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Background: Charles Bonnet syndrome (CBS) refers to the experience of visual hallucinations occurring secondary to sight loss. Although there is an increasing amount of research on this phenomenon, CBS remains a lesser-known outcome of visual impairment, with limited research into the impact on the patient. Objectives: To explore the experiences and opinions of visually impaired military veterans with CBS regarding the impact of visual hallucinations. Design: Semi-structured qualitative interviews. Methods: Forty-six telephone interviews were conducted with members of Blind Veterans UK, a charity for visually impaired ex-service men and women. One-hundred and fifteen individuals at the charity with CBS were identified and invited to a semi-structured interview (participation rate – 40%). Qualitative data was transcribed and analysed using thematic analysis. Results: Four overarching themes were identified: (1) impact of CBS (2) understanding and management of CBS (3) awareness of CBS (4) recommendations. Negative impact of CBS included feelings of fear, annoyance and disruptions to daily life and quality of life. Negative appraisal of CBS was not necessarily related to negative hallucination content. Participants expressed the value of increased awareness amongst patients and health care professionals. Knowledge and understanding of CBS provided reassurance and was considered an effective strategy to mitigate the negative impact of the condition. Conclusion: Regardless of hallucination content, CBS has a substantial impact on the lives of people with visual impairment. Increased awareness and information can help to support individuals to manage their CBS more effectively. However, the findings from this study cannot be generalized to people without a military background so further research is required to understand and optimize support for military veterans and civilians with CBS. [ABSTRACT FROM AUTHOR]

Background: Charles Bonnet syndrome (CBS) refers to the presence of visual hallucinations experienced by people, without cognitive, or psychiatric deficits that are related to sight loss. This study surveyed younger adults (18–60 years) with visual impairments, to assess the impact of anxiety, depression, loneliness, and the COVID-19 lockdowns on their visual hallucinations. Objectives: To examine the association between depression, anxiety, loneliness, the COVID-19 lockdowns, and visual hallucinations in younger adults with CBS. Design: An online survey was used with an opportunistic sample of people with sight loss. Methods: A survey assessed the frequency, duration, and valence of visual hallucinations using a five-point Likert scale, and assessed anxiety, depression, and loneliness using the Hospital Anxiety and Depression Scale and UCLA (University of California, Los Angeles) loneliness scale, respectively. Results: Twenty-nine young adults (21 female), aged 22–59 years with vision loss from a range of causes, who experience visual hallucinations, were included in the survey. The majority (76%) of participants had experienced hallucinations within the past week, with 83% stating they occurred frequently or very frequently. For 59% of participants, the hallucinations were of short duration (<2 min), but 34% experienced them continuously. Hallucinations were regarded as being unpleasant by 34% of participants, while 59% rated them as being neutral. The incidence of depression and anxiety was high in the sample (48% and 65%, respectively), and 65% experienced loneliness. Participants with scores indicating anxiety or borderline anxiety had significantly more frequent hallucinations than other participants and a similar trend was found for depression. The COVID-19 lockdowns exacerbated hallucinations in 24% of cases, but for 68% they remained unchanged. Conclusion: The study demonstrated that CBS is observed in people of all ages, with sight loss arising from a wide range of underlying causes. Depression, anxiety, and loneliness are observed in many cases of CBS. While there was some indication that high anxiety, and to some extent depression, was associated with frequent hallucinations, no other relationships were found between the psychosocial factors (depression, anxiety, and loneliness) and the frequency, duration, or valence of their visual hallucinations. [ABSTRACT FROM AUTHOR]

Background: Charles Bonnet syndrome (CBS) is a condition in which people with vision loss experience complex visual hallucinations. These complex visual hallucinations may be caused by increased excitability in the visual cortex that are present in some people with vision loss but not others. Objectives: We aimed to evaluate the association between γ-aminobutyric acid (GABA) in the visual cortex and CBS. We also tested the relationship among visually evoked responses, functional connectivity, and CBS. Design: This is a prospective, case-controlled, cross-sectional observational study. Methods: We applied 3-Tesla magnetic resonance spectroscopy, as well as task-based and resting state (RS) connectivity functional magnetic resonance imaging in six participants with CBS and six controls without CBS. GABA+ was measured in the early visual cortex (EVC) and in the lateral occipital cortex (LOC). Participants also completed visual acuity and cognitive tests, and the North-East Visual Hallucinations Interview. Results: The two groups were well-matched for age, gender, visual acuity and cognitive scores. There was no difference in GABA+ levels between groups in the visual cortex. Most participants showed the expected blood oxygenation level dependent (BOLD) activation to images of objects and the phase-scrambled control. Using a fixed effects analysis, we found that BOLD activation was greater in participants with CBS compared to controls. Analysis of RS connectivity with LOC and EVC showed little difference between groups. A fixed effects analysis showed a correlation between the extent of functional connectivity with LOC and hallucination strength. Conclusion: Overall, our results provide no strong evidence for an association between GABAergic inhibition in the visual cortex and CBS. We only found subtle differences in visual function and connectivity between groups. These findings suggest that the neurochemistry and visual connectivity for people with Charles Bonnet hallucinations are comparable to a sight loss population. Differences between groups may emerge when investigating subtle and transient changes that occur at the time of visual hallucinations. Plain language summary: Brain imaging in Charles Bonnet syndrome In Charles Bonnet Syndrome (CBS), people with sight loss start to see hallucinations that they know are not real but can be disturbing. In this study we used MRI scanning to measure how the chemistry in the visual brain differs in people with CBS and those who have sight loss but no hallucinations. Surprisingly we did not find any differences in chemistry between these groups, suggesting that their brains do not differ greatly. Any differences in how their visual brain works may be too small to measure, or only present when people hallucinate. [ABSTRACT FROM AUTHOR]

