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Christoph SEG, Boden KT, Pütz A, Januschowski K, Siegel R, Seitz B, Szurman P, Schulz A. Epidemiology and phenomenology of the Charles Bonnet syndrome in low-vision patients. Int Ophthalmol 2024; 44:375. [PMID: 39256212 PMCID: PMC11387450 DOI: 10.1007/s10792-024-03298-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 08/28/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND The occurrence of visual hallucinations in visually impaired people without mental impairment is known as Charles Bonnet Syndrome (CBS). To date, the prevalence of CBS has been reported with high variance. The present study aims at evaluating the prevalence of CBS among low-vision patients. METHODS From March 2018 to February 2022, 194 patients with a visual acuity ≥ 0.5 logMAR approached the low vision section of the Eye Clinic Sulzbach. Of these, 50 patients were found eligible, agreed to participate in the study and were screened for CBS. The course of the disease, its phenomenology and characteristics, the circumstance of onset, the ability to manipulate and resolve the hallucinations, and the psychosocial aspects of CBS were investigated. RESULTS 26% of patients with low vision suffered from CBS. Women did not suffer from CBS significantly more often than men. Often, insight into the unreality of the images is not achieved immediately. Patterns or so-called "simple" hallucinations occurred just as frequently as other types of images such as people, body parts or faces. The most frequent images were animals. Visual hallucinations, lasting only for seconds in most cases, occurred more frequently during the day and in bright surroundings. All patients experienced the hallucinations exclusively with their eyes open. The hallucinations generally did not move with the eyes. Many sufferers did neither communicate about their hallucinations nor consult any physician. CONCLUSIONS CBS among low-vision patients is common. Its prevalence constitutes clinical relevance. Future management of CBS may benefit from encouraging patients to share their experiences and consult a physician.
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Affiliation(s)
- Sophia E G Christoph
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany
- Klaus Heimann Eye Research Institute (KHERI), Sulzbach/Saar, Germany
| | - Karl T Boden
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany
| | - Annette Pütz
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany
| | - Kai Januschowski
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany
- Klaus Heimann Eye Research Institute (KHERI), Sulzbach/Saar, Germany
- Mount Saint Peter Eye Clinic, Trier, Germany
| | - Rudolf Siegel
- Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg, Germany
| | - Peter Szurman
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany
- Klaus Heimann Eye Research Institute (KHERI), Sulzbach/Saar, Germany
| | - André Schulz
- Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany.
- Klaus Heimann Eye Research Institute (KHERI), Sulzbach/Saar, Germany.
- Department of Ophthalmology, Rostock University Medical Center, Doberaner Str. 140, 18057, Rostock, Germany.
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2
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Suzuki K, Seth AK, Schwartzman DJ. Modelling phenomenological differences in aetiologically distinct visual hallucinations using deep neural networks. Front Hum Neurosci 2024; 17:1159821. [PMID: 38234594 PMCID: PMC10791985 DOI: 10.3389/fnhum.2023.1159821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/11/2023] [Indexed: 01/19/2024] Open
Abstract
Visual hallucinations (VHs) are perceptions of objects or events in the absence of the sensory stimulation that would normally support such perceptions. Although all VHs share this core characteristic, there are substantial phenomenological differences between VHs that have different aetiologies, such as those arising from Neurodegenerative conditions, visual loss, or psychedelic compounds. Here, we examine the potential mechanistic basis of these differences by leveraging recent advances in visualising the learned representations of a coupled classifier and generative deep neural network-an approach we call 'computational (neuro)phenomenology'. Examining three aetiologically distinct populations in which VHs occur-Neurodegenerative conditions (Parkinson's Disease and Lewy Body Dementia), visual loss (Charles Bonnet Syndrome, CBS), and psychedelics-we identified three dimensions relevant to distinguishing these classes of VHs: realism (veridicality), dependence on sensory input (spontaneity), and complexity. By selectively tuning the parameters of the visualisation algorithm to reflect influence along each of these phenomenological dimensions we were able to generate 'synthetic VHs' that were characteristic of the VHs experienced by each aetiology. We verified the validity of this approach experimentally in two studies that examined the phenomenology of VHs in Neurodegenerative and CBS patients, and in people with recent psychedelic experience. These studies confirmed the existence of phenomenological differences across these three dimensions between groups, and crucially, found that the appropriate synthetic VHs were rated as being representative of each group's hallucinatory phenomenology. Together, our findings highlight the phenomenological diversity of VHs associated with distinct causal factors and demonstrate how a neural network model of visual phenomenology can successfully capture the distinctive visual characteristics of hallucinatory experience.
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Affiliation(s)
- Keisuke Suzuki
- Sussex Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- Department of Informatics, University of Sussex, Brighton, United Kingdom
- Center for Human Nature, Artificial Intelligence and Neuroscience (CHAIN), Hokkaido University, Sapporo, Japan
| | - Anil K. Seth
- Sussex Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- Department of Informatics, University of Sussex, Brighton, United Kingdom
- Program on Brain, Mind, and Consciousness, Canadian Institute for Advanced Research, Toronto, ON, Canada
| | - David J. Schwartzman
- Sussex Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- Department of Informatics, University of Sussex, Brighton, United Kingdom
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Waisberg E, Ong J, Masalkhi M, Zaman N, Kamran SA, Sarker P, Lee AG, Tavakkoli A. Text-to-image artificial intelligence to aid clinicians in perceiving unique neuro-ophthalmic visual phenomena. Ir J Med Sci 2023; 192:3139-3142. [PMID: 36787030 DOI: 10.1007/s11845-023-03315-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023]
Affiliation(s)
- Ethan Waisberg
- University College Dublin School of Medicine, Belfield, Dublin 4, Ireland.
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mouayad Masalkhi
- University College Dublin School of Medicine, Belfield, Dublin 4, Ireland
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Prithul Sarker
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
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4
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Eren OE, Straube A. [Temporary and persistent visual phenomena in neurology]. DER NERVENARZT 2023; 94:344-352. [PMID: 37039876 DOI: 10.1007/s00115-023-01466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 04/12/2023]
Abstract
Temporary and persistent visual phenomena are a frequent reason for a neurological presentation. The diagnosis can usually be made with the help of a structured anamnesis with determination of the time of onset, the course and symptoms as well as the monocular vs. binocular manifestation. The visual aura in migraine is certainly the most frequent entity to be differentiated. In particular, persistent visual phenomena such as visual snow syndrome, hallucinogen persisting perception disorder and the Charles Bonnet syndrome (CBS) seem to be underdiagnosed in clinical practice for various reasons and are probably not that rare. Instrumental diagnostics are mostly used for exclusion diagnostics and are a component of a complete patient education, but can be indicative for certain questions (CBS, epilepsy). This article presents the most frequent visual phenomena from the neurological practice and their differential diagnoses, guided by a case history.
