Treatment Of Visual Hallucinations Research Articles

Transcranial Direct Current Stimulation in the Treatment of Visual Hallucinations in Charles Bonnet Syndrome: A Randomized Placebo-Controlled Crossover Trial

To investigate the potential therapeutic benefits and tolerability of inhibitory transcranial direct current stimulation (tDCS) on the remediation of visual hallucinations in Charles Bonnet syndrome (CBS). Randomized, double-masked, placebo-controlled crossover trial. Sixteen individuals diagnosed with CBS secondary to visual impairment caused by eye disease experiencing recurrent visual hallucinations. All participants received 4 consecutive days of active and placebo cathodal stimulation (current density: 0.29 mA/cm2) to the visual cortex (Oz) over 2 defined treatment weeks, separated by a 4-week washout period. Ratings of visual hallucination frequency and duration following active and placebo stimulation, accounting for treatment order, using a 2× 2 repeated-measures model. Secondary outcomes included impact ratings of visual hallucinations and electrophysiological measures. When compared with placebo treatment, active inhibitory stimulation of visual cortex resulted in a significant reduction in the frequency of visual hallucinations measured by the North East Visual Hallucinations Interview, with a moderate-to-large effect size. Impact measures of visual hallucinations improved in both placebo and active conditions, suggesting support and education for CBS may have therapeutic benefits. Participants who demonstrated greater occipital excitability on electroencephalography assessment at the start of treatment were more likely to report a positive treatment response. Stimulation was found to be tolerable in all participants, with no significant adverse effects reported, including no deterioration in preexisting visual impairment. Findings indicate that inhibitory tDCS of visual cortex may reduce the frequency of visual hallucinations in people with CBS, particularly individuals who demonstrate greater occipital excitability prior to stimulation. tDCS may offer a feasible intervention option for CBS with no significant side effects, warranting larger-scale clinical trials to further characterize its efficacy.

Successful Use of Escitalopram for the Treatment of Visual Hallucinations in Patients With Parkinson Disease

Patients with Parkinson disease (PD) frequently experience visual hallucinations (VH). Visual hallucinations are most often viewed as an adverse effect of antiparkinsonian treatment. Possible treatments for this disturbance include a reduction of antiparkinsonian medications, adding atypical antipsychotics, or cholinesterase inhibitors. Some studies demonstrated that selective serotonin reuptake inhibitors may be an optional treatment for patients experiencing psychosis or agitation in dementia. Currently, there is no standard recommended treatment for VH in patients with PD. We present here our clinical experience with escitalopram (selective serotonin reuptake inhibitor) for treating this disturbance. Thirteen patients with PD (8 men and 5 women; age range 67-83 years) experiencing VH were openly treated with escitalopram 10 or 15 mg/d as add-on. Efficacy was assessed at baseline, then after 4 and 8 weeks of treatment using Clinical Global Impression-Severity and Clinical Global Impression-Improvement. At the end of the 4th week of treatment, of 13 patients, 11 subjects demonstrated improvement, and in only 2 patients were there no changes in their condition. After an additional 4 weeks, 2 of the responders showed very significant improvement, 6 demonstrated much improvement, and 3 patients demonstrated minimal improvement. Only 1 patient showed no change in his condition. One additional patient stopped taking escitalopram after 5 weeks because of an absence of improvement in his state. Escitalopram was well tolerated as treatment of VH in PD patients. This medication could be a promising optional therapy for this disturbance; however, further randomized controlled and bigger studies are necessary.