Background: Charles Bonnet syndrome (CBS) is a condition characterised by the occurrence of vivid and complex visual hallucinations in individuals with visual impairment. Objective: To explore the relationship between emotional distress and the perceived impact of CBS symptoms on participants' lives. We tested the hypothesis that heightened negative affect was associated with a more negative appraisal of CBS symptoms, increased self-reported loneliness, and poorer quality of life (QOL). Design: Cross-sectional. Methods: Participants recruited predominantly via vision-related charities rated their hallucinations and their impact on a Likert scale. Loneliness and negative affect were assessed with the Three-Item Loneliness Scale and Positive and Negative Affect Schedule. Health index (EQ-5D-3L) and vision-related QOL (VF-9) were also assessed. Correlation analysis and multi-variable regression determined the relation between survey responses. Results: The majority of 126 respondents (81%) were aged 65+ years and 84% reported active CBS symptoms. Fifty-five percent of respondents rated impact of CBS as negative and no-one rated the impact as 'very pleasant'. A statistically significant correlation was found between impact of CBS and negative affect (p ⩽ 0.001; rho = −0.34) and impact of CBS and loneliness (p = 0.017; rho = −0.21). The relation between negative affect and CBS impact remained statistically significant when accounting for the impact of loneliness and the relationship between loneliness and CBS effect (p = 0.002, adj R 2 = 0.1). A statistically significant correlation between loneliness and negative affect (p ⩽ 0.001; rho = 0.55) was also found. Conclusion: Respondents experiencing negative emotions were more likely to perceive the impact of CBS symptoms as negative and report greater feelings of loneliness. Negative affect is an important consideration when assessing people with CBS. Plain language summary: Understanding the impact of visual hallucinations in Charles Bonnet syndrome Charles Bonnet Syndrome (CBS) is a condition where people with vision problems experience vivid and complex visual hallucinations. In this study, we wanted to see how feeling upset or lonely might affect how people with CBS view their symptoms. We asked 126 adults, most of whom were over 65 years old, about their hallucinations and how they felt about them. We also asked about feelings of loneliness and general emotional well-being. We found that the more negative emotions people felt, the more they tended to see their CBS symptoms in a negative light and feel lonelier. This suggests that understanding and addressing negative emotions is crucial when helping people with CBS. [ABSTRACT FROM AUTHOR]

Purpose: Complex visual hallucinations are rarely seen in neurooncology. They are commonly observed alongside psychotic symptoms in schizophrenia or dementia, in Parkinson's or Lewy-body disease, after opioid medications or anesthesia, and, in particular, they appear with visual impairments. Methods: Here we report two normal-sighted and mentally healthy patients with unusual visual hallucinations after the resection and irradiation of brain metastases, the main features of which were persistent colorful and meaningful images with hallucinatory perseveration. Results: These cases demonstrate the occurrence of complex visual hallucinations after resection of visual cortices as an effect of deafferentation, so-called visual release hallucinations or phantom images, similar to phantom pain after amputation of a limb. Conclusion: This case serves to heighten awareness in the radiooncology practitioner of the occurrence of visual release hallucinations (Charles Bonnet syndrome) related to multidisciplinary treatment of brain metastases. [ABSTRACT FROM AUTHOR]

Background Charles Bonnet syndrome (CBS) is a condition characterized by vivid, complex visual hallucinations in individuals with visual impairment. Despite its prevalence among the elderly and those with degenerative eye diseases, CBS remains underdiagnosed and undertreated due to a lack of awareness and misconceptions surrounding its etiology and management. Case Report A 51-year-old man presented to the emergency room after falling off his bicycle without wearing a helmet. Head imaging revealed a small right frontoparietal traumatic subarachnoid hemorrhage with an associated trace subdural hematoma along the right parietal convexity. Subsequently, he developed non-light perceiving vision loss, after which he began experiencing visual hallucinations. Conclusion CBS is frequently overlooked or left untreated. Research on diagnosing and managing CBS following head trauma is limited. Therefore, clear diagnostic criteria for CBS and a better understanding of its underlying mechanisms are needed to improve diagnosis and management strategies.

