Hallucinations in an Elderly Patient with Severe Visual Impairment

Buttar, Barjinder S; Kaell, Alan

doi:10.7759/cureus.3592

Cited by 2 publications

(2 citation statements)

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“…The patient reported complex visual hallucinations where he saw people and was involved in violent situations. Interestingly, there have been reports of a few variations of visual hallucinations in patients diagnosed with CBS, including reports of geometric hallucinations (where they see shapes and sizes like squares, triangle in animal's face, or photographs), ego-syntonic moving images (purple flowers moving long their vision), ego-dystonic images (scary wild animals or Lilliputians dressed in bright outfits and talking to each other), dendritic/branch-like patterns, perseveration (details persisting in other images), and micro/macropsia (Buttar and Kaell, 2018; Gordon, 2016). These visuals can provoke fear-induced anxiety and distress, which was also noted in our case (Koek and Espinosa, 2018).…”

Section: Discussionmentioning

confidence: 99%

Charles Bonnet Syndrome

Mansuri

Patel

Shah³

et al. 2022

J Nerv Ment Dis

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C harles Bonnet syndrome (CBS) is a rare medical disorder that is characterized by vivid, complex, and recurrent visual hallucinations that occur in visually impaired patients in the absence of neurological or psychiatric diagnoses. It is a clinical diagnosis of exclusion, and no standard treatment is presently available. In this case report, we present a 69-year-old male patient with CBS and a history of legal blindness in both eyes, who responded to a trial of olanzapine. CASEA 69-year-old White male nursing home resident presents with visual hallucinations of 5 months' duration that occur during the daytime and both before and after sleep. No specific trigger was identified for the visual hallucinations. The patient describes the hallucinations as clear and detailed and states he initially was not aware, but as time passed, he has full insight and awareness of them. The hallucinations occurred once per month for the first 3 months but have increased in frequency to multiple times in a day within the last 2 months. He described the most recent one (2 days ago) in which he was involved in a fight with an unknown man who stabbed him in the chest and made him suffer a fall. He stated that his hallucinations were mostly about people hurting him and stated that it lasts for a while until he gets attacked. He also reports daytime feelings of paranoia, that is, someone is going to hurt him from the back, midnight awakenings associated with feelings of anxiety, and an inability to resume sleep since the onset of the hallucinations.The patient denied of having any unilateral distribution, or associated headache, or frightening content of hallucinations. Simple patterns, spots, shapes, or line, or associated confabulation of vision are also absent. The patient also denied of having abnormal visual perceptions such as macropsia, micropsia, or metamorphopsia. The patient denied all other types of hallucinations, delusions, suicidal or homicidal ideations, as well as headache, trauma, and fever. Before today's visit, he had seen an outpatient psychiatrist for visual hallucinations and sleep difficulties (4 and 6 months ago). The patient was initially started on loxapine 5 mg 6 months ago, which was

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Section: Discussionmentioning

confidence: 99%

Charles Bonnet Syndrome

Mansuri

Patel

Shah³

et al. 2022

J Nerv Ment Dis

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“…Evidence suggests supportive care is often the most effective treatment for CBS. Patients who have received education about CBS, understanding that the hallucinations are the result of visual impairment and are not dangerous, have better outcomes [11]. There are no official recommendations for treatment with medication, but a variety of medications, including selective serotonin reuptake inhibitors (SSRIs), antipsychotics, anti-anxiety, and anticonvulsants, have been used with varying degrees of success.…”

Section: Introductionmentioning

confidence: 99%

Charles Bonnet Syndrome With Superimposed Delirium

Karson¹,

Kang²,

Albrecht³

et al. 2022

Cureus

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Charles Bonnet Syndrome (CBS) is diagnosed when a patient who is psychiatrically intact experiences visual hallucinations in the setting of significant visual acuity or field loss. The exact pathophysiology of the CBS hallucinations remains largely unknown. The main theories include the deafferentation theory and perceptual release theory. There are suspected neurotransmitters involved, including acetylcholine and dopamine. There is no defined treatment protocol with medication for CBS, but various psychotropic medications have been used with varying degrees of remission of symptoms.This case report describes a 64-year-old male with Charles Bonnet Syndrome in the setting of superimposed delirium. We note the different medications that were trialed to reduce his CBS symptoms and decrease episodes of behavioral disturbances. Clinical features of this rare syndrome with superimposed delirium are summarized in hopes of providing directions for management and future study.

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Hallucinations in an Elderly Patient with Severe Visual Impairment

Cited by 2 publications

References 4 publications

Charles Bonnet Syndrome

Charles Bonnet Syndrome

Charles Bonnet Syndrome With Superimposed Delirium

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