Treatment of visual hallucinations in Lewy body dementia with rTMS

Treatment of visual hallucinations in Lewy body dementia with rTMS

AN EVALUATION OF THE SAFETY OF NELOTANSERIN, A HIGHLY POTENT AND SELECTIVE 5-HT2A INVERSE AGONIST THAT IS BEING DEVELOPED AS A TREATMENT FOR VISUAL HALLUCINATIONS AND REM BEHAVIOR DISORDER IN LEWY BODY DEMENTIA

AN EVALUATION OF THE SAFETY OF NELOTANSERIN, A HIGHLY POTENT AND SELECTIVE 5-HT2A INVERSE AGONIST THAT IS BEING DEVELOPED AS A TREATMENT FOR VISUAL HALLUCINATIONS AND REM BEHAVIOR DISORDER IN LEWY BODY DEMENTIA

Modulatory effect of the 5-HT1A agonist buspirone and the mixed non-hallucinogenic 5-HT1A/2A agonist ergotamine on psilocybin-induced psychedelic experience

The mixed serotonin (5-HT) 1A/2A/2B/2C/6/7 receptor agonist psilocybin dose-dependently induces an altered state of consciousness (ASC) that is characterized by changes in sensory perception, mood, thought, and the sense of self. The psychological effects of psilocybin are primarily mediated by 5-HT2A receptor activation. However, accumulating evidence suggests that 5-HT1A or an interaction between 5-HT1A and 5-HT2A receptors may contribute to the overall effects of psilocybin. Therefore, we used a double-blind, counterbalanced, within-subject design to investigate the modulatory effects of the partial 5-HT1A agonist buspirone (20mg p.o.) and the non-hallucinogenic 5-HT2A/1A agonist ergotamine (3mg p.o.) on psilocybin-induced (170µg/kg p.o.) psychological effects in two groups (n=19, n=17) of healthy human subjects. Psychological effects were assessed using the Altered State of Consciousness (5D-ASC) rating scale. Buspirone significantly reduced the 5D-ASC main scale score for Visionary Restructuralization (VR) (p<0.001), which was mostly driven by a reduction of the VR item cluster scores for elementary and complex visual hallucinations. Further, buspirone also reduced the main scale score for Oceanic Boundlessness (OB) including derealisation and depersonalisation phenomena at a trend level (p=0.062), whereas ergotamine did not show any effects on the psilocybin-induced 5D-ASC main scale scores. The present finding demonstrates that buspirone exerts inhibitory effects on psilocybin-induced effects, presumably via 5-HT1A receptor activation, an interaction between 5-HT1A and 5-HT2A receptors, or both. The data suggest that the modulation of 5-HT1A receptor activity may be a useful target in the treatment of visual hallucinations in different psychiatric and neurological diseases.

Kampo therapy and behavioral and psychological symptoms of dementia

Behavioral and psychological symptoms of dementia (BPSD) occur in approximately 80–90% of patients with dementia. Although antipsychotics are used to treat BPSD, patients often suffer from parkinsonism and impaired activities of daily living (ADL). In addition, an increased mortality rate has been reported in patients with dementia taking antipsychotics. Thus, Kampo therapy is one alternative to antipsychotic medicines. Yokukansan has been reported to be effective for treatment of agitation/aggression, and irritability/lability in patients with Alzheimer's disease (AD), dementia with Lewy bodies (DLB), vascular dementia (VD), and frontotemporal dementia. In addition, yokukansan is effective for treatment of visual hallucinations in DLB patients. Because DLB patients have hypersensitivity to antipsychotics, and often have severe adverse reactions to these drugs, the beneficial effects and tolerability of yokukansan for DLB patients are particularly significant. Orengedokuto has been reported to be effective for treating irritability and sullenness in patients with VD, and to improve excitement, depression, anxiety, and restlessness in patients with cerebrovascular lesions. Chotosan has been found to be effective for treatment of delirium, insomnia, hallucination, and delusion in patients with VD. Tokishakuyakusan has been reported to improve emotional lability, restlessness, and sleep disturbances in patients with AD and VD. Kampo therapy does not induce extrapyramidal symptoms and anticholinergic symptoms, and has no adverse effects on ADL and cognitive function. In addition, Kampo therapy has been reported to have various neuroprotective effects. Thus, Kampo therapy is safe and promising for patients with BPSD, and should be further utilized for treatment of BPSD.