Background: Visual hallucinations occur in a variety of clinical settings and may be extremely troubling to individuals experiencing them. We report a case of delayed-onset visual hallucinations 20 years after initiation of medical therapy to highlight the importance of considering iatrogenic causes when managing such patients. Case Report: An 88-year-old woman presented with recurring hypnopompic formed visual hallucinations for the past 20 years. These hallucinations began 20 years after she was started on propranolol to treat her systemic hypertension 40 years earlier. Her hallucinations began with plants and insects. They later progressed to vivid, detailed human figures of different races, ages, genders, and religious personnel such as monks, nuns, and priests. The hallucinations occurred almost daily and upon awakening from sleep. Each episode of visual hallucinations lasted for 10 to 20 seconds, occurring when she awoke after dozing off, multiple times each day. The patient became mentally distressed by her visual hallucinations and began to attribute them to supernatural causes. After substituting her propranolol with atenolol, the patient’s hallucinations decreased dramatically and became rare and non-frightening. The dramatic improvement suggested a drug-induced etiology. Conclusions: Our case illustrates the importance of considering iatrogenic causes in the diagnosis of visual hallucinations and having a high index of suspicion, even if the onset of symptoms is delayed for many years after initiation of therapy. This iatrogenic condition can easily be rectified to drastically improve the quality of life in affected patients. [ABSTRACT FROM AUTHOR]

There is a lack of high‐quality evidence for pharmacological treatment options for Charles Bonnet syndrome and guidelines do not recommend any particular pharmacological option. Here, a case is presented of an older age male who developed complex visual hallucinations following stroke and central retinal artery occlusion (one after the other leading to loss of vision in both eyes), thus indicative of CBS secondary to vascular pathology. This case demonstrates a sustained progressive improvement in hallucinations in CBS following the initiation of acetylcholinesterase inhibitor, donepezil. [ABSTRACT FROM AUTHOR]

Charles Bonnet syndrome(CBS)refers to hallucinations resulting from visual pathway damage in individuals without neuropsychiatric disorders. CBS patients typically have insight into the unreality of their hallucinations, and the disorder may be episodic, periodic, or chronic. The condition's prevalence varies from 0.4% to 30% due to the absence of agreed diagnostic criteria for CBS and some patients' reluctance to acknowledge hallucinations. Massive studies have demonstrated an association between CBS and ocular diseases, such as age-related macular degeneration and glaucoma. Additionally, there have been reports of CBS occurring after ophthalmic surgery or medication. Therefore, clinicians should be vigilant in diagnosing CBS promptly and reassuring patients. There is a lack of literature on CBS in ophthalmology, and further research is needed to explore its pathogenesis and diagnostic and therapeutic options. This article reviews some of the studies related to CBS in recent years.

Introduction: We report an epileptic patient who experienced hallucinatory visual experiences of autobiographical memories from her past. These visual experiences were confined to the lower left quadrant of her visual field. Methods: We carried out a single-case study that used brain-imaging, EEG and behavioural methods to study this patient. Results: We found that this patient had an incomplete left inferior homonymous quadrantanopia due to a lesion of right occipital cortex, and also that she showed neurological abnormalities in right temporal cortex, a region that is part of the brain's autobiographical-memory circuit. Conclusion: We attribute the occurrence of this patient's autobiographical-memory hallucinations to the combination of degraded visual input to right temporal cortex plus hyperexcitability of that region. [ABSTRACT FROM AUTHOR]

Background: Charles Bonnet syndrome (CBS) is characterized by visual hallucinations occurring in people with visual impairment. CBS can negatively impact psychological well-being, and the COVID-19 pandemic period was associated with an exacerbation of symptoms. Objectives: To compare clinical practice patterns and reporting of CBS at a tertiary eye care center between an interval prior to the COVID-19 pandemic and an interval during the pandemic. Design: Retrospective chart review. Methods: A search of electronic medical records for all suspected CBS cases was conducted between 1 March 2019 and 29 February 2020 (prior pandemic interval) and between 1 September 2020 and 29 August 2021 (peri-pandemic interval). Data retrieved from records included patient demographics, visual acuity at the time of CBS onset, type of hallucinations, reporting healthcare professional, management strategies and patient-reported impact of hallucinations. Results: In total, 223 appointments referred to CBS in 156 patients at the prior interval, while 239 appointments referred to CBS in 155 patients at the peri-pandemic interval, representing 0.07% and 0.09% of all hospital attendance, respectively. Clinical subspecialty where CBS was most commonly reported was medical retina, and a greater proportion of patients at both time intervals were female. Types of hallucinations, management strategies and patient-reported impact were seldom reported, although documentation improved at the latter interval. Conclusion: Practice patterns and patient characteristics were similar between the two intervals; however, subtle differences suggest a growing awareness of CBS. Targeted interventions in high-burden clinical subspecialties may encourage reporting and improve documentation of CBS. [ABSTRACT FROM AUTHOR]

ABSTRACT Musical hallucinations and musical obsessions are distinct phenomena. The first can be understood as a manifestation of the musical ear syndrome, which produces deafferentation auditory hallucinations, while the latter is an obsessive symptom of obsessive-compulsive disorders. Both symptoms are often poorly understood and mistaken for one another or for signs of psychotic disorders. We report two cases, one characterized by musical hallucinations and the other by musical obsessions, both with comorbid hearing impairment, which is the main confounding factor in their differential diagnosis. We critically compare the two cases and their key features, allowing diagnostic differentiation and a targeted therapeutic approach.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction. Complex visual hallucinations with retention of insight due to visual impairment are key symptoms of Charles Bonnet syndrome. The syndrome is a standalone diagnosis in the International Classification of Diseases, 11th Revision. Nevertheless, in clinical praxis, it is often misdiagnosed as psychosis or early stages of dementia, and it goes underreported by patients because of the fear of being diagnosed with a mental illness. Case report. We presented four elderly patients, who were referred for psychiatric consultation due to visual hallucinations, with preserved insight, but with impaired vision. All four patients had complex, vivid, and colorful hallucinations consisting of realistic objects, people, animals, or scenery that tend to recur. Their emotional response and impact on quality of life differed, and psychopharmacotherapy was determined according to their psychological symptoms. Empathic explanation of the symptoms' origin and reassurance of the absence of mental illness for patients and caregivers were of vital importance in all cases. Conclusion. With the aging of the population, the number of patients with impaired vision also increases, and the importance of a multidisciplinary approach in the diagnostic procedures and treatment of Charles Bonnet syndrome is emphasized. Increased awareness of clinical characteristics and therapeutic approaches is required among all physicians who are in contact with elderly and/or impaired vision patients. [ABSTRACT FROM AUTHOR]