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Affiliation(s)
- Ozan E Eren
- Neurologie, München Klinik Bogenhausen, München, Deutschland
- Neurologie, Klinikum der Universität München, Marchioninistraße 15, 81377, München, Deutschland
| | - Andreas Straube
- Neurologie, Klinikum der Universität München, Marchioninistraße 15, 81377, München, Deutschland.
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Dhooge PPA, Teunisse RJ, Liefers B, Lambertus S, Bax NM, Hoyng CB, Cruysberg JRM, Klevering BJ. Charles Bonnet syndrome in patients with Stargardt disease: prevalence and risk factors. Br J Ophthalmol 2023; 107:248-253. [PMID: 34348923 DOI: 10.1136/bjophthalmol-2021-319525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/26/2021] [Indexed: 01/25/2023]
Abstract
AIMS To describe the prevalence of the Charles Bonnet syndrome (CBS) and search for potential CBS risk factors in a Dutch Stargardt disease (STGD1) cohort. METHODS Eighty-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. RESULTS CBS 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. CONCLUSION The 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.
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Affiliation(s)
- Patty P A Dhooge
- Department of Ophthalmology, Radboudumc, Nijmegen, The Netherlands.,Donders Insitute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Rob J Teunisse
- Department of Old Age Psychiatry, GGNet Network for Mental Health Care in East Gelderland and Zutphen, Warnsveld, The Netherlands
| | - Bart Liefers
- Diagnostic Image Analysis Group, Department of Radiology, Radboudumc, Nijmegen, The Netherlands
| | | | - Nathalie M Bax
- Department of Ophthalmology, Radboudumc, Nijmegen, The Netherlands
| | - Carel B Hoyng
- Department of Ophthalmology, Radboudumc, Nijmegen, The Netherlands
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Fisher K, Sanders C, Stanmore E. Impact of Charles Bonnet Syndrome on visually impaired older adults’ ability to engage in physical activity: A scoping review. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2022. [DOI: 10.1177/02646196221112800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Charles Bonnet syndrome (CBS) is a condition associated with sight loss, characterised by vivid, spontaneous visual hallucinations. Currently, it is unclear whether CBS presents challenges to participation in physical activities, in addition to barriers attributed to sight loss alone. The purpose of this scoping review was to establish the extent of the literature, and gaps in the knowledge base, concerning the impact of CBS on older adults’ engagement in physical activities. Review conduct was informed by Arksey and O’Malley and Levac et al.’s scoping review methodologies. Six academic databases were searched during May 2021, yielding 2709 results: eight articles met eligibility criteria. Two additional sources were located via a reference check of included papers and stakeholder consultation. Quantitative cross-sectional studies ( n = 3) indicate that CBS may interfere with the ability to move around, while qualitative sources (case report/series n = 6; autobiography n = 1) show that sudden presentation of hallucinations in a person’s pathway, or threatening content, may jeopardise safety while walking. Moving to avoid a hallucination could present a fall risk if attention is diverted from environmental hazards. One case report stated that CBS did not affect personal care activities. Due to a limited evidence base, further empirical research is needed to achieve a comprehensive understanding about how CBS affects older adults’ participation in physical activities.
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Affiliation(s)
| | - Caroline Sanders
- University of Manchester, UK; Manchester Academic Health Science Centre (MAHSC), UK
| | - Emma Stanmore
- University of Manchester, UK; Manchester Academic Health Science Centre (MAHSC), UK; Manchester University NHS Foundation Trust, UK
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7
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Piarulli A, Annen J, Kupers R, Laureys S, Martial C. High-Density EEG in a Charles Bonnet Syndrome Patient during and without Visual Hallucinations: A Case-Report Study. Cells 2021; 10:cells10081991. [PMID: 34440760 PMCID: PMC8392863 DOI: 10.3390/cells10081991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 02/01/2023] Open
Abstract
Charles Bonnet syndrome (CBS) is a rare clinical condition characterized by complex visual hallucinations in people with loss of vision. So far, the neurobiological mechanisms underlying the hallucinations remain elusive. This case-report study aims at investigating electrical activity changes in a CBS patient during visual hallucinations, as compared to a resting-state period (without hallucinations). Prior to the EEG, the patient underwent neuropsychological, ophthalmologic, and neurological examinations. Spectral and connectivity, graph analyses and signal diversity were applied to high-density EEG data. Visual hallucinations (as compared to resting-state) were characterized by a significant reduction of power in the frontal areas, paralleled by an increase in the midline posterior regions in delta and theta bands and by an increase of alpha power in the occipital and midline posterior regions. We next observed a reduction of theta connectivity in the frontal and right posterior areas, which at a network level was complemented by a disruption of small-worldness (lower local and global efficiency) and by an increase of network modularity. Finally, we found a higher signal complexity especially when considering the frontal areas in the alpha band. The emergence of hallucinations may stem from these changes in the visual cortex and in core cortical regions encompassing both the default mode and the fronto-parietal attentional networks.
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Affiliation(s)
- Andrea Piarulli
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy;
- Coma Science Group, GIGA-Consciousness, University of Liège, 4000 Liège, Belgium; (J.A.); (S.L.)
| | - Jitka Annen
- Coma Science Group, GIGA-Consciousness, University of Liège, 4000 Liège, Belgium; (J.A.); (S.L.)
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
| | - Ron Kupers
- Department of Neuroscience, University of Copenhagen, 1050 Copenhagen, Denmark;
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, 4000 Liège, Belgium; (J.A.); (S.L.)
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, 4000 Liège, Belgium; (J.A.); (S.L.)
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
- Correspondence: ; Tel.: +32-428-43612
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8
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Hamedani AG. Vision loss and hallucinations: perspectives from neurology and ophthalmology. Curr Opin Neurol 2021; 34:84-88. [PMID: 33230034 DOI: 10.1097/wco.0000000000000882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to summarize the evidence for visual impairment as a risk factor for visual hallucinations in neurologic disease and recent advances in our understanding of the central visual pathways that mediate this association. RECENT FINDINGS Recent studies have described the prevalence Charles Bonnet syndrome and questioned its lack of association with cognitive impairment, used advanced neuroimaging to show that disinhibition of the occipital lobe is involved in the pathogenesis of visual hallucinations in Parkinson's disease, and demonstrated that visual impairment because of eye disease is a consistent risk factor for visual hallucinations across a number of different neurodegenerative disease populations. SUMMARY Through connections between the primary visual cortex and other brain structures, visual function is closely tied to visual hallucinations. Given that the vast majority of vision loss is caused by ophthalmic disease, much of which is preventable or treatable, the detection and treatment of vision loss in at-risk populations may reduce the burden and consequences of visual hallucinations in older adults.