P.3.f.009 Charles Bonnet syndrome: successful treatment of visual hallucinations due to vision loss with escitalopram in three cases

first admission; for the remaining patients (n = 36), the follow-up objectified an evolution towards schizophrenia in 41.6%, bipolar disorder in 16.6%, schizoaffective disorder in 8.3%, delusional disorder in 2.7%, second episode psychosis in 13.8%, and a complete remission in 16.6%. Forty-four per cent of patients were readmitted after the first episode psychosis. The average number of hospitalization was 0.88±1.1; 40.7% of patients having a regular follow-up has benefited of an atypical antipsychotic treatment; the average treatment dose was 619.8±419.8mg in equivalent chlorpromazine. 31.6% were given a mood stabilizer. Discussion and Conclusion: In recent years, many studies on the identification and early treatment of psychotic disorders have focused on a solution to the issue of the evolution of a firstepisode psychosis through highlighting the factors of vulnerability and the clinical, biological or cognitive markers. What is in question is, then, more a confirmation of a diagnosis and the initiation of measures to limit the effects of chronic pathologies (schizophrenia, bipolar disorder) than the treatment of the firstpsychotic episode. This study highlights firstly a high percentage of patients with first-episode psychosis diagnosed at the stage of schizophrenia, then, a large number of patients who discontinue monitoring after a first-episode psychosis, and finally an evolution in a large number of cases to chronic pathologies. Our study initiates the establishment of an early detection and monitoring service for the first-episode psychosis in Fattouma Bourguiba psychiatry department.

Advances In the Treatment of Visual Hallucinations In Neurodegenerative Diseases

Treatment of visual hallucinations in neurodegenerative disorders is not well advanced. The complexity of underlying mechanisms presents a number of potential avenues for developing treatments, but also suggests that any single one may be of limited efficacy. Reducing medication, with the careful introduction of antidementia medication if needed, is the mainstay of current management. Antipsychotic medication leads to excessive morbidity and mortality and should only be used in cases of high distress that do not otherwise respond. Education, reduction of risk factors and psychological treatments have limited evidence of efficacy, but are unlikely to cause harm.

Escitalopram for antipsychotic nonresponsive visual hallucinosis: eight patients suffering from Charles Bonnet syndrome

The Charles Bonnet syndrome (CBS) is characterized by distinct visual hallucinations and ocularpathology causing visual impairment in patients with insight and the absence of psychiatric comorbidity. The number of reported cases of CBS is expanding as the population ages and the prevalence of vision disorders increases. Antipsychotic medications are often prescribed. However, their efficacy in CBS has been based on sketchy evidence. The use of serotonin selective reuptake inhibitor (SSRI) for CBS was anecdotally reported. We herein describe effectiveness of escitalopram in a series of patients suffering from CBS who were unresponsive to antipsychotic treatment. Eight consecutive patients suffering from CBS who did not respond to standard antipsychotic treatment were switched to escitalopram. CBS severity prior to escitalopram treatment was quantified using the Clinical Global Impression (CGI) scale and again after eight weeks of treatment. All had undergone brain CT and cognitive assessment. Brain CT imaging was normal except for an incidental finding of a small frontal meningioma in one patient. All had Mini-Mental Status Examination scores of ≥ 27/30. There were four men and four women, with a mean age of 81.7 ± 7.3 years. Previous antipsychotic treatment was mostly with risperidone, 1.0 to 3.0 mg/daily. Mean CGI-severity upon switching to escitalopram treatment was 5.7. This was significantly reduced to 1.8 (p < 0.001) after eight weeks of escitalopram treatment (mean dose: 11.8 mg/daily). There were no side effects, nor any adverse events were reported. This is the first case-series to show that SSRI is an effective and well-tolerated treatment for visual hallucinations associated with vision impairment such as in CBS.