The aim of this article is to explain age-related macular degeneration (AMD) and how it impacts on the wellbeing of patients in the community setting. It explores the anatomy and physiology associated with AMD, its symptoms and treatment, and goes on to discuss related nursing care. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Charles Bonnet syndrome presents with complex visual hallucinations in a visually impaired or blind person. The case highlights complex neuropsychiatric manifestations due to pituitary macroadenoma in geriatrics requiring multi‐collaborative care. An 81‐year‐old man presented with a 3‐year history of vivid visual hallucinations preceded by visual impairment and recurrence of a pituitary macroadenoma. Remission of hallucination occurred within 2 weeks of 1.5 mg of haloperidol per oral once daily; this is a rare case of Charles Bonnet syndrome after recurrent pituitary macroadenoma. [ABSTRACT FROM AUTHOR]

Introduction: Charles Bonnet syndrome (CBS) is a condition related to patients having complex visual hallucinations and visual loss due to ophthalmologic disease, without cognitive impairment. CBS is an important differential diagnosis of dementia syndromes, and the correct diagnosis has a great impact on the quality of life of those who suffer from the stigma of psychiatric disease. Objective: The objective of the present study is to determine the impact and review symptoms of CBS in patients with visual loss due to age-related macular degeneration (AMD) by using a questionnaire. Method: Sixty patients suffering from AMD were forwarded from the Retina Sector of the Ophthalmology Service of the Hospital do Servidor Público Estadual de São Paulo to the Low Vision Sector for a cognitive assessment questionnaire. Results: Of the 60 patients studied, 10 were diagnosed with CBS, thus representing 16.6% of the incidence of CBS cases in individuals with AMD. Among these 10 cases, males represented 30% versus females who represented 70% of the total. Patients over 80 years old represented 50% of those who were diagnosed with CBS. CBS represents an important co-diagnosis in AMD patients. Conclusion: The research highlights the utility of the cognitive assessment questionnaire as a valuable tool for easily diagnosing the syndrome in patients with AMD. This tool facilitates the identification of the condition, enabling the recommendation of appropriate clinical treatments and the provision of essential psychosocial support.

Key Clinical Message Charles Bonnet syndrome presents with complex visual hallucinations in a visually impaired or blind person. The case highlights complex neuropsychiatric manifestations due to pituitary macroadenoma in geriatrics requiring multi‐collaborative care. Abstract An 81‐year‐old man presented with a 3‐year history of vivid visual hallucinations preceded by visual impairment and recurrence of a pituitary macroadenoma. Remission of hallucination occurred within 2 weeks of 1.5 mg of haloperidol per oral once daily; this is a rare case of Charles Bonnet syndrome after recurrent pituitary macroadenoma.

Introduction. Complex visual hallucinations with retention of insight due to visual impairment are key symptoms of Charles Bonnet syndrome. The syndrome is a standalone diagnosis in the International Classification of Diseases, 11th Revision. Nevertheless, in clinical praxis, it is often misdiagnosed as psychosis or early stages of dementia, and it goes underreported by patients because of the fear of being diagnosed with a mental illness. Case report. We presented four elderly patients, who were referred for psychiatric consultation due to visual hallucinations, with preserved insight, but with impaired vision. All four patients had complex, vivid, and colorful hallucinations consisting of realistic objects, people, animals, or scenery that tend to recur. Their emotional response and impact on quality of life differed, and psychopharmacotherapy was determined according to their psychological symptoms. Empathic explanation of the symptoms’ origin and reassurance of the absence of mental illness for patients and caregivers were of vital importance in all cases. Conclusion. With the aging of the population, the number of patients with impaired vision also increases, and the importance of a multidisciplinary approach in the diagnostic procedures and treatment of Charles Bonnet syndrome is emphasized. Increased aware-ness of clinical characteristics and therapeutic approaches is required among all physicians who are in contact with elderly and/or impaired vision patients.

