Diagnosis Of Charles Bonnet Syndrome Research Articles

Chronic delusional disorder and Chales Bonnet syndrome: differential diagnosis or comorbidity

Introduction Delusional idea disorders are a group of syndromes whose main or unique characteristic is the presence of consolidated delusional ideas that usually have a chronic character and do not fit into other diagnoses such as schizophrenia, affective disorder or other organic diseases. On the other hand, Charles Bonnet syndrome is an organ hallucinosis in whose context visual hallucinations may appear in patients with a visual deficit. Historically, it has been considered that the presence of another psychiatric condition is an exclusion criterion for the diagnosis of Charles Bonnet syndrome, although the presence of similar etiological and maintenance factors means that this situation of dignous exclusion must be reconsidered.ObjectivesThe objective of the present communication is to study the current state of the topics “delusional disorder” and “Charles Bonnet syndrome”. Another objective is to reconsider that the presence of previous or concurrent psychiatric pathology is an exclusion criterion for the diagnosis of Charles Bonnet syndrome..MethodsA bibliographic review on “delusional ideas disorder” and “Charles Bonnet syndrome” has been carried out, as well as a discussion on the diagnostic and exclusion criteria, based on the etiopathogenic and maintenance factors.ResultsBoth in “delusional ideas disorder” and in “charles bonnet syndrome” advanced age, social isolation and deficiencies in sense organs constitute etiological factors that facilitate the appearance of these syndromes and make their treatment difficult.ConclusionsDue to this, we consider that the appearance of another previous or present psychiatric illness should not be an exclusion criterion, both can appear in the same patient.DisclosureNo significant relationships.

¡ I see presenters in my house !

IntroductionCharles Bonnet syndrome (CBS) is characterized by the presence of visual hallucinations, generally complex, which occurs in patients with alterations in the visual pathway. The majority of affected patients are elderly. It appears in 15% of people with visual loss, predominantly in the 80-year-old female gender.ObjectivesTo present a clinical case of a patient with visual hallucinations and a possible diagnosis of Charles Bonnet syndrome. Highlight the importance of an adequate differential diagnosis.MethodsBibliographic review of the treatment and diagnosis of CBS, from articles published in the last 5 years in Pubmed.ResultsWoman, 80 years old. No ophthalmological history except those associated with advanced age. She goes to the emergency room due to the presence of visual hallucinosis, in the form of “television presenters” of whom she makes partial criticism, being aware most of the time of their unreality. Hallucinations are not accompanied by anxiety or significant affective repercussions. Discarded delirium, intoxication by substances or drugs that cause the condition. Currently under follow-up to rule out other causes.ConclusionsThe diagnosis of SCB requires a multidisciplinary approach between neurologists, psychiatrists and ophthalmologists in order to avoid erroneous diagnoses. The differential diagnosis should be made with pathologies such as Lewy body dementia, Parkinson’s disease, delirium, substance intoxication, migraine aura, and metabolic encephalopathy, among others. It is important to involve the family in the treatment of the syndrome to reinforce the recognition of the unreality of these hallucinations in the patients. Antipsychotic treatment can be effective only if the condition is extremely distressing.

Charles Bonnet syndrome: a case report

A 72 year old female presented with claims that she was seeing well formed, detailed images of people in her home and garden. While this was suggestive of visual hallucinations, she retained some insight into this phenomenon. She had no symptoms of a mood disorder or dementia, but was found to have impaired vision with macular degeneration. She received a vision with macular degeneration. She received a diagnosis of Charles Bonnet Syndrome and was treated successfully with low dose olanzapine as well as follow-up with ophthalmologist.

Cognitive impairment and Charles Bonnet syndrome: a prospective study.

Charles Bonnet syndrome (CBS) is a common cause of visual hallucinations in older people. The relationship between CBS and cognitive impairment is unclear, but anecdotal reports exist of dementia emerging in patients diagnosed with CBS. This work set out to determine if there is an increased incidence of dementia, and increased severity of cognitive impairment, in people with CBS compared to controls from the same clinical setting. People over 65 attending low-vision and glaucoma clinics, and a cohort of age-matched controls, underwent a psychiatric assessment. The cohorts were followed up after one year. Mild cognitive impairment was present in 2/12 CBS participants and 2/10 controls. Partial insight was seen in nine CBS participants. Two participants with CBS, and no controls, developed dementia at follow-up. No significant differences in performance on the ACE-R were found between the groups. Both participants who developed dementia had partial insight and hallucinations of familiar figures at diagnosis of CBS, and one had mild cognitive impairment. Reassurance that CBS is universally benign may be misplaced. Some people given this diagnosis go on to develop dementia. Cognitive testing at the point of diagnosis was unable to identify those at risk of this outcome. Partial insight, the presence of Mild Cognitive Impairment, and hallucinations of familiar figures at diagnosis of CBS may confer an increased risk of subsequent dementia diagnosis. Copyright © 2017 John Wiley & Sons, Ltd.

