People. Families were calling frequently reporting that their loved ones were “seeing things”. Possible underlying causes include: social isolation, sensory and perceptual deprivation, visual impairment and Charles Bonnet syndrome, lack of cognitive stimulation activities with progress of dementia, superimposed delirium, in addition to depression secondary to loneliness, reduction in community support, increased alcohol consumption and negative effects of repeated media consumption.ConclusionThere has been a marked increase in reporting visual hallucinations in the shielding older people population in the community during the period of lockdown in the COVID-19 pandemic. This shielded population was not exposed to COVID-19, so it didn't give an explanation to this new phenomenon. Though there are multiple possible causative factors, the effect of the lockdown itself with its resultant social isolation and sensory deprivation remains to be the most significant. Shielding the older people population throughout the COVID-19 pandemic came as an essential measure as the physical safety and preventing loss of lives was the priority; however the lockdown had significant negative effects on the mental health of the shielding population. It remains unclear if those negative effects are going to be reversible in the future, resulting in poor quality of life.

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The relation between charles bonnet syndrome and brain tumors (case report)

European Psychiatry ◽

10.1016/s0924-9338(11)72689-x ◽

2011 ◽

Vol 26 (S2) ◽

pp. 984-984

Author(s):

A. Ghaffarinejad ◽

F. Estilaee

Keyword(s):

Diabetes Mellitus ◽

Type Ii Diabetes ◽

Visually Impaired ◽

Parietal Lobe ◽

Type Ii Diabetes Mellitus ◽

Type Ii ◽

Visual Hallucinations ◽

Major Depressive ◽

Charles Bonnet Syndrome ◽

The Brain

Charles Bonnet syndrome (CBS) is an under-diagnosed and under-reported disorder that involves formal, persistent, vivid and complex visual hallucinations in visually impaired individuals.Some neurological, psychiatric and internal disorders such as major depressive disorder, panic disorder, multiple sclerosis, temporal arthritis, delirium and type II diabetes mellitus have been reported which occur concurrently with CBS.A 72-year-old woman with a slowly progressive tumor (probably astrocytoma) in her right parietal lobe which evaluated with MRI will be described. She presents new symptoms after 2 years. These symptoms were complex, well-formed and vivid visual hallucinations. These visions were dead acquaintances. Patient was seeing them with open eyes. Visions lasted for minutes to hours. She mentioned visions she saw when she was awake. She had recognized these hallucinatory experiences were not real.The etiology of CBS is not described well and it is not recognized where the pathologic site in the brain is. Cases with CBS and concurrent brain pathologies can help us finding these relations. This is the first report of concurrent CBS and astrocytoma in parietal lobe.

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The Charles Bonnet Syndrome: A Large Prospective Study in the Netherlands

The British Journal of Psychiatry ◽

10.1192/bjp.166.2.254 ◽

1995 ◽

Vol 166 (2) ◽

pp. 254-257 ◽

Cited By ~ 95

Author(s):

Robert J. Teunisse ◽

Johan R. M. Cruysberg ◽

André Verbeek ◽

Frans G. Zitman

Keyword(s):

Mental State ◽

Mini Mental State Examination ◽

Low Vision ◽

Sensory Deprivation ◽

Structured Interview ◽

Sociodemographic Factors ◽

Visual Hallucinations ◽

Charles Bonnet Syndrome ◽

State Examination ◽

Partial Retention

BackgroundThe aims were to determine the prevalence of the Charles Bonnet syndrome (CBS) in low-vision patients and analyse possible associated ophthalmic and sociodemographic factors.MethodA semi-structured interview on visual hallucinations was given to 300 adult low-vision patients and 200 elderly general ophthalmic patients. Positive cases were examined with the Geriatric Mental State Schedule and the Mini Mental State Examination. Diagnostic criteria were as follows: complex, persistent, or repetitive visual hallucinations; full or partial retention of insight; no hallucinations in other modalities; and no delusions. Ophthalmic and sociodemographic data were gathered for all patients.ResultsThe prevalence of CBS in low-vision patients was 11%. CBS was significantly associated with an age over 64 years and a visual acuity in the best eye of 0.3 or less. No significant associations with ophthalmic diagnoses, patient sex, marital status, or social circumstances were found.ConclusionOur findings support association of CBS with sensory deprivation and advanced age.

