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Psychosis in Children and Young People
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
Tony James, Lakshmeesh Muttur Somashekhar
The clinical presentations for psychosis are very varied (Table 47.2). At one extreme is the acute disturbance of perceptions, most often auditory hallucinations, second or third person, speaking in a derogatory manner and commenting on the subject. Visual hallucinations are frequent, especially following drug use. In the acute state, paranoid ideation of delusions can drive the patient to become extremely agitated, frightened and to act in a defensive or aggressive manner.
Reflections of a child and adolescent psychiatrist
Published in Chris Donovan, Heather C Suckling, Zoe Walker, Janet Bell, Tami Kramer, Sheila R Cross, Difficult Consultations with Adolescents, 2018
Chris Donovan, Heather C Suckling, Zoe Walker, Janet Bell, Tami Kramer, Sheila R Cross
Acute presentations are easier to identify. These include abnormal thoughts (incoherent, illogical speech), beliefs (false beliefs that are impervious to reason and often paranoid), perceptions (auditory hallucinations are most common) and mobility (abnormal postures or stupor). Remember that the presence of visual hallucinations is more commonly suggestive of an organic pathology such as intoxication or withdrawal from an illicit substance, infection, seizures, etc. Acute presentations should be referred to CAMHS urgently. With a very non-specific insidious presentation, close follow-up over time may be required. If the picture is persistent, with no other obvious cause, refer the adolescent for a specialist opinion.
Signs and Symptoms in Psychiatry
Published in Mohamed Ahmed Abd El-Hay, Essentials of Psychiatric Assessment, 2018
Visual hallucination: false perception involving vision, consisting of both formed (complex) images, e.g., people, and ill-defined (elementary) images and colors, e.g., flashes of light. They may appear normal or abnormal in size; if the latter, they are more often smaller than the corresponding real percept (sometimes called Lilliputian). Visual hallucinations occur in many mental disorders, often in conjunction with auditory hallucinations. However, visual and tactile hallucinations are usually linked to organic conditions (Tombini et al., 2012); i.e., they occur more in cases of dementia, delirium, recently developed blindness, drug withdrawal states, drug intoxications (e.g., hallucinogenic, anticholinergic, or dopaminergic substances), temporal lobe epilepsy, migraine, and other organic mental disorders. Ill-defined visual experiences occur in ocular and neurologic diseases, e.g., flashing lights occur with retinal detachment, whereas scintillating lights, a series of undulating jagged lines, blurred areas, or dark spots occur in migraine (scotomas). Seeing a curtain of darkness over the lower visual field is a sign of transient ischemic attack. Small dark specks, called floaters, that drift across the visual field are a common and benign result of senescent changes in the eye.
Bilateral Vision Loss and Visual Hallucinations in Subacute Sclerosing Panencephalitis: A Case Report
Published in Neuro-Ophthalmology, 2023
Ravi Uniyal, Ravindra Kumar Garg, Hardeep Singh Malhotra, Neeraj Kumar, Shweta Pandey, Imran Rizvi, Amita Jain, Nidhi Tejan, Rupesh Singh kirar
This patient also developed visual hallucinations. Simple visual hallucinations occur due to hyperactivity or irritation of the primary visual cortex, while complex visual hallucinations can occur due to the involvement of visual association cortices.5 Visual hallucinations can be associated with various psychiatric, neurologic, and ophthalmologic conditions. In patients with severe vision loss, visual deafferentation may cause cortical release phenomenon, in the form of visual hallucinations, which is typically known as Charles Bonnet syndrome (CBS).5 CBS can be associated with vision loss due to any cause. Visual hallucinations in CBS tend to involve people, animals, faces, and even inanimate objects.5 The appearance of visual hallucinations in this patient can be explained by CBS secondary to vision loss; however, the occurrence of seizures suggests that brain parenchyma per se is also contributory.
Neuro-Ophthalmic Literature Review
Published in Neuro-Ophthalmology, 2022
David A. Bellows, John J. Chen, Hui-Chen Cheng, Panitha Jindahra, Peter W. MacIntosh, Collin McClelland, Michael S. Vaphiades, Xiaojun Zhang
Visual hallucinations are frequently encountered in clinical practice. It is critical for neurologists, particularly those in training, to develop a systematic approach for evaluating patients presenting with such unique and often perplexing symptoms. Here, the authors present the case of a 48-year-old woman who developed vivid visual hallucinations after receiving nivolumab, an immune checkpoint inhibitor (ICI), for melanoma. The authors discuss the broad differential diagnosis for visual hallucinations and how the history and examination can guide one’s evaluation. This patient was diagnosed with ICI-associated optic neuritis and Charles Bonnet syndrome (CBS). Highlights of the paper are the table on the differential diagnosis of visual hallucinations and the fact that the patient in question had relativity good central visual acuity of 20/50 with her right eye and 20/25 with her left eye but still experienced CBS. Also of interest is the discussion of the optic neuritis work-up and ICI-associated optic neuritis.
Treating hallucinations in Parkinson’s disease
Published in Expert Review of Neurotherapeutics, 2022
Alice Powell, Elie Matar, Simon J. G. Lewis
Several disease specific, non-disease and medication related factors have been associated with an increased risk of developing visual hallucinations in PD. Identified disease related factors may reflect the distribution of pathology and the severity of PD. Non-disease related features, such as older age and sensory impairments highlight our understanding of hallucinations and their relationship to disrupted sensory processing. Medications that modulate dopamine and other neurotransmitter systems are also implicated but are not always associated with these phenomena, indicating significant heterogeneity in the pattern of neurodegeneration between patients [17]. Finally, the association between hallucinations and other psychiatric symptoms and diagnoses has not been fully explored but may signify the breadth of neurodegeneration and prodromal non-motor symptoms seen in PD as well as the psychological impacts of the disease and its symptoms.