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Affiliation(s)
- Ali G Hamedani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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9
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Petty KJ. Beyond the senses: perception, the environment, and vision impairment. JOURNAL OF THE ROYAL ANTHROPOLOGICAL INSTITUTE 2021. [DOI: 10.1111/1467-9655.13490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Karis Jade Petty
- Department of Anthropology University of Sussex Falmer East Sussex BN1 9RH UK
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10
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Doeller B, Kratochwil M, Sifari L, Hirnschall N, Findl O. Benefit of psychiatric evaluation on anxiety in patients with Charles Bonnet syndrome. BMJ Open Ophthalmol 2021; 6:e000463. [PMID: 33693058 PMCID: PMC7907871 DOI: 10.1136/bmjophth-2020-000463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 11/03/2022] Open
Abstract
Objective Charles Bonnet syndrome (CBS) is defined as an occurrence of visual hallucinations (VHs) in the absence of any psychiatric/neurological disorder. Significantly reduced vision due to age-related macular degeneration (AMD), cataract or glaucoma is the most common cause for CBS. Aim of this randomized controlled study was to assess whether additional treatment by a psychiatrist is beneficial for patients with CBS. Methods and Analysis Patients with visual acuity of 0.5 LogMAR or worse in the better eye were screened. Instruments used were an interview asking about details of the VH, a mental test and a questionnaire on quality of life. Patients with CBS were randomised into two groups: in group 1, a patient-doctor consultation was performed by an ophthalmologist, and in group 2 a consultation and, if needed, additional medical assessment and treatment was given by a psychiatrist. Results 4900 patients were screened. 390 patients met the inclusion criteria and among these a CBS prevalence of 34 patients (8.7%) was found. The female-to-male ratio was 4:1 and the average age was 79.3 ± 9.7 years. Four different types of VH were observed: 41% humans (n=14), 32% geometrical shapes/patterns (n=11), 15% plants (n=5) and 12% animals (n=4). The change in quality of life in patients with CBS was not significantly different in both groups (p=0.727, ophthalmologist: n=18, psychiatrist: n=16). Conclusion It is essential for medical staff involved with patients suffering from severe vision loss to be aware of CBS. This will help to better identify and interpret symptoms and could also lead to a more adequate treatment for affected patients. Discussion It is essential for medical staff involved with patients suffering from severe vision loss to be aware of CBS. This will help to better identify and interpret symptoms and could also lead to a more adequate treatment for affected patients.
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Affiliation(s)
- Birgit Doeller
- Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Wien, Austria
| | | | - Lena Sifari
- Psychiatry and psychotherapy, Hanusch Hospital, Wien, Austria
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Abstract
Complex visual hallucinations can occur in visually impaired individuals with no underlying psychiatric disorder. This phenomenon is known as Charles Bonnet syndrome (CBS). It is more common in elderly patients who are suffering from impaired vision due to ocular or neurological disease processes, resulting in sensory deprivation. We report a case of CBS in an elderly female with marked ptosis, which was exacerbated following a knee replacement surgery under general anaesthesia. Her CBS symptoms persisted until surgical correction of the ptosis, with a rapid and dramatic resolution of her hallucinations. Although CBS is typically a chronic condition, unusually in this case it was acute and reversible.
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Affiliation(s)
| | - Siddharth Ogra
- Oculoplastics Fellow, Wye Valley NHS Trust , Hereford, UK
| | - Simon Madge
- Ophthalmologist, Wye Valley NHS Trust , Hereford, UK
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12
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Hamedani AG, Pelak VS. The Charles Bonnet Syndrome: a Systematic Review of Diagnostic Criteria. Curr Treat Options Neurol 2019; 21:41. [DOI: 10.1007/s11940-019-0582-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Martial C, Larroque SK, Cavaliere C, Wannez S, Annen J, Kupers R, Laureys S, Di Perri C. Resting-state functional connectivity and cortical thickness characterization of a patient with Charles Bonnet syndrome. PLoS One 2019; 14:e0219656. [PMID: 31318888 PMCID: PMC6638931 DOI: 10.1371/journal.pone.0219656] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/28/2019] [Indexed: 11/19/2022] Open
Abstract
Charles Bonnet syndrome (CBS) is a rare condition characterized by visual impairment associated with complex visual hallucinations in elderly people. Although studies suggested that visual hallucinations may be caused by brain damage in the visual system in CBS patients, alterations in specific brain regions in the occipital cortex have not been studied. Functional connectivity during resting-state functional magnetic resonance imaging (rs-fMRI; without hallucinations) in CBS patients, has never been explored. We aimed to investigate brain structural and functional changes in a patient with CBS, as compared with late blind (LB) and normally sighted subjects. We employed voxel-based morphometry and cortical thickness analyses to investigate alterations in grey matter characteristics, and rs-fMRI to study changes in functional brain connectivity. Decreased grey matter volume was observed in the middle occipital gyrus and in the cuneus in the CBS patient, and in the middle occipital gyrus and in the lingual gyrus within LB subjects, compared to their respective control groups. Reductions in cortical thickness in associative and multimodal cortices were observed in the CBS patient when comparing with LB subjects. The precuneus exhibited increased functional connectivity with the secondary visual cortex in the CBS patient compared to the controls. In contrast, LB patients showed decreased functional connectivity compared to sighted controls between the DMN and the temporo-occipital fusiform gyrus, a region known to support hallucinations. Our findings suggest a reorganization of the functional connectivity between regions involved in self-awareness and in visual and salience processing in CBS that may contribute to the appearance of visual hallucinations.
