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Visual hallucinations in the elderly: a case series and discussion of aetiology and treatment

Published online by Cambridge University Press:  13 July 2015

C. Concannon ,
P. Reynolds  and
A. M. Meaney
C. Concannon*
Affiliation:
North Lee Mental Health Service, Mercy University Hospital, Cork, Ireland
P. Reynolds
Affiliation:
Department of Old Age Psychiatry, Seanoira Day Hospital, St. Camillus’s Hospital, Limerick, Ireland
A. M. Meaney
Affiliation:
Department of Old Age Psychiatry, Seanoira Day Hospital, St. Camillus’s Hospital, Limerick, Ireland
*
*Address for correspondence: Dr C. Concannon, St. Michael’s Unit, Mercy University Hospital, Cork, Ireland. (Email: Ciaran.concannon@hotmail.com)
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Abstract

Background

Visual hallucinations are a common phenomenon, among the older adult population. They can be functional or organic in aetiology. However, new onset visual hallucinations in this population are strongly suggestive of organic brain disease. Visual impairment, cerebrovascular disease and Parkinson’s disease are three causes of visual hallucinations, considered in this case series. The evidence in the literature, for the treatment of these conditions is scant at best. There is a paucity of randomised controlled trials available concerning possible therapeutic options.

Aims/Methods

We describe three case reports of visual hallucinations due to diverse underlying aetiologies. We then discuss the aetiologies of visual hallucinations in general and then in these particular cases and finally include results of a literature search examining the available evidence for any therapeutic options proposed.

Results

Our three cases have different, underlying aetiologies. One case is of Charles Bonnet syndrome. The next is of visual hallucinations associated with vascular dementia. The final case is of visual hallucinations associated with Parkinson’s disease. The first two cases are of particular interest due to the efficacy of Amisulpride in both clinical scenarios.

Conclusions

Visual hallucinations are a common phenomenon in the elderly population

They can be due to a myriad of underlying causes. There are a number of neurochemical factors and neuroanatomical structures implicated. The evidence for psychopharmacological interventions is scanty. Randomised controlled trials are lacking in the area. An interesting finding in this case series, was of the clinical utility of Amisulpiride. Given this agent’s unique psychopharmacological profile it is possible that it may be efficacious in other cases of visual hallucinations associated with particular neurochemical factors.

Keywords

AetiologyCharles Bonnet syndromeolder adultParkinson’s diseasepsychopharmacologytreatmentvascular dementiavisual hallucinations
Type
Case Report
Information
Irish Journal of Psychological Medicine , Volume 33 , Issue 1 , March 2016 , pp. 33 - 41
Copyright
© College of Psychiatrists of Ireland 2015 