Charles Bonnet Syndrome in an Elderly Patient Following Cataract Surgery

Introduction: The incidence and prevalence of visual impairment among the elderly population in the United States progressively shows an increase. The escalating trend among the geriatric population is relevant not only to ophthalmologists, but surprisingly relevant to Psychiatrists. Advancements in medicine have made state of the art surgical interventions available for individuals with visual impairments. However, Psychiatrists needs to be adequately informed of rare signs pointing towards complex ocular misperception-related disorders among the geriatric population which seem like psychotic episodes. One of such complex diagnoses includes Charles Bonnet syndrome. Case presentation: This case report describes the constellation of presenting symptoms, relevance of a visual field examination and appropriate discharge disposition in an elderly female with a past medical history of cataracts status-post surgical extraction. Presenting symptoms included paranoia, agitation, visual hallucinations, and irritable mood despite treatment with multiple psychotropic medications at home. The working diagnosis of Charles Bonnet Syndrome was effectively utilized in managing this patient. Conclusion: As the incidence of visual impairment and cataract surgeries increase consistently in the United States of America, there is an increased need for Psychiatrists to be more aware of broad neuro-ophthalmology differential diagnoses especially when assessing the behaviors of geriatric patients.

Visual Hallucinations and Ischemic Stroke: Review of 5 Cases

Background: Charles Bonnet syndrome (CBS) presents with complex, vivid, repetitive visual hallucinations that occur in people who have lost some of their vision. The most common cause is senile macular degeneration. CBS can occur, rarely, in patients whose visual pathways are affected. We present five patients with complex visual hallucinations who had occipital lobe lesions after ischemic stroke. Case report: The patients included four men and one woman with a mean age of 71.8 ± 13.08 years. The neurological examinations showed left homonymous hemianopsia in four patients and right homonymous hemianopsia in one, plus there was hemiparesis in two patients and ataxia in one patient. An acute ischemic lesion was seen in the posterior cerebral artery territory in all patients on diffusion-weighted magnetic resonance imaging (MRI). Visual hallucinations in the hemianopic area occurred within the first 48 h of the stroke and lasted from a few minutes to half an hour. Electroencephalography (EEG) taken while symptomatic or shortly thereafter showed mild bioelectrical slowing in the right hemisphere in one patient, while the EEGs of the other patients were normal. During follow-up, the visual hallucinations disappeared in all patients within 3 months, without special treatment. Conclusion: The correct diagnosis of CBS, and treatment if necessary, are important and require an evaluation by a multidisciplinary team that includes neurologists, ophthalmologists, and psychiatrists.

Charles Bonnet syndrome and cognitive impairment: a systematic review.

ABSTRACT Background: Charles Bonnet syndrome (CBS) is defined as complex persistent visual hallucinations in the absence of mental disorder. It is common in conditions causing significant visual impairment. Many authors advise reassurance, considering the condition benign. However, others have suggested that CBS may in some patients represent the early stages of dementia. This review seeks to systematically examine the evidence for any link between CBS and cognitive impairment. Methods: Literature search using OVID Medline, PsychINFO, and Embase. Results: Three studies where cognitive functioning was the primary focus of the research were found. All were small, did not properly apply diagnostic criteria, and reported conflicting results. Eight other studies commented on cognitive functioning, but none used tests sufficiently sensitive to detect changes seen in early dementia. One hundred and thirty four case reports were scrutinized, and reports found of 16 patients with CBS where dementia emerged. High rates of partial insight at diagnosis of CBS were seen in these patients. Conclusions: There have been no adequately powered studies, using accepted diagnostic criteria, where changes in cognitive functioning were the primary outcome. Existing studies are of limited methodological quality and allow no conclusion regarding a relationship between cognitive impairment and CBS to be reached. Numerous case reports of dementia developing in patients with CBS and partial insight raise the possibility of a link between these conditions. There is a clear need for properly constructed studies to investigate this.

The diagnosis of Charles Bonnet syndrome in visual field defects

The diagnosis of Charles Bonnet syndrome in visual field defects

Acute Charles Bonnet syndrome secondary to eye patching

ObjectiveThe aim of this study was to report a case of Charles Bonnet syndrome secondary to eye patching following eyelid reconstruction with an unusually acute onset. MethodAn observational case report was conducted. ResultsThe patient reported complex visual hallucinations that started less than 10 minutes after patching of her right eye (the left eye had poor vision from previous trauma). The patch was removed after 2 days, and the hallucinations gradually stopped over the subsequent 2 days. ConclusionThis case of Charles Bonnet syndrome describes an unusually acute onset of hallucinations and is only the second reported case following eye patching. Eye patching is commonly used in a number of situations, and it is important to be aware of this association, as the diagnosis of Charles Bonnet syndrome is often overlooked.