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Affiliation(s)
- Charlotte Martial
- GIGA-Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
- * E-mail: ,
| | - Stephen Karl Larroque
- GIGA-Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Carlo Cavaliere
- GIGA-Consciousness, University of Liège, Liège, Belgium
- NAPLab, IRCCS SDN Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | - Sarah Wannez
- GIGA-Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Jitka Annen
- GIGA-Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Ron Kupers
- BRAINlab, Department of Neuroscience, Panum Institute, University of Copenhagen, Copenhagen, Denmark
- Unité COSY, Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
- Harland Sanders Chair in Visual Science, School of Optometry, University of Montreal, Montreal, Quebec, Canada
| | - Steven Laureys
- GIGA-Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Carol Di Perri
- GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre for Clinical brain Sciences, Centre for Dementia Prevention, IK Dementia Research Institute, University of Edinburght, Edinburgh, United Kingdom
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Grouios G, Alevriadou A, Koidou I. Weight-Discrimination Sensitivity in Congenitally Blind and Sighted Adults. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2019. [DOI: 10.1177/0145482x0109500104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study compared the weight-discrimination sensitivity of 41 congenitally blind and 41 normally sighted adults. The superior weight-discrimination sensitivity of the congenitally blind subjects suggests that blindness from birth can cause compensatory adaptations within the cutaneous modality.
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Affiliation(s)
- George Grouios
- Department of Physical Education and Sport Sciences, Aristotelian University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Alevriadou
- Department of Psychology, Aristotelian University of Thessaloniki, Thessaloniki, Greece
| | - Irene Koidou
- Department of Physical Education and Sport Sciences, Aristotelian University of Thessaloniki, Thessaloniki, Greece
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15
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Springer JM. Charles Bonnet Syndrome: An Often-Misunderstood Clinical Condition. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2019. [DOI: 10.1177/0145482x0009400906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Joseph M. Springer
- Department of Psychology, Georgian Court College, 900 Lakewood Avenue, Lakewood, NJ 08701-2697, and consulting psychologist, Joseph Kohn Rehabilitation Center, New Brunswick NJ
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Sabel BA, Flammer J, Merabet LB. Residual vision activation and the brain-eye-vascular triad: Dysregulation, plasticity and restoration in low vision and blindness - a review. Restor Neurol Neurosci 2019; 36:767-791. [PMID: 30412515 PMCID: PMC6294586 DOI: 10.3233/rnn-180880] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Vision loss due to ocular diseases such as glaucoma, optic neuropathy, macular degeneration, or diabetic retinopathy, are generally considered an exclusive affair of the retina and/or optic nerve. However, the brain, through multiple indirect influences, has also a major impact on functional visual impairment. Such indirect influences include intracerebral pressure, eye movements, top-down modulation (attention, cognition), and emotionally triggered stress hormone release affecting blood vessel dysregulation. Therefore, vision loss should be viewed as the result of multiple interactions within a “brain-eye-vascular triad”, and several eye diseases may also be considered as brain diseases in disguise. While the brain is part of the problem, it can also be part of the solution. Neuronal networks of the brain can “amplify” residual vision through neuroplasticity changes of local and global functional connectivity by activating, modulating and strengthening residual visual signals. The activation of residual vision can be achieved by different means such as vision restoration training, non-invasive brain stimulation, or blood flow enhancing medications. Modulating brain functional networks and improving vascular regulation may offer new opportunities to recover or restore low vision by increasing visual field size, visual acuity and overall functional vision. Hence, neuroscience offers new insights to better understand vision loss, and modulating brain and vascular function is a promising source for new opportunities to activate residual vision to achieve restoration and recovery to improve quality of live in patients suffering from low vision.
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Affiliation(s)
- Bernhard A Sabel
- Institute of Medical Psychology, Medical Faculty, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - Josef Flammer
- Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Lotfi B Merabet
- Department of Ophthalmology, The Laboratory for Visual Neuroplasticity, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA
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O'Farrell L, Lewis S, McKenzie A, Jones L. Charles Bonnet Syndrome: A Review of the Literature. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2019. [DOI: 10.1177/0145482x1010400502] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Charles Bonnet syndrome (CBS) commonly occurs in older adults with visual impairments, particularly those with age-related macular degeneration. It is characterized by complex visual hallucinations in individuals without mental disorders. The authors explore diagnostic criteria, demographic characteristics, clinical features, theories of pathogenesis, and management options for people who are diagnosed with CBS.
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Affiliation(s)
- Lauren O'Farrell
- Charlie Norwood VA Medical Center, One Freedom Way, Augusta, GA 30904
| | - Sandra Lewis
- Florida State University, 2205 Stone Building, Tallahassee, FL 32306-4459
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Park YM, Jeong JG. The Prevalence and Clinical Characteristics of Charles Bonnet Syndrome in the Republic of Korea. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.12.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Young Myoung Park
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
| | - Jin Gu Jeong
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
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Abstract
BACKGROUND Charles Bonnet syndrome is characterized by formed visual hallucinations in individuals with vision loss. It is reported that one in five older adults with vision loss suffer from Charles Bonnet syndrome and the suspected lack of awareness amongst family physicians may lead to misdiagnosis and inappropriate treatment. OBJECTIVE To assess Canadian family physicians' awareness of Charles Bonnet syndrome. METHODS We conducted a national perception and practices survey of family physicians across Canada to assess (i) the level of awareness of Charles Bonnet syndrome amongst family physicians; (ii) the frequency of family physicians' encounters with patients with visual hallucinations and (iii) management strategies and referral patterns for patients with Charles Bonnet syndrome presenting to family physicians. RESULTS Four hundred and ninety-nine family physicians across Canada answered at least one question on the survey. 54.7% indicated they were not at all aware and 19.7% indicated they were slightly aware of Charles Bonnet syndrome. 72.8% of physicians had patients present with visual hallucinations once a year or less often. The frequency of patients seen in practice with visual hallucinations is significantly associated with awareness by physicians of Charles Bonnet syndrome (β = 0.501, t(388) = 5.59, P < 0.001). Of those who encountered patients with visual hallucinations, the majority of respondents (77.4%) provided counselling or education to the patient. CONCLUSION There is a great lack of knowledge about Charles Bonnet syndrome among family physicians. Awareness of Charles Bonnet syndrome is critical to appropriate diagnosis, assessment and treatment of this condition and to reassure patients that they are not suffering from a mental disorder.