2560 – Esitalopram for antipsychotic non-responsive complex visual hallucinations: eight patients suffering from charles-bonnet syndrome

Background The Charles Bonnet syndrome (CBS) is characterized by distinct visual hallucinations and visual impairment in patients with insight and the absence of psychiatric comorbidity. The number of reported cases of CBS is expanding as the population ages and the prevalence of vision disorders increases. The efficacy of antipsychotics in CBS is based on sketchy evidence. The use of serotonin selective re-uptake antidepressants (SSRI) for CBS is anecdotal. Aim To describe effectiveness of escitalopram in a series of patients suffering from CBS who were unresponsive to antipsychotic treatment. Methods Eight consecutive patients suffering from CBS who did not respond to standard antipsychotic treatment were switched to escitalopram. CBS severity prior to escitalopram treatment was quantified using the Clinical Global Impression (CGI) scale and again after 8 weeks of treatment. All had undergone brain -CT and cognitive assessment. Results There were 4 men and 4 women, mean age 81.7 ± 7.3 years. Brain-CT imaging was normal except for an incidental finding of a small frontal meningioma in one patient. All had MMSE scores ≥ 27/30. Previous antipsychotic treatment was mostly with risperidone 1.0 to 3.0 mgs/daily. Mean CGI-severity upon switching to escitalopram treatment was 5.7. This was significantly reduced to 1.8 (p Conclusions This is the first case-series to show that SSRIs are an effective and well-tolerated treatment for visual hallucinations associated with vision impairment such as in the CBS.

P.3.e.015 Charles Bonnet syndrome: successful treatment of visual hallucinations due to vision loss with trazodone in three cases

P.3.e.015 Charles Bonnet syndrome: successful treatment of visual hallucinations due to vision loss with trazodone in three cases

QUETIAPINE IMPROVES VISUAL HALLUCINATIONS IN PARKINSON DISEASE BUT NOT THROUGH NORMALIZATION OF SLEEP ARCHITECTURE: RESULTS FROM A DOUBLE-BLIND CLINICAL-POLYSOMNOGRAPHY STUDY

Polysomnographic studies of Parkinson's disease (PD) patients with visual hallucinations (VH) usually reveal short, fragmented rapid eye movement (REM) sleep, with lower sleep efficiency and reduced total REM sleep. Quetiapine has been demonstrated in open-label trials to be effective for the treatment of insomnia and VH in PD. To confirm quetiapine's efficacy in improving VH, and to determine whether the mechanism was due to its effect on REM sleep architecture, we performed a pilot, double-blind, placebo-controlled study. Sixteen PD patients experiencing VH were recruited. Eight patients were randomized to quetiapine and eight patients to placebo. Patients underwent pre- and post-treatment polysomnography. The Clinical Global Impression Scale (CGIS), Brief Psychiatric Rating Scale (BPRS), and Unified Parkinson Disease Rating Scale (UPDRS) motor subscale were obtained. There were no differences in baseline characteristics between the treatment arms except that the placebo group had more sleep in stage REM (74.7 min vs. 40.1 min; p < .001). Data were imputed for all patients who prematurely discontinued (four quetiapine and one placebo) in an intention-to-treat analysis. The average quetiapine dose was 58.3 mg/day. While there was no significant difference in the change in REM duration pre- vs. post-treatment in either arm, patients randomized to quetiapine improved on the CGIS (p = .03) and the hallucination item of the BPRS (p = .02). No difference was noted in the UPDRS motor scores. Despite the small sample, this is the first double-blind trial to show quetiapine's efficacy over placebo in controlling VH in the PD population. However, normalization of sleep architecture was not supported as the mechanism.