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References

Aarsland, D, Ballard, C, Rongve, A, Broadstock, M, Svenningsson, P (2012). Clinical trials of dementia with Lewy bodies and Parkinson’s disease dementia. Current Neurology Neuroscience Reports 12, 492–501.Google Scholar
Bergman, J, Lerner, V (2002). Successful use of donepezil for the treatment of psychotic symptoms in patients with Parkinson’s disease. Clinical Neuropharmacology 25, 107–110.Google Scholar
Bhatia, MS, Srivastava, S, Jhanjee, A (2012). Amisulpiride in Charles Bonnet syndrome. Journal of Neuropsychiatry and Clinical Neurosciences 24, 130–133.CrossRefGoogle Scholar
Boecker, H, Ceballos-Baumann, AO, Volk, D (2007). Metabolic alterations in patients with Parkinson’s disease and visual hallucinations. Archives of Neurology 64, 984–988.Google Scholar
Bullock, R, Cameron, A (2002). Rivastigmine for the treatment of dementia and visual hallucinations associated with Parkinson’s disease: a case series. Current Medical Research and Opinion 18, 258–264.Google Scholar
Burke, W (2002). The neural basis of Charles Bonnet hallucinations: a hypothesis. Journal of Neurology, Neuroscience and Psychiatry 73, 535–541.Google Scholar
Burn, D, Emre, M, McKeith, I (2006). Effects of rivastigmine in patients with and without visual hallucinations in dementia associated with Parkinson’s disease. Movement Disorders 21, 1899–1907.CrossRefGoogle ScholarPubMed
Chen, J-H, Tzeng, N-S (2010). Successful treatment with amisulpiride for poststroke psychosis. Journal of Neuropsychiatry and Clinical Neurosciences 22, 210–222:352.CrossRefGoogle Scholar
Collerton, D, Dudley, R (2004). A cognitive behavioural framework for the treatment of distressing visual hallucinations in older people. Behavioral and Cognitive Psychotherapy 32, 443–455.Google Scholar
Collerton, D, Dudley, R, Mosimann, UP (2011). Working psychologically with hallucinations in later life. PSIGE Newsletter 117, 19–25.Google Scholar
Collerton, D, Perry, E, Mc Keith, I (2005). Why people see things that are not there: a novel perception and attention deficit model for recurrent complex visual hallucinations. Behavioral and Brain Sciences 28, 737–757, Discussion 757–794.Google Scholar
Diederich, NJ, Pieri, V, Goetz, CG (2003). Coping strategies for visual hallucinations in Parkinson’s disease. Movement Disorders 18, 831–832.CrossRefGoogle ScholarPubMed
Ffytche, DH, Howard, RJ, Brammer, MJ, David, A, Woodruff, P, Williams, S (1998). The anatomy of conscious vision: an fMRI study of visual hallucinations. Nature Neuroscience 1, 738–742.CrossRefGoogle ScholarPubMed
Goetz, CG, Stebbins, GT (1995). Mortality and hallucinations in nursing home patients with advanced Parkinson’s disease. Neurology 45, 669–671.CrossRefGoogle ScholarPubMed
Gorgens, K, Liedtke, M (1998). Charles Bonnet syndrome. Psychiatric Praxis 25, 85–86.Google Scholar
Harding, AJ, Halliday, GM (2001). Cortical Lewy body pathology in the diagnosis of dementia. Acta Neuropathologica (Berlin) 102, 355–363.Google Scholar
Hori, H, Terao, T, Shiraishi, Y, Nakamura, J (2000). Treatment of Charles Bonnet Syndrome with Valproate. International Clinical Psychopharmacology 15(2).Google Scholar
Khan, JC, Shahid, H, Thurlby, DA, Yates, JR, Moore, AT (2008). Charles bonnet syndrome in age-related macular degeneration: the nature and frequency of images in subjects with end stage disease. Ophthalmic Epidemiology 15, 202–208.Google Scholar
Lang, UE, Stogowski, D, Schulze, D, Domula, M, Schmidt, E, Gallinat, J, Tugtekin, SM, Felber, W (2007). Charles Bonnet syndrome: successful treatment of visual hallucinations due to vision loss with selective serotonin reuptake inhibitors. Journal of Psychopharmacology 21, 553–555.Google Scholar
Leucht, S, Pitschel-Waltz, G, Engel, R, Kissling, W (2002). Amisulpride, an unusual “atypical” antipsychotic – a meta analysis of randomised controlled trials. American Journal of Psychiatry 159, 180–190.Google Scholar
Lippa, CF, Duda, JE, Grossman, M, Hurtig, HI, Aarsland, D, Boeve, BF, Brooks, DJ, Dickson, DW, Dubois, B, Emre, M, Fahn, S, Farmer, JM, Galasko, D, Galvin, JE, Goetz, CG, Growdon, JH, Gwinn-Hardy, KA, Hardy, J, Heutink, P, Iwatsubo, T, Kosaka, K, Lee, VM, Leverenz, JB, Masliah, E, McKeith, IG, Nussbaum, RL, Olanow, CW, Ravina, BM, Singleton, AB, Tanner, CM, Trojanowski, JQ, Wszolek, ZK, DLB/PDD Working group (2007). DLB and PDD boundary issues: diagnosis, treatment, molecular pathology, and biomarkers. Neurology 68, 812–819.Google Scholar