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Affiliation(s)
- Keith D Gordon
- Research Department, Canadian National Institute for the Blind, Toronto, Canada
| | - Tina Felfeli
- Faculty of Medicine, University of Toronto, Toronto, Canada
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20
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Vision: It Is About the Brain. J Neuroophthalmol 2018; 38:271-275. [PMID: 30106800 DOI: 10.1097/wno.0000000000000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Taddei RN, Cankaya S, Dhaliwal S, Chaudhuri KR. Management of Psychosis in Parkinson's Disease: Emphasizing Clinical Subtypes and Pathophysiological Mechanisms of the Condition. PARKINSON'S DISEASE 2017; 2017:3256542. [PMID: 29104810 PMCID: PMC5613459 DOI: 10.1155/2017/3256542] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/06/2017] [Indexed: 02/07/2023]
Abstract
Investigation into neuropsychiatric symptoms in Parkinson's disease (PD) is sparse and current drug development is mainly focused on the motor aspect of PD. The tight association of psychosis with an impaired quality of life in PD, together with an important underreporting of this comorbid condition, contributes to its actual insufficient assessment and management. Furthermore, the withdrawal from access to readily available treatment interventions is unacceptable and has an impact on PD prognosis. Despite its impact, to date no standardized guidelines to the adequate management of PD psychosis are available and they are therefore highly needed. Readily available knowledge on distinct clinical features as well as early biomarkers of psychosis in PD justifies the potential for its timely diagnosis and for early intervention strategies. Also, its specific characterisation opens up the possibility of further understanding the underlying pathophysiological mechanisms giving rise to more targeted therapeutic developments in the nearer future. A literature review on the most recent knowledge with special focus on specific clinical subtypes and pathophysiological mechanisms will not only contribute to an up to date practical approach of this condition for the health care providers, but furthermore open up new ideas for research in the near future.
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Affiliation(s)
- Raquel N. Taddei
- Maurice Wohl Clinical Neuroscience Institute and NIHR Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College Hospital, London, UK
| | - Seyda Cankaya
- Maurice Wohl Clinical Neuroscience Institute and NIHR Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College Hospital, London, UK
| | - Sandeep Dhaliwal
- Maurice Wohl Clinical Neuroscience Institute and NIHR Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College Hospital, London, UK
| | - K. Ray Chaudhuri
- Maurice Wohl Clinical Neuroscience Institute and NIHR Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College Hospital, London, UK
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Abstract
Supplemental digital content is available in the text. Charles Bonnet Syndrome is a condition where visual hallucinations occur as a result of damage along the visual pathway. Patients with Charles Bonnet Syndrome maintain partial or full insight that the hallucinations are not real, absence of psychological conditions, and absence of hallucinations affecting other sensory modalities, while maintaining intact intellectual functioning. Charles Bonnet Syndrome has been well documented in neurologic, geriatric medicine, and psychiatric literature, but there is lack of information in optometric and ophthalmologic literature. Therefore, increased awareness of signs and symptoms associated with Charles Bonnet Syndrome is required among practicing clinicians. This review of the literature will also identify other etiologies of visual hallucinations, pathophysiology of Charles Bonnet Syndrome, and effective management strategies.
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Mitchell CAA, Maybery MT, Russell-Smith SN, Collerton D, Gignac GE, Waters F. The Structure and Measurement of Unusual Sensory Experiences in Different Modalities: The Multi-Modality Unusual Sensory Experiences Questionnaire (MUSEQ). Front Psychol 2017; 8:1363. [PMID: 28848477 PMCID: PMC5554527 DOI: 10.3389/fpsyg.2017.01363] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/27/2017] [Indexed: 12/11/2022] Open
Abstract
Hallucinations and other unusual sensory experiences (USE) can occur in all modalities in the general population. Yet, the existing literature is dominated by investigations into auditory hallucinations (“voices”), while other modalities remain under-researched. Furthermore, there is a paucity of measures which can systematically assess different modalities, which limits our ability to detect individual and group differences across modalities. The current study explored such differences using a new scale, the Multi-Modality Unusual Sensory Experiences Questionnaire (MUSEQ). The MUSEQ is a 43-item self-report measure which assesses USE in six modalities: auditory, visual, olfactory, gustatory, bodily sensations, and sensed presence. Scale development and validation involved a total of 1,300 participants, which included: 513 students and community members for initial development, 32 individuals with schizophrenia spectrum disorder or bipolar disorder for validation, 659 students for factor replication, and 96 students for test-retest reliability. Confirmatory factor analyses showed that a correlated-factors model and bifactor model yielded acceptable model fit, while a unidimensional model fitted poorly. These findings were confirmed in the replication sample. Results showed contributions from a general common factor, as well as modality-specific factors. The latter accounted for less variance than the general factor, but could still detect theoretically meaningful group differences. The MUSEQ showed good reliability, construct validity, and could discriminate non-clinical and clinical groups. The MUSEQ offers a reliable means of measuring hallucinations and other USE in six different modalities.
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Affiliation(s)
- Claire A A Mitchell
- School of Psychological Science, The University of Western AustraliaCrawley, WA, Australia
| | - Murray T Maybery
- School of Psychological Science, The University of Western AustraliaCrawley, WA, Australia
| | | | - Daniel Collerton
- Northumberland, Tyne and Wear NHS Foundation Trust, Bensham HospitalGateshead, United Kingdom.,Institute of Neuroscience, Newcastle UniversityNewcastle upon Tyne, United Kingdom
| | - Gilles E Gignac
- School of Psychological Science, The University of Western AustraliaCrawley, WA, Australia
| | - Flavie Waters
- School of Psychological Science, The University of Western AustraliaCrawley, WA, Australia.,Clinical Research Centre, Graylands Hospital, North Metro Health Service Mental HealthMount Claremont, WA, Australia
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Adaptive and maladaptive neural compensatory consequences of sensory deprivation-From a phantom percept perspective. Prog Neurobiol 2017; 153:1-17. [PMID: 28408150 DOI: 10.1016/j.pneurobio.2017.03.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/21/2017] [Accepted: 03/28/2017] [Indexed: 12/19/2022]
Abstract
It is suggested that the brain undergoes plastic changes in order to adapt to changing environmental needs. Sensory deprivation results in decreased input to the brain leading to adaptive or maladaptive changes. Although several theories hypothesize the mechanism of these adaptive and maladaptive changes, the course of action taken by the brain heavily depends on the age of incidence of damage. The growing body of literature on the topic proposes that maladaptive changes in the brain are instrumental in creating phantom percepts, defined as the perception of a sensory experience in the absence of a physical stimulus. The current article reviews the mechanisms of adaptive and maladaptive plasticity in the brain in congenital, early, and late-onset sensory deprivation in conjunction with the phantom percepts in the different sensory domains. We propose that the mechanisms of adaptive and maladaptive plasticity fall under a universal construct of updating hierarchical Bayesian prediction errors. This theory of the Bayesian brain hypothesizes that the brain constantly compares its internal milieu with changing environmental cues and either adjusts its predictions or discards the change, depending on the novelty or salience of the external stimulus. We propose that adaptive plasticity reflects both successful bottom-up compensation and top-down updating of the model while maladaptive plasticity reflects failure in one or both mechanisms, resulting in a constant prediction-error. Finally, we hypothesize that phantom percepts are generated by the brain as a solution to this prediction error and are thus a manifestation of unsuccessful adaptation to sensory deprivation.