Kampo therapy as an alternative to pharmacotherapy using antipsychotic medicines for behavioral and psychological symptoms of dementia (BPSD)

AbstractThe behavioral and psychological symptoms of dementia (BPSD), including aggression, agitation, screaming, wandering, hallucinations, and delusions, occur in 50–90% of patients with dementia, and have a negative impact on the activity of daily living (ADL) of patients, as well as caregivers. Patients with severe BPSD often require management with antipsychotic medicines. However, an increased mortality rate has been reported in patients with dementia taking antipsychotic medicine and, thus, there is an urgent need to develop safer treatments for BPSD. Kampo medicines are an alternative to antipsychotic medicines and several Kampo medicines have been reported to be effective in the treatment of BPSD. Oren‐gedoku‐to has been reported to be effective for the treatment of irritability and sullenness in patients with vascular dementia, as well as improving excitement, depression, anxiety, and restlessness of patients with cerebrovascular lesions. Choto‐san has been reported to be effective in the treatment of delirium, insomnia, and hallucinations/delusions in patients with vascular dementia. Toki‐syakuyaku‐san has been reported to improve emotional lability, restlessness, and sleep disturbances in patients with dementia. Yokukan‐san has been reported to be effective for hallucinations, agitation/aggression, irritability/lability, and aberrant motor activity, as well as being effective in the treatment of visual hallucinations in patients with dementia with Lewy bodies (DLB). A multicenter randomized crossover study confirmed that Yokukan‐san is effective in the treatment of BPSD and is well‐tolerated. Kampo medicines do not induce extrapyramidal or anticholinergic symptoms and have no adverse effects on ADL or cognitive function. Thus, Kampo therapy is recommended for patients who cannot tolerate treatment with neuroleptics, patients who have extrapyramidal symptoms and gait disturbance, and patients with DLB. In future, to confirm the effectiveness of Kampo medicines in the treatment of BPSD, further studies, such as randomized control trials, are needed. In addition, basic studies are required to elucidate the processes by which Kampo medicines are metabolized, as well as any interactions between Western and Kampo medicines.

Successful Treatment of Hallucinations Associated With Sensory Impairment Using Gabapentin

Successful Treatment of Hallucinations Associated With Sensory Impairment Using Gabapentin

The Possible Role of Vision Rehabilitation in the Treatment of Visual Hallucinations in the Elderly

The Possible Role of Vision Rehabilitation in the Treatment of Visual Hallucinations in the Elderly

Visual Hallucination in Craniometaphyseal Dysplasia Successfully Treated with Olanzapine

Objective: To report the successful treatment of visual hallucinations in a patient with craniometaphyseal dysplasia (CMD) with olanzapine. Case Summary: A 15-year-old girl with CMD presenting with transient episodes of total blindness and complex visual hallucinations was successfully treated with olanzapine. Discussion: The co-occurrence of visual hallucination and blindness in this patient suggests a variety of the Charles Bonnet syndrome, a diagnosis made almost exclusively in the older population. Compared with traditional antipsychotics, the reduced propensity of olanzapine to produce extrapyramidal side effects may make it more favorable in specific situations. Conclusions: More experience with olanzapine in treating visual hallucinations is needed to determine whether it is more effective than typical antipsychotics in treating visual hallucinations associated with CMD or Charles Bonnet syndrome.

Cisapride in the Treatment of Visual Hallucinations Caused by Vision Loss: The Charles Bonnet Syndrome

The authors describe the use of cisapride (Propulsid), a potent 5-HT(3) antagonist, in the treatment of visual hallucinations in two patients with vision loss (the Charles Bonnet syndrome).