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. [ABSTRACT FROM AUTHOR]

Age‐related macular degeneration (AMD) is the leading cause of blindness in the developed world and primarily affects the older population. This project developed a virtual reality (VR) simulation of AMD that allows users to alter the intensity of the impairments while using the simulation, as well as offering a guided timelapse of the possible progression of the condition. The simulation also demonstrates Charles Bonnet Syndrome (CBS), showing numerous different types of visual hallucinations that may occur alongside AMD. [ABSTRACT FROM AUTHOR]

Visual hallucinations after central or peripheral impairment, commonly called Charles Bonnet syndrome, are often highly distressing and with few available treatment options. Here we report a case where an adolescent developed severely distressing visual hallucinations after hypoxic damage to the occipital cortex following a suicide attempt. The patient received active and sham occipital continuous theta-burst stimulation (cTBS) in a single-case experimental research design and a subsequent open phase, to evaluate cTBS as a Charles Bonnet treatment. The visual hallucinations seemed to decrease more during active than sham cTBS in the blind phase, and in the following week of repeated five daily treatments they almost disappeared. A normalization of increased activity in the lateral visual network after cTBS was observed on a functional magnetic resonance imaging resting-state analysis compared with 42 healthy controls. Visual evoked potentials stayed largely unchanged both in the sham-controlled blind phase and the subsequent open phase. During the two weeks after the open phase with repeated cTBS sessions, the visual hallucinations gradually reappeared and almost returned to the baseline level. Our findings suggest that active cTBS over the primary visual cortex can reduce visual hallucinations through modulation of downstream visual regions, though the effect is temporally limited. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: Age-related macular degeneration (AMD) is the most prevalent cause of irreversible visual loss in the developed world. In late stages, it may lead to extremely low visual acuities, especially when associated with geographic atrophy or choroidal neovascularization. According to recent literature, Charles Bonnet syndrome (CBS) may be a rather common feature of late AMD. Methods: One hundred patients with late-stage age-related macular degeneration were actively asked whether they had symptoms of Charles Bonnet syndrome. Those that answered positively underwent a comprehensive questionnaire about the details of the visual hallucinations. Results: The following factors were significantly associated with Charles Bonnet syndrome: older age (+6.3 years; p=0.003), lower visual acuity in the better eye (Charles Bonnet Syndrome Group: 0.11; Non-Charles Bonnet Syndrome Group: 0.42; p=0.005) and female sex (Charles Bonnet Syndrome Group: 88%; Non-Charles Bonnet Syndrome Group: 43%; p=0.02). The visual hallucinations occurred mainly straight ahead (n=5), once per day (n=4), at no particular time (n=6), lasted some minutes (n=5), and disappeared after blinking (n=3) or looking away (n=3). The majority of patients lived alone (n=7), had not told anyone about the hallucinations (n=6), and associated the episodes with severe distress (n=5). Conclusion: Charles Bonnet syndrome was fairly prevalent in this late-stage age-related macular degeneration population. Our sample shows the importance of directly asking subjects about Charles Bonnet syndrome since they are often reluctant to admit to having visual hallucinations. Reassurance about its benignity is crucial to improve their quality of life.

ObjectiveTo analyze the highlights of diagnosis and treatment of Charles Bonnet syndrome （CBS） and improve the level of diagnosis and treatment of CBS. MethodsOne case of CBS was reported. Literature review was conduced from PubMed, SinoMed,CNKI, Wanfang Data, Chongqing VIP and CMAPH using the searching words of “Charles Bonnet syndrome”, “hallucination” and “visual hallucination” in English and Chinese. Clinical data of retrieved cases were collected and analyzed. Results The patient presented with visual hallucination as the initial manifestation and complained of seeing “an invisible small-sized man” at home, whereas the patient understood that it was visual hallucination. No abnormality was found in mental assessment. The patient’s insight was not impaired and no other patterns of hallucination were found. The diagnosis of CBS was eventually confirmed. Cognitive therapy was given to this patient to deepen the understanding of CBS and reduce psychological burden. Fourteen CBS cases were retrieved by literature review, and they developed different patterns of visual hallucination. No effective drugs were available for visual hallucination. Conclusions It is difficult to make a diagnosis of CBS, there is no clear and effective treatment for it. Clinicians should pay more attention to improve the ability of diagnosis and treatment of CBS and lower the rates of misdiagnosis and mistreatment.

Objective: Age-related macular degeneration (AMD) is the most prevalent cause of irreversible visual loss in the developed world. In late stages, it may lead to extremely low visual acuities, especially when associated with geographic atrophy or choroidal neovascularization. According to recent literature, Charles Bonnet syndrome (CBS) may be a rather common feature of late AMD. Methods: One hundred patients with late-stage age-related macular degeneration were actively asked whether they had symptoms of Charles Bonnet syndrome. Those that answered positively underwent a comprehensive questionnaire about the details of the visual hallucinations. Results: The following factors were significantly associated with Charles Bonnet syndrome: older age (+6.3 years; p=0.003), lower visual acuity in the better eye (Charles Bonnet Syndrome Group: 0.11; Non- Charles Bonnet Syndrome Group: 0.42; p=0.005) and female sex (Charles Bonnet Syndrome Group: 88%; Non-Charles Bonnet Syndrome Group: 43%; p=0.02). The visual hallucinations occurred mainly straight ahead (n=5), once per day (n=4), at no particular time (n=6), lasted some minutes (n=5), and disappeared after blinking (n=3) or looking away (n=3). The majority of patients lived alone (n=7), had not told anyone about the hallucinations (n=6), and associated the episodes with severe distress (n=5). Conclusion: Charles Bonnet syndrome was fairly prevalent in this late-stage age-related macular degeneration population. Our sample shows the importance of directly asking subjects about Charles Bonnet syndrome since they are often reluctant to admit to having visual hallucinations. Reassurance about its benignity is crucial to improve their quality of life. [ABSTRACT FROM AUTHOR]