P0010 EARLY ORTHOGERIATRIC INTERVENTION IN NECK OF FEMUR FRACTURES DECREASES LENGTH OF HOSPITAL STAY

Introduction: -Visual hallucinations are generally unpleasant and distressing especially when they are part of a complex psychiatric condition. However, when it occurs as a sole manifestation in the presence of normal insight, it is often non distressing. Visual hallucination in the presence of normal insight and cognition is Charles Bonnet Syndrome (CBS). Although it commonly occurs in patients with visual impairment it is not a prerequisite for diagnosis. Objectives: To illustrate different types of visual hallucinations in CBS, its management and explore the literature. Materials & methods: We report 3 cases of Charles Bonnet Syndrome and discuss the details of associated visual hallucination Results: Case one 93 year old lady presented with one week history of seeing images of her friends and relatives and sometimes pleasant images like angels. These images were stereotyped, recurrent, occurring mostly when she was alone in the evenings. She had full insight of her hallucinations and therefore she was not frightened of them. She had marked visual impairment. The clinical examination and investigations did not reveal any other cause. A diagnosis of CBS was made and she was managed successfully. Case two A 92 year old women presented with the history of recurrent episodes of seeing the images of her son-in-law walking around her house. She had complete insight and started to ignore them from the onset. Clinical examination revealed no evidence of cognitive impairment. Importantly, she had no visual impairment. CT head scan showed changes consistent with small vessel disease only. Her management was based on reassurance that this was not a psychiatric condition and she became free of hallucinations within a month. Case three A 75 year women had an episode of seeing a ‘jagged edge box’ with ‘wavy lines’. She experienced this in both eyes simultaneously but was not perturbed. Her cognitive status and neurological examination were normal. Although she appeared stressed, she did not display evidence of depression. Neuro imaging and blood tests were also normal. She was reassured about the nature of her visual hallucination and her symptom did not recur during the follow up over the next one year. Discussion & conclusion: A careful history and consideration of CBS as a possible cause of visual hallucination can lead to reduction of unnecessary investigations and associated anxiety. Unlike those associated with psychiatric symptoms, visual hallucination in CBS responds adequately to reassurance alone.

P0009 VISUAL HALLUCINATIONS- A RATHER PLEASANT EXPERIENCE! CHARLES BONNET SYNDROME

Introduction: -Visual hallucinations are generally unpleasant and distressing especially when they are part of a complex psychiatric condition. However, when it occurs as a sole manifestation in the presence of normal insight, it is often non distressing. Visual hallucination in the presence of normal insight and cognition is Charles Bonnet Syndrome (CBS). Although it commonly occurs in patients with visual impairment it is not a prerequisite for diagnosis. Objectives: To illustrate different types of visual hallucinations in CBS, its management and explore the literature. Materials & methods: We report 3 cases of Charles Bonnet Syndrome and discuss the details of associated visual hallucination Results: Case one 93 year old lady presented with one week history of seeing images of her friends and relatives and sometimes pleasant images like angels. These images were stereotyped, recurrent, occurring mostly when she was alone in the evenings. She had full insight of her hallucinations and therefore she was not frightened of them. She had marked visual impairment. The clinical examination and investigations did not reveal any other cause. A diagnosis of CBS was made and she was managed successfully. Case two A 92 year old women presented with the history of recurrent episodes of seeing the images of her son-in-law walking around her house. She had complete insight and started to ignore them from the onset. Clinical examination revealed no evidence of cognitive impairment. Importantly, she had no visual impairment. CT head scan showed changes consistent with small vessel disease only. Her management was based on reassurance that this was not a psychiatric condition and she became free of hallucinations within a month. Case three A 75 year women had an episode of seeing a ‘jagged edge box’ with ‘wavy lines’. She experienced this in both eyes simultaneously but was not perturbed. Her cognitive status and neurological examination were normal. Although she appeared stressed, she did not display evidence of depression. Neuro imaging and blood tests were also normal. She was reassured about the nature of her visual hallucination and her symptom did not recur during the follow up over the next one year. Discussion & conclusion: A careful history and consideration of CBS as a possible cause of visual hallucination can lead to reduction of unnecessary investigations and associated anxiety. Unlike those associated with psychiatric symptoms, visual hallucination in CBS responds adequately to reassurance alone.