529 The hallucinogen psilocybin increases prepulse inhibition of the startle reflex in healthy humans

The mixed serotonin (5-HT) 1A/2A/2B/2C/6/7 receptor agonist psilocybin dose-dependently induces an altered state of consciousness (ASC) that is characterized by changes in sensory perception, mood, thought, and the sense of self. The psychological effects of psilocybin are primarily mediated by 5-HT2A receptor activation. However, accumulating evidence suggests that 5-HT1A or an interaction between 5-HT1A and 5-HT2A receptors may contribute to the overall effects of psilocybin. Therefore, we used a double-blind, counterbalanced, within-subject design to investigate the modulatory effects of the partial 5-HT1A agonist buspirone (20 mg p.o.) and the non-hallucinogenic 5-HT2A/1A agonist ergotamine (3 mg p.o.) on psilocybin-induced (170 µg/kg p.o.) psychological effects in two groups (n=19, n=17) of healthy human subjects. Psychological effects were assessed using the Altered State of Consciousness (5D-ASC) rating scale. Buspirone significantly reduced the 5D-ASC main scale score for Visionary Restructuralization (VR) (p<0.001), which was mostly driven by a reduction of the VR item cluster scores for elementary and complex visual hallucinations. Further, buspirone also reduced the main scale score for Oceanic Boundlessness (OB) including derealisation and depersonalisation phenomena at a trend level (p=0.062), whereas ergotamine did not show any effects on the psilocybin-induced 5D-ASC main scale scores. The present finding demonstrates that buspirone exerts inhibitory effects on psilocybin-induced effects, presumably via 5-HT1A receptor activation, an interaction between 5-HT1A and 5-HT2A receptors, or both. The data suggest that the modulation of 5-HT1A receptor activity may be a useful target in the treatment of visual hallucinations in different psychiatric and neurological diseases.

Visual hallucinations in the elderly.

Visual hallucinations, without auditory hallucinations and in the elderly, are not usually based on previous psychiatric illness. The elderly can, of course, hallucinate as part of severe depression or a life-long schizophrenia, but the clinician should assume that there is an organic basis when an elderly individual begins to develop visual hallucinations for the first time. Representative cases that illustrate visual hallucinations due to ophthalmological, vascular, or degenerative processes are presented. Visual hallucinations can be linked to disorders in multiple parts of the nervous system. Even when related to medications, dementia may also be contributory, as is illustrated by the hallucinations seen in those with Parkinson's disease. Treatment of visual hallucinations is treatment of the underlying cause although some newer drugs such as clozapine may also be helpful for selected patients.

Anticholinergic Agents

The mixed serotonin (5-HT) 1A/2A/2B/2C/6/7 receptor agonist psilocybin dose-dependently induces an altered state of consciousness (ASC) that is characterized by changes in sensory perception, mood, thought, and the sense of self. The psychological effects of psilocybin are primarily mediated by 5-HT2A receptor activation. However, accumulating evidence suggests that 5-HT1A or an interaction between 5-HT1A and 5-HT2A receptors may contribute to the overall effects of psilocybin. Therefore, we used a double-blind, counterbalanced, within-subject design to investigate the modulatory effects of the partial 5-HT1A agonist buspirone (20 mg p.o.) and the non-hallucinogenic 5-HT2A/1A agonist ergotamine (3 mg p.o.) on psilocybin-induced (170 µg/kg p.o.) psychological effects in two groups (n=19, n=17) of healthy human subjects. Psychological effects were assessed using the Altered State of Consciousness (5D-ASC) rating scale. Buspirone significantly reduced the 5D-ASC main scale score for Visionary Restructuralization (VR) (p<0.001), which was mostly driven by a reduction of the VR item cluster scores for elementary and complex visual hallucinations. Further, buspirone also reduced the main scale score for Oceanic Boundlessness (OB) including derealisation and depersonalisation phenomena at a trend level (p=0.062), whereas ergotamine did not show any effects on the psilocybin-induced 5D-ASC main scale scores. The present finding demonstrates that buspirone exerts inhibitory effects on psilocybin-induced effects, presumably via 5-HT1A receptor activation, an interaction between 5-HT1A and 5-HT2A receptors, or both. The data suggest that the modulation of 5-HT1A receptor activity may be a useful target in the treatment of visual hallucinations in different psychiatric and neurological diseases.