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25
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Prävalenz des Charles Bonnet Syndroms – eine Übersicht der Literatur. SPEKTRUM DER AUGENHEILKUNDE 2017. [DOI: 10.1007/s00717-017-0331-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Abstract
In this commentary, we present two examples where perception is not only influenced by, but also in fact driven by, top-down effects: hallucinations and mental imagery. Crucially, both examples avoid all six of the potential confounds that Firestone & Scholl (F&S) raised as arguments against previous studies claiming to demonstrate the influence of top-down effects on perception.
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27
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Cognitive Penetrability of Perception in the Age of Prediction: Predictive Systems are Penetrable Systems. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s13164-015-0253-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Lana-Peixoto MA. Complex visual hallucinations in mentally healthy people. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:331-332. [PMID: 24863506 DOI: 10.1590/0004-282x20140050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/02/2014] [Indexed: 06/03/2023]
Affiliation(s)
- Marco A Lana-Peixoto
- Departamento de Neuro-Oftalmologia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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29
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Lindahl JR, Kaplan CT, Winget EM, Britton WB. A phenomenology of meditation-induced light experiences: traditional buddhist and neurobiological perspectives. Front Psychol 2014; 4:973. [PMID: 24427148 PMCID: PMC3879457 DOI: 10.3389/fpsyg.2013.00973] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 12/09/2013] [Indexed: 11/23/2022] Open
Abstract
The scientific study of Buddhist meditation has proceeded without much attention to Buddhist literature that details the range of psychological and physiological changes thought to occur during meditation. This paper presents reports of various meditation-induced light experiences derived from American Buddhist practitioners. The reports of light experiences are classified into two main types: discrete lightforms and patterned or diffuse lights. Similar phenomena are well documented in traditional Buddhist texts but are virtually undocumented in scientific literature on meditation. Within Buddhist traditions, these phenomena are attributed a range of interpretations. However, because it is insufficient and problematic to rely solely upon the textual sources as a means of investigating the cause or significance of these phenomena, these qualitative reports are also considered in relation to scientific research on light-related experiences in the context of sensory deprivation, perceptual isolation, and clinical disorders of the visual system. The typologies derived from these studies also rely upon reports of experiences and closely match typologies derived from the qualitative study of contemporary practitioners and typologies found in Buddhist literary traditions. Taken together, these studies also provide evidence in support of the hypothesis that certain meditative practices – especially those that deliberately decrease social, kinesthetic, and sensory stimulation and emphasize focused attention – have perceptual and cognitive outcomes similar to sensory deprivation. Given that sensory deprivation increases neuroplasticity, meditation may also have an enhanced neuroplastic potential beyond ordinary experience-dependent changes. By providing and contextualizing these reports of meditation-induced light experiences, scientists, clinicians, and meditators gain a more informed view of the range of experiences that can be elicited by contemplative practices.
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Affiliation(s)
- Jared R Lindahl
- Department of Religious Studies, Warren Wilson College Asheville, NC, USA
| | - Christopher T Kaplan
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University Providence, RI, USA
| | - Evan M Winget
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University Providence, RI, USA
| | - Willoughby B Britton
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University Providence, RI, USA
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30
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Cocchini G, Lello O, McIntosh RD, Della Sala S. Phantabulation: a case of visual imagery interference on visual perception. Neurocase 2014; 20:581-90. [PMID: 23962109 DOI: 10.1080/13554794.2013.826689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report the case of a 52-year old man who, following rupture of an anterior communicating artery aneurysm, presented with a phenomenon not previously described, which we have labelled "Phantabulation." Phantabulation is characterized by frequent and purposeful interactions with contextually appropriate imagined objects. We suggest that this phenomenon results from confusion between real and imagined objects, caused by failure to inhibit florid visual imagery, facilitated by cortical release mechanisms.
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Affiliation(s)
- Gianna Cocchini
- a Department of Psychology , Goldsmiths University of London , London , UK
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31
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Rosa AM, Silva MF, Ferreira S, Murta J, Castelo-Branco M. Plasticity in the human visual cortex: an ophthalmology-based perspective. BIOMED RESEARCH INTERNATIONAL 2013; 2013:568354. [PMID: 24205505 PMCID: PMC3800612 DOI: 10.1155/2013/568354] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/05/2013] [Accepted: 08/19/2013] [Indexed: 11/17/2022]
Abstract
Neuroplasticity refers to the ability of the brain to reorganize the function and structure of its connections in response to changes in the environment. Adult human visual cortex shows several manifestations of plasticity, such as perceptual learning and adaptation, working under the top-down influence of attention. Plasticity results from the interplay of several mechanisms, including the GABAergic system, epigenetic factors, mitochondrial activity, and structural remodeling of synaptic connectivity. There is also a downside of plasticity, that is, maladaptive plasticity, in which there are behavioral losses resulting from plasticity changes in the human brain. Understanding plasticity mechanisms could have major implications in the diagnosis and treatment of ocular diseases, such as retinal disorders, cataract and refractive surgery, amblyopia, and in the evaluation of surgical materials and techniques. Furthermore, eliciting plasticity could open new perspectives in the development of strategies that trigger plasticity for better medical and surgical outcomes.