A Case of Charles Bonnet Syndrome After Resection of a Meningioma

Purpose: To report a case of Charles Bonnet syndrome that developed after resection of a meningioma. Case summary: The authors reviewed the medical record, brain magnetic resonance image, and Goldmann visual field test of a 56-year-old male patient who was diagnosed with a meningioma in the right parietal and occipital lobe and underwent resection of the tumor. The preoperative Goldmann visual field test showed homonymous left inferior quadrantanopsia. Subtotal resection of the mass in the right parietal and occipital lobe was performed, and postoperative histopathologic examination confirmed the diagnosis of a meningioma. Postoperatively, the patient complained of visual hallucination in an area of the eye with visual field defects. However, his consciousness and orientations were intact, and other cognitive functions were also normal. Conclusions: Visual hallucination can manifest in an area with visual field defects after resection of abrain tumor. In such a case, a diagnosis of Charles Bonnet syndrome should be considered.

Episodic Ataxia vs Somatization Disorder

Dear Editor: Charles Bonnet syndrome (CBS) is characterized by complex visual hallucinations in psychologically normal people; it is usually seen in elderly people in the context of ocular pathology causing visual deterioration (1). The main hypothesis is that these hallucinations represent release phenomena attributable to deafferentation of the visual association areas of the cerebral cortex that leads to a form of phantom vision. Most intriguingly, unlike visual hallucinations associated with psychiatric disorders, patients with CBS have insight and report the hallucinations as nonthreatening. Several modalities have been tried to treat this condition, including valpromide (2), reperidone (3), carbamazepine (4), melperone (5), valproate (6), cisapride (7), and ondansetron (8). We report a case of CBS successfully treated with mirtazapine. Case Report An African-American man, aged 59 years, was admitted to a tertiary care community hospital for pneumonia. The patient had a history of type 2 diabetes, chronic renal failure requiring dialysis, and bilateral macular degeneration. His visual acuity was almost hand motion. On the fifth day of his hospitalization, psychiatry was consulted because he was experiencing visual hallucinations. The patient had no psychiatric history and had never taken any psychotropics. To everyone's astonishment, he had been visually hallucinating for at least 3 years and had never mentioned this to any one except his family members. His hallucinations consisted of seeing groups of people and farm animals, more frequently in the evening. They usually occurred during periods of wakefulness and with his eyes open. He reported them as nonthreatening and felt comfortable seeing very vivid pictures. He acknowledged some sleep problems and inconsistent appetite but gave no evidence of having depressive disorder or any other psychiatric condition. His cognition was intact, as he scored 27/30 on the Mini-Mental State Examination (3), only losing points on the visual items. A complete blood count and complete metabolic profile revealed results consistent with chronic renal failure. A magnetic resonance imaging study showed age-related atrophie changes. He was given the diagnosis of CBS, and we started him on mirtazapine 7.5 mg at bedtime. Supportive therapy and therapy to increase insight into his condition were also considered. His antibiotics were gradually weaned as his pneumonia slowly resolved. The patient's sleep pattern improved, and his visual hallucinations remitted within the next 3 days. He had no recurrence of visual hallucinations after a month of follow-up with his primary care physician. We chose mirtazapine for several reasons. First, cisapride and ondansetron are also 5-HT^sub 3^ receptor antagonists (8) and have been shown to treat CBS. Mirtazapine is a presynaptic alpha 2 antagonist that acts by increasing noradrencrgic and serotonergic neurotransmission (8). …

Visual hallucinations and macular degeneration: An example of the Charles Bonnet syndrome

Abstract Purpose: Patients with any form of visual disturbance, no matter how unusual, often present first to their ophthalmologist. An example of the Charles Bonnet syndrome as a result of bilateral macular degeneration is presented. The significance of early diagnosis is highlighted as reassurance and explanation of the condition seems to be the cornerstone of management. Methods/Results: A chronological case history, results of investigations and management are presented. Conclusions: The diagnosis of Charles Bonnet syndrome should be considered in elderly, cognitively intact patients who present with vivid, elaborate and complex visual hallucinations following ocular pathology. Although there is no universal definition of this entity and there is no specific pharmacotherapy, patients may be referred for counselling.

Charles Bonnet Syndrome in a Centenarian

To the Editor. —Charles Bonnet syndrome (CBS) includes visual pseudohallucinations (hallucinations with preserved insight), visual deprivation, and preserved cognitive status.1We present a patient who improved without medications. Report of a Case. —A 103-year-old widow presented with a 1-year history of visual hallucinations, which she recognized as unreal. They appeared during the day and disappeared when she closed her eyes. The visions were related to past experiences, such as when she was a child or a teacher, and were often pleasant. She was previously treated with phenothiazines, but without effect. She had glaucoma of the right eye and a cataract in the left eye. She had decreased visual acuity (OD 20/200, OS 20/100). Results of her neurological examination, cognitive status, Geriatric Depression Scale, and computed tomographic scan were normal. Increasing communication and occupational therapy decreased the frequency of the visions. Comment. —The diagnosis of CBS is by exclusion of