Objectives: Friedreich's ataxia (FA) is the most common hereditary ataxia, characterized by multisystemic manifestations including neurological, cardiological, and skeletal abnormalities. In this study, we aimed to analyze the incidences of disease-related and unrelated comorbidities occurring in different stages of the disease progression.Methods: We analyzed longitudinal data from a 10-year prospective observational study in a cohort of 175 FA patients with disease onset < 25 years. We analyzed the time of diagnosis for the most frequently reported medical conditions, with respect to age and disease duration of each patient.Results: In the early stage of the disease, scoliosis (53.3%), hypertrophic cardiomyopathy (46.7%), and pes cavus (33.3%) were the most frequently diagnosed conditions, sometimes occurring even before the onset of ataxia. Diabetes, bone fractures, and depression have the same incidence at all disease stages. In patients with > 20 years of disease duration, the most frequent complications were hearing and visual loss (20% and 26%), arrhythmias (16%), and psychosis (18%). Thirteen patients presented hallucinations/delusions in the absence of neurological acute events or mental illness predisposing to psychotic manifestations. Six of these patients fulfill the diagnostic criteria for Charles Bonnet syndrome.Conclusions: Incidence of FA-related medical conditions varies according to disease duration. In patients with very long disease duration, we observed an unexpectedly high incidence of visual and auditory pseudo-hallucinations that were not previously reported in FA patients. We hypothesized that these late complications may be possibly related to the severe sensory deafferentation syndrome observed in the advanced stages of FA disease. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

We report a patient’s challenging case who suffered two acute ischaemic strokes, first in the right occipital lobe and later in the right dorsolateral thalamus (with affection of the lateral geniculate nucleus) who developed a yellow-tinted left homonymous visual hemi-field. No previously described case matched our peculiar symptom presentation in combination with the described brain lesions. Especially, the visual phenomena of patients with these brain lesions that were up until now described in literature were complex and vivid visual hallucinations. Here, we discuss possible explanations and mechanisms of this visual phenomenon (acquired hemidyschromatopsia, peduncular hallucinosis, focal epilepsy with visual symptoms, visual hallucinations) and in light of the current literature, we argue that the most likely explanation is a form of simple visual hallucination due to release phenomena (Charles Bonnet syndrome).

Purpose: Chloropsia (green-colored vision) is an extremely uncommon and relatively unstudied clinical finding. We report a case where cerebral chloropsia was the presenting symptom of the Charles Bonnet syndrome. Observations: A 66-year-old male physician with a previous ocular history of advanced bilateral primary open-angle glaucoma presented with acute, diffuse chloropsia, which he described as “light green and oval-shaped.” The patient was not taking any drugs that commonly cause altered color perception and did not have a previously diagnosed psychiatric disorder. Ophthalmic examination findings showed poor visual acuity, central visual field loss, and altered color perception in both eyes. Common laboratory tests and visual imaging showed no abnormalities that could be associated with the patient's symptoms. Conclusions and Importance: Our patient meets all diagnostic criteria for Charles Bonnet syndrome, even though, to the best of our knowledge, chloropsia has never been previously associated with this disorder. Physicians should monitor patients for altered color perception, which cannot be explained by other ocular, psychiatric, or systemic mechanisms, as this could be a sign of Charles Bonnet syndrome.

Objective: Visual release hallucinations are perceptual disturbances that occur in individuals who have experienced vision loss. Almost 50 million people worldwide are believed to experience visual release hallucinations, yet they are profoundly underdiagnosed. Although first described within the Charles Bonnet syndrome, the paradigm underlying this syndrome precludes their consideration in many populations, such as those with underlying psychiatric illness or dementia. Consequently, visual release hallucinations have rarely been studied in patients presenting with psychosis. We conducted a scoping review to determine whether visual-release hallucinations occur in psychotic patients., Methods: The PubMed research database was searched from inception through April 2023. Cases were collected reporting on psychotic patients experiencing suspected visual release hallucinations. Individual treatment courses and responses were extracted., Results: Thirteen cases compiled from 11 different studies were summarized to provide baseline characteristics and overall trends in treatment response. Most patients did not remit from pharmacological management alone. All patients who received reafferentation therapy remitted, though many were not candidates. Almost half of the patients did not achieve remission., Conclusions: Visual release hallucinations can manifest in psychosis and may contribute to treatment-resistant psychosis among psychiatric populations. A shift in our understanding of visual release hallucinations may aid their recognition in psychotic patients by shifting the focus toward visual release features. Recognizing release features among patients with hallucinatory conditions may open new treatment avenues for managing patients with psychosis. A preliminary screening index for visual release features is provided to support this shift.

