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Charles Bonnet syndrome is a typical entity in the elderly and is manifested by patients experiencing visual hallucinations. At the same time, people with Charles Bonnet syndrome do not experience other mental disorders. So what causes Charles Bonnet's syndrome and what are the treatment options for this problem?

Charles Bonnet syndromeis most common in patients between the ages of 70 and 85. The exact frequency of this problem is unknown, possibly due to the fact that many patients do not report any hallucinations they experience. The reason for hiding such a fact may be, for example, the fear that they will be accused of suffering from a mental illness. It is estimated that even more than 60% of patients with Charles Bonnet syndrome may go undiagnosed.

In medicine, hallucinations are usually included in the group of psychopathological symptoms. Indeed, it is true that hallucinations (i.e., incorrect sensory experiences) are experienced primarily by patients with mental disorders, but hallucinations can also be experienced by people with a completely properly functioning psyche. What's more, hallucinations can be treated not only by psychiatrists, but also … ophthalmologists - this is the case with Charles Bonnet's syndrome.

Symptoms of Charles Bonnet syndrome

In the course of Charles Bonnet's syndrome, patients experience visual hallucinations. These hallucinations can be very different: they can be both so-called simple hallucinations (in the form of flashes or colors) and complex hallucinations. In the case of the latter type of hallucinations, patients may see, for example, people, animals, but also entire rooms or even buildings and landscapes.

Just as the types of hallucinations experienced can vary, the course of Charles Bonnet syndrome can vary from patient to patient. Typically, patients initially experience hallucinations daily, and the duration of a given false visual sensation varies - sometimes the patient experiences hallucinations for only a few minutes, sometimes even for several hours.

Important

It should be emphasized that the occurrence of Charles Bonnet's syndrome in a patient does not mean that a patient will become illhim for a mental illness. Usually in such people, hallucinations are the only psychopathological deviation, and in addition, patients are aware that what they see is not really there - the so-called insight, i.e. the awareness that the perceived impressions are not real.

Causes of Charles Bonnet Syndrome

The first description of Charles Bonnet's team was written over 250 years ago, in 1760. Charles Bonnet was its author, and the description referred to the man's almost 90-year-old grandfather. The older man suffered from bilateral cataracts, a condition in the course of which vision is impaired. This patient also experienced other problems, which were visual hallucinations. non-existent people, animals or objects.

Although quite a long time has passed since the description of Charles Bonnet's syndrome, the views on the pathogenesis of this unit have not changed so far - it is caused by various types of ophthalmological diseases related to vision loss. Such diseases may include the already mentioned cataracts, but also glaucoma, age-related macular degeneration (AMD) or diabetic retinopathy. In the course of such problems, patients may indeed lose their eyesight, so why should they experience additional, false sensations, i.e. visual hallucinations?

A certain and unequivocal cause of Charles Bonnet syndrome has not been established so far. There are some hypotheses as to why vision loss patients develop visual hallucinations. Under physiological conditions, stimuli from the organ of sight reach the cerebral cortex. In a situation where the perception of impressions from the eyeball deteriorates, the brain receives significantly less nervous stimuli than before. You can meet the saying that "nature does not like a vacuum" - it can be similar with the human brain. In the case when the structures of the cerebral cortex responsible for the processes related to vision (i.e. centers located mainly in the occipital area) receive less nervous stimulation, they can … spontaneously generate their own stimulation. This is why vision loss patients would see things that don't really exist.

The theory described above can be confirmed by the research carried out so far. It turns out that sensory deprivation in the organ of sight can lead to visual hallucinations. The researchers also found that in patients with Charles Bonnet syndrome, when they experience visual hallucinations, functional imaging tests show increased activity of the cerebral cortex inwithin the occipital lobes of the brain.

How is Charles Bonnet syndrome diagnosed?

There are currently no clear criteria for the diagnosis of Charles Bonnet syndrome. However, there are some indications that may lead clinicians to make this diagnosis. Among them, the following stand out:

  • the patient does not experience delusions,
  • the patient's awareness that the objects he sees are not real,
  • occurrence of at least one episode of complex visual hallucinations in the last four weeks,
  • no hallucinations from other sense organs.

Hallucinations are not a disorder that only occurs in people with Charles Bonnet syndrome, so before a diagnosis of this syndrome is made, it is important to rule out other potential but more common causes of visual hallucinations. Patients can be tested, for example, blood tests (to exclude, for example, poisoning with some psychoactive substances or to detect possible electrolyte disturbances), imaging tests (to eliminate, for example, a stroke as the cause of hallucinations) or a psychiatric test (during which it is excluded will be e.g. the occurrence of psychosis or an episode of delirium).

Treatment of Charles Bonnet syndrome

The good news for patients with Charles Bonnet syndrome is that often the symptoms of this entity gradually decline over time. Visual hallucinations may persist for several or several months (during this time the patient may experience hallucinations less and less often), until they may stop appearing at all.

Some patients, unfortunately, experience visual hallucinations continuously, sometimes even for several years. Here is the bad news - medicine currently does not know the methods of treating Charles Bonnet syndrome. Are the patients completely helpless as a result? Definitely not.

It turns out that helping patients with Charles Bonnet syndrome can solve their vision problems. For example, after cataract surgery - which will improve the patient's vision - the visual hallucinations associated with the described syndrome may cease to occur. Patients can also be recommended several techniques that they can use at home.

In Charles Bonnet's syndrome, visual hallucinations mainly occur when patients are motionless and idle. It can help to simply turn on the radio or TV - when the brain receives various nervous stimuli,it also reduces the chance of its spontaneous activation and of visual hallucinations. Some patients also find it helps to make certain eye movements. Moving them back and forth ( alternately to the right and left) for several seconds may lead to the disappearance of visual hallucinations.

Some patients are unable to cope with the visual hallucinations themselves. For such people, it may be beneficial to refer to a psychologist or psychotherapist. It is important that, if necessary, such help is implemented quickly enough, before the patient develops any mental disorders secondary to Charles Bonnet's syndrome, such as, for example, mood disorders or anxiety disorders.

It has already been emphasized that the mental state of patients with Charles Bonnet syndrome does not differ from the norm. Despite this, some scientists have managed to prove that sometimes patients can reduce the severity of hallucinations they experience by introducing treatment with antipsychotics (neuroleptics). However, this is not a procedure recommended for all people with the described syndrome - this is due to the fact that such treatment is associated with, for example, the risk of its side effects. For this reason, antipsychotics, if already prescribed, are only for those patients with Charles Bonnet syndrome who experience extremely frequent visual hallucinations and in whom they lead to a significant impairment of daily functioning.

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Category:

Neurology