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Visual Hallucinations in Elderly People: Early Dementia, Psychosis or Charles Bonnet Syndrome? Review and Case Report

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1084 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S650-S650

Author(s):

M. García Moreno ◽

A. De Cos Milas ◽

B. Poza Cano ◽

L. Beatobe Carreño

Keyword(s):

Differential Diagnosis ◽

Cognitive Impairment ◽

Case Report ◽

Psychiatric Illness ◽

Late Onset ◽

Medical Condition ◽

Rare Condition ◽

Disruptive Behaviour ◽

Visual Hallucinations ◽

Charles Bonnet Syndrome

IntroductionCharles Bonnet Syndrome (CBS) is an uncommon disease that involves visual hallucinations in visually impaired individuals, in absence of cognitive impairment or psychiatric illness, although some authors propose CBS as an early maker of dementia.ObjectivesShow the importance of differential diagnosis in individuals with presence of visual hallucinations, with distinction of CBS from others psychiatric or organic disorders such as hypnogogic and hypnopompic hallucinations, epileptic phenomenon, Parkinson disease, dementia, delirum tremens or late-onset psychosis.MethodsLiterature review about visual hallucinations in people with psychiatric illness, dementia or in absence of these status, followed by a case report of a patient who met criteria for CBS.ResultsEighty one-years-old female with no previous psychiatric illness, experience suddenly visual hallucinations (animals, insects) with secondary anxiety, fear and insomnia as well as disruptive behaviour (throw lye to kill the animals) and delusional interpretations of the hallucinations considering them as a divine proof. Clinical exam, neuroimaging tests and SPECT confirmed just a minimal cognitive impairment nor suggestive of dementia. She had personal history of cataracts and macular degeneration, with no other medical condition. Olanzapine was prescribed but it was withdrew because of adverse effects. Later, haloperidol was introduced with well tolerance and symptom's recovery ad integrum.ConclusionsCharles Bonnet syndrome is a rare condition that may sometimes be the beginning of a dementia. Medical evaluation and complementary tests help differential diagnosis in order to reject others psychiatric/somatic disorders. Neuroleptic and anti-epileptic treatment should be useful to control symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530318666180830112709 ◽

2019 ◽

Vol 19 (1) ◽

pp. 84-89 ◽

Cited By ~ 3

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.

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The Symptom Structure of Postdisaster Major Depression: Convergence of Evidence from 11 Disaster Studies Using Consistent Methods

Behavioral Sciences ◽

10.3390/bs11010008 ◽

2021 ◽

Vol 11 (1) ◽

pp. 8

Author(s):

Carol S. North ◽

David Baron

Keyword(s):

Major Depressive Disorder ◽

Major Depression ◽

Depressive Disorder ◽

Diagnostic Assessment ◽

Self Report ◽

Depression Symptoms ◽

Symptom Scale ◽

Major Depressive ◽

Report Symptom ◽

Symptom Patterns

Agreement has not been achieved across symptom factor studies of major depressive disorder, and no studies have identified characteristic postdisaster depressive symptom structures. This study examined the symptom structure of major depression across two databases of 1181 survivors of 11 disasters studied using consistent research methods and full diagnostic assessment, addressing limitations of prior self-report symptom-scale studies. The sample included 808 directly-exposed survivors of 10 disasters assessed 1–6 months post disaster and 373 employees of 8 organizations affected by the September 11, 2001 terrorist attacks assessed nearly 3 years after the attacks. Consistent symptom patterns identifying postdisaster major depression were not found across the 2 databases, and database factor analyses suggested a cohesive grouping of depression symptoms. In conclusion, this study did not find symptom clusters identifying postdisaster major depression to guide the construction and validation of screeners for this disorder. A full diagnostic assessment for identification of postdisaster major depressive disorder remains necessary.

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An overview of psychological and social factors in Charles Bonnet syndrome

Therapeutic Advances in Ophthalmology ◽

10.1177/25158414211034715 ◽

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.

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