Charles Bonnet syndrome (CBS) describes the presence of hallucinations in patients with poor or deteriorating vision. The physician awareness of CBS is low, despite reporting of CBS hallucinations occurring in a range of ocular and central nervous system conditions. Following mild traumatic brain injury (mTBI), patients can experience visual or oculomotor dysfunction. As such, it is possible that CBS might present following mTBI. An adult male suffered an mTBI and whiplash injury following a motor vehicle accident. He developed persistent post-concussion symptoms (PPCS) including headaches and vestibular and visual disturbances. He reported experiencing visual hallucinations eight months post-mTBI and was diagnosed with CBS. Interventions for PPCS and hallucinations have persisted for five years. The treatment options for CBS are limited and the patient's PPCS made participating in visual therapy challenging. Physicians assessing patients following mTBI should be aware of CBS and should take PPCS into consideration when recommending treatments for CBS., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Dr. Ranita Manocha declare(s) a grant from McCaig Institute for Bone and Joint Health. Dr. Ranita Manocha declare(s) a grant from The Ehlers-Danlos Society. Dr. Ranita Manocha declare(s) a grant from Canadian Academy of Sport and Exercise Medicine. Dr. Chantel Debert declare(s) a grant from Hotchkiss Brain Institute. Dr. Chantel Debert declare(s) a grant from Province of Alberta. Dr. Ranita Manocha declare(s) a grant from University of Calgary. Dr. Chantel Debert declare(s) a grant from National Football League. Dr. Chantel Debert declare(s) a grant from Canadian Department of National Defense. Dr. Ranita Manocha declare(s) a grant from Alberta Health Services. Dr. Chantel Debert declare(s) a grant from Pfizer Pharmaceuticals. Dr. Ranita Manocha declare(s) a grant from Natural Sciences and Engineering Research Council of Canada. Dr. Ranita Manocha declare(s) non-financial support from Canadian Association of Physical Medicine and Rehabilitation. Dr. Chantel Debert declare(s) Expert panelist from Teva Pharmaceuticals. Dr. Chantel Debert declare(s) a grant from Canadian Institute of Health Research. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Campbell et al.)

The UK has a higher than global average older population. In 2017, approximately 18% of the UK population were aged 65 years or over and this figure is projected to grow to almost 21% by 2027. The risk of sensory impairment increases with age and many older people are living with varying degrees of hearing impairment, visual impairment, or both. Similarly, the risk of developing dementia increases significantly with age. Hearing and visual impairment are common among older people with dementia, and have been linked to reduced functioning, poor quality of life, and increased carer burden. It has therefore been suggested that improving hearing and/ or vision in a person with dementia can have a positive impact on their health and wellbeing. This paper considers the scale of the issue and how the symptoms and issues associated with sensory impairment and/or dementia can be misinterpreted through the lens of two case studies. [ABSTRACT FROM AUTHOR]

We report a case of an 84-year-old female who presented following a fall from standing height. There was immediate loss of vision in the right eye. On day 3 of admission, the patient described seeing hallucinations in the right eye. She described seeing children playing in the garden while sitting in the hospital bed. She was found to have an indirect traumatic optic neuropathy with an associated Charles Bonnet syndrome. The patient underwent conservative management and on 2 weeks follow-up her right eye vision improved to hand motions. To our knowledge, there is no reported case of this kind in the literature.

Objectives: It is believed that inadequate environmental light, especially in facilities such as care homes, contribute to the diurnal changes of behavioural and psychological symptoms of dementia (BPSD) historically referred to as "sundowning syndrome". Conceptual models of sundowning phenomena have shifted emphasis from the role of light in vision (image forming) to its role in circadian rhythm modulation. However, the grounds for this change are unclear and the evidence on which it is based has not been examined comprehensively.Methods: We have searched literature on sundowning syndrome and its association with light and studies evaluating BPSD, behavioural rhythm and environmental light in care homes in four databases (PubMed, Web of Science, Embase and Cochrane Library) from inception to 31 January 2021.Results: Of the nine studies investigating light, behavioural rhythm and BPSD in care homes identified, we found evidence that insufficient natural light exposure was associated with worsening of BPSD and disrupted activity rhythm but it was not clear whether this related to image forming or disrupted circadian rhythm. There was a paucity of evidence in relation to the role of low levels of light for image forming in the context of a specific BPSD symptom: visual hallucinations. We also found literature on the possible role of light outside the visible spectrum influencing cognition. Based on the evidence, we proposed a new model integrating different components of light in BPSD and sundowning syndrome that combines its image forming and circadian roles.Conclusions: Inadequate light may be a risk factor for BPSD and sundowning syndrome for dementia patients through a range of different mechanisms. It is recommended that multiple neuro-endocrinological and socio-environmental factors relevant to light such as adjusting the environmental setting, increasing light exposure, and scheduling activities should be considered when treating dementia patients with BPSD. [ABSTRACT FROM AUTHOR]

Background: Visual hallucinations (VH) have mainly been considered as late symptoms of Parkinson's disease (PD); however, minor forms of VH also occur in early stages of the disease. Initially dopaminergic overstimulation was discussed as the cause and later on VH have been considered as an early red flag of dementia in PD. Objective: The present study analyzed whether the pathophysiological concept of VH has been enlarged in recent years. Material and methods: Clinical, pharmacological, neuropathological as well as functional magnetic resonance imaging studies dealing with VH were reviewed. A systematic classification in monomodal and multimodal models of VH is proposed. The applicability to various forms of VH and various triggering situations is critically examined. Results: Reduction of the visual information input, erroneous visual processing, attention deficits, and dysfunctional connectivity between various cerebral networks have been shown. There is partial overlapping with the Lhermitte syndrome and the Charles Bonnet syndrome. No model is able to fully explain all VH variants. Not all VH have the same pathogenesis and the same poor prognosis. Conclusion: The chain of causes underlying VH is complex and can vary from patient to patient. So far the therapeutic applications are largely unexplored; however, there is preliminary evidence that beside adjustment of the medication, improvement of visual acuity, active involvement of the partner, and possibly, individually adaptable coping strategies could be successfully implemented. [ABSTRACT FROM AUTHOR]

