Benefit of psychiatric evaluation on anxiety in patients with Charles Bonnet syndrome
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Published on: July 31, 2016
Birgit Doeller1, Martin Kratochwil2, Lena Sifari2
1Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Wien, Austria.
Insights
Charles Bonnet syndrome (CBS) causes visual hallucinations in people with severe vision loss. This study found that additional psychiatric treatment did not significantly improve quality of life compared to ophthalmologist care for CBS patients.
Area of Science:
- Ophthalmology
- Neurology
- Psychiatry
Background:
- Charles Bonnet syndrome (CBS) is characterized by visual hallucinations (VHs) in individuals without psychiatric or neurological disorders.
- Severe vision impairment from conditions like age-related macular degeneration (AMD), cataracts, or glaucoma commonly triggers CBS.
Purpose of the Study:
- To evaluate the efficacy of supplementary psychiatric treatment for patients experiencing Charles Bonnet syndrome.
- To determine if psychiatric intervention offers additional benefits beyond standard ophthalmological care for CBS.
Main Methods:
- A randomized controlled study screened 4900 patients with visual acuity of 0.5 LogMAR or worse.
- 34 patients diagnosed with CBS were randomized into two groups: ophthalmologist consultation only, or ophthalmologist plus psychiatrist consultation.
- Quality of life was assessed using interviews, mental tests, and questionnaires.
Main Results:
- The prevalence of CBS was 8.7% (34 out of 390 eligible patients), with a female predominance (4:1 ratio) and an average age of 79.3 years.
- The most frequent VHs reported were humans (41%), geometrical shapes (32%), plants (15%), and animals (12%).
- No significant difference in the change of quality of life was observed between the group receiving only ophthalmologist care and the group receiving additional psychiatric care (p=0.727).
Conclusions:
- Awareness of CBS among healthcare professionals treating patients with severe vision loss is crucial for accurate diagnosis and management.
- Current findings suggest that additional psychiatric treatment does not significantly enhance the quality of life for CBS patients compared to standard ophthalmological care.
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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