Maeda, K, Shirayama, Y, Nukina, S, Yoshioka, S, Karahara, R (2003). Charles Bonnet syndrome with visual hallucinations of childhood experiences: successful treatment of one patient with risperidone. Journal of Clinical Psychiatry 64, 1131–1132.CrossRefGoogle Scholar
Manford, M, Andermann, F (1998). Review article complex visual hallucinations. Clinical and neurobiological insights. Brain 121, 1819–1840.CrossRefGoogle ScholarPubMed
Matsui, H, Nishinaka, K, Oda, M, Hara, N (2006a). Hypoperfusion of the visual pathway in PDs with visual hallucinations. Movement Disorders 21, 2140–2144.CrossRefGoogle Scholar
Matsui, H, Nishinaka, K, Oda, M, Hara, N (2006b). Hypoperfusion of the visual pathway in PDs with visual hallucinations. Movement Disorders 21, 2165–2169.Google Scholar
McKeith, I, Del Ser, T, Spano, P, Emre, M, Wesnes, K, Anand, R, Cicin-Salin, A, Ferrara, R, Spiegel, R (2000). Efficacy of rivastigmine in dementia with Lewy bodies – a randomised, double blind, placebo controlled international study. Lancet 356, 2031–2036.Google Scholar
Menon, GJ, Rahman, I, Menon, SJ, Dutton, GN (2003). Complex visual hallucinations in the visually impaired: the Charles Bonnet syndrome. Survey of Ophthalmology 48, 58–72.Google Scholar
Mosimann, UP, Collerton, D (2010). Hallucinations in the context of dementing illnesses. In Hallucinations: A Guide to Treatment and Management (ed. F Laroi and A Aleman), pp. 323–350. Oxford University Press: Oxford, UK.Google Scholar
National Institute for Clinical Excellence (NICE) (2010). Delirium: Diagnosis, Prevention and Management. Clinical Guideline 103. National Clinical Guideline Centre: London, UK.Google Scholar
Paulig, M, Mentrup, H (2001). Charles Bonnet syndrome: complete remission of complex visual hallucinations treated by gabapentin. Journal of Neurology, Neurosurgery and Psychiatry 70, 813–814.CrossRefGoogle ScholarPubMed
Perry, EK, Kilford, L, Lees, AJ, Burn, DJ, Perry, RH (2003). Increased Alzeimer pathology in Parkinson’s disease related to antimuscarinic drugs. Annals of Neurology 54, 235–238.Google Scholar
Qu, Y, Eysel, UT, Vandesande, F, Arckens, L (2000). Effect of partial sensory deprivation on monoaminergic neuromodulators in striate cortex of adult cat. Neuroscience 101, 863–868.Google Scholar
Ramirez-Ruiz, B, Junque, C, Marti, M-J, Valldeoriola, F, Tolossa, E (2007). Cognitive changes in Parkinson’s disease patients with visual hallucinations. Dementia and Geriatric Cognitive Disorders 23, 281–288.Google Scholar
Ranen, NG, Pasternak, RE, Rovner, BW (1999). Cisapride in the treatment of visual hallucinations caused by vision loss – the CBS syndrome. American Journal of Geriatric Psychiatry 7, 264–266.Google Scholar
Rushmore, RJ, Payne, BR, Lombar, SG (2005). Functional impact of the primary visual cortex deprivation in subcortical target structures in the thalamus and the midbrain. Journal of Comparative Neurology 488, 414–426.Google Scholar
Seeburg, DP, Liu, X, Chen, C (2004). Frequency-dependent modulation of retinogeniculate transmission by serotonin. The Journal of Neuroscience 24, 10950–10962.CrossRefGoogle ScholarPubMed
Skovronsky, DM, Lee, VMY, Trojanowski, JQ (2006). Neurodegenerative diseases: new concepts of pathogenesis and their therapeutic complications. Annual Review of Pathology 1, 151–170.Google Scholar
Stebbins, GT, Goetz, CG, Carillo, MC (2004). Altered cortical visual processing in Parkinson’s disease with hallucinations: an fMRI study. Neurology 63, 1409–1416.Google Scholar
Ukai, S, Yakamoto, M, Tanaka, M, Takeda, M (2004). Treatment of typical Charles Bonnet syndrome with donepezil. International Clinical Psychopharmacology 19, 355–357.Google Scholar
Valencia, C, Franco, JG (2008). Charles Bonnet syndrome: report of one case managed with haloperidol. Revista médica de Chile 136, 347–350.Google Scholar
Victor, M, Adams, RD (1952). The effect of alcohol on the nervous system. In Metabolic and Toxic Disease of the Nervous System (ed. HH Merritt and CC Hare), pp. 526–573. Williams and Wilkins: Baltimore.Google Scholar
Webster, R, Holroyd, S (2000). Prevalence of psychotic symptoms in delirium Psychosomatics 41, 519–522.Google Scholar
West, LJ (1962). A general theory of hallucinations and dreams. chapter 26. In Hallucinations (ed. Grune and Stratton), pp. 273–291. Grune & Stratton: New York.Google Scholar
Williams-Gray, CH, Foltynie, TH, Lewis, SJG, Barker, RA (2006). Cognitive deficits and psychosis in Parkinson’s disease: a review of pathophysiology and therapeutic options. CNS Drugs 20, 477–505.Google Scholar
Wolters, ACH (2006). Parkinson’s disease-related psychosis: pathophysiology with therapeutical strategies. Journal of Neural Transmission 71 (Suppl.): 31–37.Google Scholar