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Affiliation(s)
- Andreia Martins Rosa
- Departamento de Oftalmologia, Centro Hospitalar e Universitário de Coimbra, 3000 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Maria Fátima Silva
- Visual Neuroscience Laboratory, IBILI, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Sónia Ferreira
- Visual Neuroscience Laboratory, IBILI, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Joaquim Murta
- Departamento de Oftalmologia, Centro Hospitalar e Universitário de Coimbra, 3000 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
- Visual Neuroscience Laboratory, IBILI, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Miguel Castelo-Branco
- Visual Neuroscience Laboratory, IBILI, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
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Charles Bonnet syndrome and Terson’s syndrome from subarachnoid hemorrhage: good news from bad news. Graefes Arch Clin Exp Ophthalmol 2013; 251:2255. [DOI: 10.1007/s00417-012-2233-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 12/03/2012] [Indexed: 10/27/2022] Open
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33
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Güçlü O, Senormancı O, Güçlü DG, Konkan R. Musical hallucinations of an unidentified melody. Gen Hosp Psychiatry 2013; 35:e7-8. [PMID: 23347456 DOI: 10.1016/j.genhosppsych.2012.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 12/13/2012] [Accepted: 12/17/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Oya Güçlü
- Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, İstanbul, Turkey
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34
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Reichert DP, Seriès P, Storkey AJ. Charles Bonnet syndrome: evidence for a generative model in the cortex? PLoS Comput Biol 2013; 9:e1003134. [PMID: 23874177 PMCID: PMC3715531 DOI: 10.1371/journal.pcbi.1003134] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 05/28/2013] [Indexed: 11/25/2022] Open
Abstract
Several theories propose that the cortex implements an internal model to explain, predict, and learn about sensory data, but the nature of this model is unclear. One condition that could be highly informative here is Charles Bonnet syndrome (CBS), where loss of vision leads to complex, vivid visual hallucinations of objects, people, and whole scenes. CBS could be taken as indication that there is a generative model in the brain, specifically one that can synthesise rich, consistent visual representations even in the absence of actual visual input. The processes that lead to CBS are poorly understood. Here, we argue that a model recently introduced in machine learning, the deep Boltzmann machine (DBM), could capture the relevant aspects of (hypothetical) generative processing in the cortex. The DBM carries both the semantics of a probabilistic generative model and of a neural network. The latter allows us to model a concrete neural mechanism that could underlie CBS, namely, homeostatic regulation of neuronal activity. We show that homeostatic plasticity could serve to make the learnt internal model robust against e.g. degradation of sensory input, but overcompensate in the case of CBS, leading to hallucinations. We demonstrate how a wide range of features of CBS can be explained in the model and suggest a potential role for the neuromodulator acetylcholine. This work constitutes the first concrete computational model of CBS and the first application of the DBM as a model in computational neuroscience. Our results lend further credence to the hypothesis of a generative model in the brain. The cerebral cortex is central to many aspects of cognition and intelligence in humans and other mammals, but our scientific understanding of the computational principles underlying cortical processing is still limited. We might gain insights by considering visual hallucinations, specifically in a pathology known as Charles Bonnet syndrome, where patients suffering from visual impairment experience hallucinatory images that rival the vividness and complexity of normal seeing. Such generation of rich internal imagery could naturally be accounted for by theories that posit that the cortex implements an internal generative model of sensory input. Perception then could entail the synthesis of internal explanations that are evaluated by testing whether what they predict is consistent with actual sensory input. Here, we take an approach from artificial intelligence that is based on similar ideas, the deep Boltzmann machine, use it as a model of generative processing in the cortex, and examine various aspects of Charles Bonnet syndrome in computer simulations. In particular, we explain why the synthesis of internal explanations, which is so useful for perception, goes astray in the syndrome as neurons overcompensate for the lack of sensory input by increasing spontaneous activity.
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Affiliation(s)
- David P Reichert
- Institute for Adaptive and Neural Computation, University of Edinburgh, Edinburgh, United Kingdom.
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35
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36
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Affiliation(s)
- Louis W. Lim
- National Healthcare Group Eye Institute, Tan Tock Seng, Singapore
| | - Kelvin Z. Li
- National Healthcare Group Eye Institute, Tan Tock Seng, Singapore
| | - Colin S. Tan
- National Healthcare Group Eye Institute, Tan Tock Seng, Singapore
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
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37
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Nguyen ND, Osterweil D, Hoffman J. Charles Bonnet Syndrome: Treating Nonpsychiatric Hallucinations. ACTA ACUST UNITED AC 2013; 28:184-8. [DOI: 10.4140/tcp.n.2013.184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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38
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Tan CS, Li KZ, Lim LW, Kiong NW. Occipital lobe epilepsy presenting with visual hallucinations (Charles Bonnet syndrome). Am J Emerg Med 2013; 31:624-5. [DOI: 10.1016/j.ajem.2012.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 11/28/2012] [Indexed: 10/27/2022] Open
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Lapid MI, Burton MC, Chang MT, Rummans TA, Cha SS, Leavitt JA, Boeve BF. Clinical phenomenology and mortality in Charles Bonnet syndrome. J Geriatr Psychiatry Neurol 2013; 26:3-9. [PMID: 23385362 DOI: 10.1177/0891988712473800] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIM Despite existing diagnostic criteria for Charles Bonnet syndrome (CBS), clinical manifestations vary greatly. We examined the clinical course and mortality of patients diagnosed with CBS. METHODS We conducted a retrospective chart review of patients with CBS. We collected demographic and clinical information and medical burden scores. Kaplan-Meier mortality curves were compared using log-rank test. Cox proportional hazard model was used for multivariate analysis and hazard ratio (HR). Mortality was compared to expected mortality from Minnesota population. RESULTS Seventy-seven patients with CBS had a mean age of 79.5 (standard deviation ± 13.0) and were predominantly Caucasian (97%) and female (73%). In all, 20 (26%) subsequently developed a dementia syndrome, most often Lewy body. A total of 46 (60%) deaths occurred with an average follow-up time of 33.0 months. Characteristics associated with mortality included older age (75-84 [HR 3.34, P = .029], >85 [HR 4.58, P = .007]) and renal disease (HR 3.39 with 95% confidence interval 1.31-8.80, P = .012). Medical burden scores were not associated with overall mortality. Mortality was high compared to Minnesota population (P < .0001). CONCLUSIONS A large proportion of patients with CBS developed dementia, and there was a high mortality rate associated with older age and renal disease. Medical burden was not associated with mortality.
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Affiliation(s)
- Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
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Contribution of sensory C-fiber neuron injury to mechanical dynamic allodynia in a murine model of postherpetic neuralgia. Neuroreport 2013; 24:137-41. [DOI: 10.1097/wnr.0b013e32835df4d9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lerario A, Ciammola A, Poletti B, Girotti F, Silani V. Charles Bonnet syndrome: two case reports and review of the literature. J Neurol 2013; 260:1180-6. [PMID: 23381616 DOI: 10.1007/s00415-013-6857-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 01/03/2013] [Accepted: 01/24/2013] [Indexed: 10/27/2022]
Abstract
Visual hallucinations (VHs) can be associated with a variety of clinical conditions, and are also experienced by healthy people due to visual impairment. The condition is known as Charles Bonnet Syndrome (CBS). The circumstances favoring VHs support the hypothesis that sensory deprivation enhances the ongoing activity of the visual system after sensory loss. Clinician should be aware that a significant proportion of visually impaired patients experience complex VHs, which are sometimes distressing. Herein, we report two cases of CBS. Case 1 is a 60-year-old man with visual impairment due to orbit pseudotumor in autoimmune hypothyroidism. Case 2 is an 87-year-old woman with Parkinson's disease and a 15-year history of intermittent complex VHs due to age-related macular degeneration in both eyes. In both cases investigations for alternative pathological causes of VHs were negative and, therefore, the aetiology of hallucinations was attributed to CBS. The course and treatment of CBS patients vary according to the nature of the visual dysfunction. Drug treatments remain partially satisfactory, with individual cases successfully treated with atypical antipsychotics. Nonpharmacological interventions aimed to reduce the visual pathway deprivation. Reassurance of the benign nature of CBS is essential to support patients and reduce caregiver's burden.