Objective: Charles Bonnet Syndrome (CBS) consists of visual hallucinations occurring in patients with visual impairment. CBS is commonly overlooked by medical professionals and underreported by patients due to the underlying stigma attached to the presence of hallucinations. Lack of awareness regarding CBS among medical professionals may lead to failures in providing forewarning and education to patients with visual impairment. In patients who are not familiar with CBS, this might lead to a higher risk of distress, misattribution to cultural belief or mental illness, and the potential of developing psychosis, especially in elderly patients with other modalities of sensory deprivation. This case report aims to increase awareness and knowledge about CBS among clinicians for the proper management of patients. Method: This case illustrated a patient with worsening visual impairment who presented with typical CBS and later progressed to visual hallucination and persecutory delusion Results: Providing information on CBS and antipsychotics resulted in less distress and improved the patient’s visual hallucination and delusion Conclusion: Education and reassurance play a role in the management of CBS. It is important for medical professionals to be aware of CBS and provide clear information for patients who are at risk to lower their distress.

We report a patient's challenging case who suffered two acute ischaemic strokes, first in the right occipital lobe and later in the right dorsolateral thalamus (with affection of the lateral geniculate nucleus) who developed a yellow-tinted left homonymous visual hemi-field. No previously described case matched our peculiar symptom presentation in combination with the described brain lesions. Especially, the visual phenomena of patients with these brain lesions that were up until now described in literature were complex and vivid visual hallucinations. Here, we discuss possible explanations and mechanisms of this visual phenomenon (acquired hemidyschromatopsia, peduncular hallucinosis, focal epilepsy with visual symptoms, visual hallucinations) and in light of the current literature, we argue that the most likely explanation is a form of simple visual hallucination due to release phenomena (Charles Bonnet syndrome). [ABSTRACT FROM AUTHOR]

Background and objectives: In Charles Bonnet Syndrome (CBS), visual hallucinations (VH) are experienced by people with sight loss due to eye disease or lesional damage to early visual pathways. The aim of this cross-sectional study was to investigate structural brain changes using magnetic resonance imaging (MRI) in CBS. Methods: Sixteen CBS patients, 17 with eye disease but no VH, and 19 normally sighted people took part. Participants were imaged on a 3T scanner, with 1 mm resolution T1 weighted structural imaging, and diffusion tensor imaging with 64 diffusion directions. Results: The three groups were well matched for age, sex and cognitive scores (MMSE). The two eye disease groups were matched on visual acuity. Compared to the sighted controls, we found reduced grey matter in the occipital cortex in both eye disease groups. We also found reductions of fractional anisotropy and increased diffusivity in widespread areas, including occipital tracts, the corpus callosum, and the anterior thalamic radiation. We did not find any significant differences between the eye disease participants with VH versus without VH, but did observe a negative association between hippocampal volume and VH severity in the CBS group. Discussion: Our findings suggest that although there are cortical and subcortical effects associated with sight loss, structural changes do not explain the occurrence of VHs. CBS may relate instead to connectivity or excitability changes in brain networks linked to vision.

Psychedelics like LSD (Lysergic acid diethylamide) and psilocybin are known to modulate perceptual modalities due to the activation of mostly serotonin receptors in specific cortical (e.g., visual cortex) and subcortical (e.g., thalamus) regions of the brain. In the visual domain, these psychedelic modulations often result in peculiar disturbances of viewed objects and light and sometimes even in hallucinations of non-existent environments, objects, and creatures. Although the underlying processes are poorly understood, research conducted over the past twenty years on the subjective experience of psychedelics details theories that attempt to explain these perceptual alterations due to a disruption of communication between cortical and subcortical regions. However, rare medical conditions in the visual system like Charles Bonnet syndrome that cause perceptual distortions may shed new light on the additional importance of the retinofugal pathway in psychedelic subjective experiences. Interneurons in the retina called amacrine cells could be the first site of visual psychedelic modulation and aid in disrupting the hierarchical structure of how humans perceive visual information. This paper presents an understanding of how the retinofugal pathway communicates and modulates visual information in psychedelic and clinical conditions. Therefore, we elucidate a new theory of psychedelic modulation in the retinofugal pathway., Competing Interests: Conflict of Interest No conflicts of interest, (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Musical hallucinations and musical obsessions are distinct phenomena. The first can be understood as a manifestation of the musical ear syndrome, which produces deafferentation auditory hallucinations, while the latter is an obsessive symptom of obsessive-compulsive disorders. Both symptoms are often poorly understood and mistaken for one another or for signs of psychotic disorders. We report two cases, one characterized by musical hallucinations and the other by musical obsessions, both with comorbid hearing impairment, which is the main confounding factor in their differential diagnosis. We critically compare the two cases and their key features, allowing diagnostic differentiation and a targeted therapeutic approach., Competing Interests: Disclosure: The authors report no conflicts of interest.