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Affiliation(s)
- Alberto Lerario
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy.
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Jan T, Del Castillo J. Visual hallucinations: charles bonnet syndrome. West J Emerg Med 2013; 13:544-7. [PMID: 23357937 PMCID: PMC3555593 DOI: 10.5811/westjem.2012.7.12891] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/27/2012] [Accepted: 07/09/2012] [Indexed: 11/11/2022] Open
Abstract
The following is a case of Charles Bonnet syndrome in an 86-year-old woman who presented with visual hallucinations. The differential diagnosis of visual hallucinations is broad and emergency physicians should be knowledgeable of the possible etiologies.
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Affiliation(s)
- Tiffany Jan
- University of Chicago, Department of Emergency Medicine, Chicago, Illinois
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Issa BA, Yussuf AD. Charles bonnet syndrome, management with simple behavioral technique. J Neurosci Rural Pract 2013; 4:63-5. [PMID: 23546356 PMCID: PMC3579052 DOI: 10.4103/0976-3147.105618] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Charles Bonnet syndrome occurs in visually impaired but cognitively normal individuals. This report describes a condition of vivid visual hallucination (phantom images) in an 85-year-old conscious man, who had been blind by bilateral progressively worsening glaucoma. This common, but rarely reported, condition was managed by behavioral approach of repeated blinking, intermittent eyes closure, and reassurance. While emotional, mood and cognitive disorders need to be ruled out, the condition, though frightening to the afflicted, is benign and remediable with simple, inexpensive approach. Health workers managing people with terminal blindness should always ask for the presence of hallucinations from their patients to forestall a preventable distress resulting from wrong perception without visual stimulus.
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Affiliation(s)
- Baba Awoye Issa
- Department of Behavioural Sciences, University of Ilorin, PMB 1515, Ilorin, Nigeria
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Melzack R, Katz J. Pain. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2012; 4:1-15. [DOI: 10.1002/wcs.1201] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Oaklander AL. Chapter 31 Neuropathological examination of peripheral nerves in painful neuropathies (neuralgias). HANDBOOK OF CLINICAL NEUROLOGY 2012; 81:463-XII. [PMID: 18808853 DOI: 10.1016/s0072-9752(06)80035-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
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Reichert DP, Series P, Storkey AJ. Homeostasis causes hallucinations in a hierarchical generative model of the visual cortex: the Charles Bonnet Syndrome. BMC Neurosci 2011. [PMCID: PMC3240433 DOI: 10.1186/1471-2202-12-s1-p319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Jang JW, Youn YC, Seok JW, Ha SY, Shin HW, Ahan SW, Park KY, Kwon OS. Hypermetabolism in the left thalamus and right inferior temporal area on positron emission tomography–statistical parametric mapping (PET–SPM) in a patient with Charles Bonnet syndrome resolving after treatment with valproic acid. J Clin Neurosci 2011; 18:1130-2. [DOI: 10.1016/j.jocn.2010.12.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 08/12/2010] [Accepted: 12/12/2010] [Indexed: 11/28/2022]
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van der Werf M, Thewissen V, Dominguez MD, Lieb R, Wittchen H, van Os J. Adolescent development of psychosis as an outcome of hearing impairment: a 10-year longitudinal study. Psychol Med 2011; 41:477-485. [PMID: 21272386 DOI: 10.1017/s0033291710000978] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND It has long been acknowledged that hearing impairment may increase the risk for psychotic experiences. Recent work suggests that young people in particular may be at risk, indicating a possible developmental mechanism. METHOD The hypothesis that individuals exposed to hearing impairment in early adolescence would display the highest risk for psychotic symptoms was examined in a prospective cohort study of a population sample of originally 3021 adolescents and young adults aged 14-24 years at baseline, in Munich, Germany (Early Developmental Stages of Psychopathology Study). The expression of psychosis was assessed at multiple time points over a period of up to 10 years, using a diagnostic interview (Munich Composite International Diagnostic Interview; CIDI) administered by clinical psychologists. RESULTS Hearing impairment was associated with CIDI psychotic symptoms [odds ratio (OR) 2.04, 95% confidence interval (CI) 1.10-3.81], particularly more severe psychotic symptoms (OR 5.66, 95% CI 1.64-19.49). The association between hearing impairment and CIDI psychotic symptoms was much stronger in the youngest group aged 14-17 years at baseline (OR 3.28, 95% CI 1.54-7.01) than in the older group aged 18-24 years at baseline (OR 0.82, 95% CI 0.24-2.84). CONCLUSIONS The finding of an age-specific association between hearing impairment and psychotic experiences suggests that disruption of development at a critical adolescent phase, in interaction with other personal and social vulnerabilities, may increase the risk for psychotic symptoms.
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Affiliation(s)
- M van der Werf
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON Graduate School of Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Katz J, Melzack R. A Conceptual Framework for Understanding Pain in the Human. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Vukicevic M. Frightening visual hallucinations: atypical presentation of Charles Bonnet syndrome triggered by the Black Saturday bushfires. Med J Aust 2010; 193:181-2. [PMID: 20678049 DOI: 10.5694/j.1326-5377.2010.tb03843.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 06/18/2010] [Indexed: 11/17/2022]
Abstract
Charles Bonnet syndrome (CBS) is a disorder in which psychologically normal people, often with vision impairment, experience complex visual hallucinations. The hallucinations are purely visual and do not occur in any other sensory modality, and people with CBS have full insight into the unreal nature of the hallucinations. This report describes the case of a CBS sufferer who experienced a distressing change in the nature of her visual hallucinations following a stressful event--the Black Saturday bushfires of February 2009.
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Affiliation(s)
- Meri Vukicevic
- Department of Clinical Vision Sciences, La Trobe University, Melbourne, VIC, Australia.
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