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Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia

Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia
Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia: Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia

Visual illusions can be an early symptom of dementia, but in some cases they may be a sign of a purely ophthalmic condition, Charles Bonnet syndrome (CBS). This rare disease describes visual hallucinations that occur as a result of structural damage to the visual pathway in patients without a neuropsychiatric disorder.  One of the largest analyses to date on CBS, published in Ophthalmology, shows potential associations with age-related macular degeneration (AMD), glaucoma, and cataract surgery.

Investigators examined 10-year data based on 4203 participants in the Age-Related Eye Disease Study 2 (AREDS 2). They found 12.22% (446) of 3651 individuals who answered questions about CBS symptoms during the study period reported visual hallucinations. 

“Taken together, these observations and ours support a call to raise awareness of detection and management of CBS in the ophthalmology community,” according to the analysis. These phantom lines and forms do not typically interfere with visual function, but can affect visual quality of life. The research added that results are most likely an underestimate of actual numbers for those with CBS, due to patients not remembering or reporting the symptoms.

In CBS, the illusions can occur from damage in the visual pathway. “Disruption to visual input may result in an overcompensated response in the visual cortex,” according to the report. An individual’s cognition and neuropsychiatric status are typically normal, and patients are usually aware that extraneous lines, geometric shapes, patterns, or facial images seen are hallucinations. At 10 years, 86% of those with symptoms had been diagnosed with late AMD and 64% had undergone cataract surgery, in either 1 or both eyes.

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For affected individuals, 238 participants offered descriptions or drawings of the shapes, with mean time for the imagery lasting 3 years. Nearly 50% of these individuals saw more than 1 type of form, with faces or people most frequently visualized. Participants with symptoms of CBS had an approximately 51% greater likelihood — 14% to 2 times greater likelihood — of experiencing depressive symptoms compared with individuals without CBS symptoms (P =.004). Patients with CBS were not likely to have cognitive impairment (P =.772).

AREDS 2 participants attended annual comprehensive eye examinations for 5 years, and responded to questions in phone interviews between the visits. A 5-year follow-on study included phone meetings twice a year and a 10-year in-person visit.

The research comprised a nondiverse White, well-educated sample. Regarding study limitations, associations involving progressive disorders may change or evolve. Also, some hallucinations could have been due to early Parkinson disease or use of medications such as proton-pump inhibitors. Strengths of this investigation included certified interviewers, centralized grading, and use of validated non-vision-dependent assessments.

“When CBS is suspected, it is important to educate, provide reassurance that hallucinations alone do not indicate underlying neuropsychiatric disorders, and offer simple steps to attempt to decrease hallucination,” according to the analysis. 

Reference

Le JT, Peprah D, Agrón E, Keenan TDL, Clemons TE, Chew EY, for the AREDS 2 Research Group. Associations between age-related eye diseases and Charles Bonnet syndrome in participants of the Age-Related Eye Disease Study 2: AREDS2 Report Number 26. Ophthalmology. Published online August 19, 2021. doi:10.1016/j.ophtha.2021.08.012

The post Hallucinations May Be Charles Bonnet Syndrome, Not Early Dementia appeared first on Psychiatry Advisor.

https://www.psychiatryadvisor.com/home/topics/neurocognitive-disorders/alzheimers-disease-and-dementia/visual-illusions-may-be-visual-pathway-damage-not-neurological-disease/
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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(512) 764-9858
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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(512) 764-9858
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Aura MD | Ashley Toutounchi, MD - Psychiatrist Austin - Online Telepsychiatry Texas
200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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200 Lee Barton Dr #100, Austin, TX 78704, United States
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Slight Decline Seen in Opioid Prescription Rates

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Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
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Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates
Slight Decline Seen in Opioid Prescription Rates: Slight Decline Seen in Opioid Prescription Rates

The rate at which physicians prescribed opioids fell by 4.6% between 2015 and 2017 compared with 2009 through 2011. The decline in prescribing was seen in physicians who scored highest on the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) examination, according to the results of a study published in JAMA Network.

Given the risks associated with opioids and the change in guidance that began around 2015, the researchers wanted to explore why opioid prescription rates remain high. The authors hypothesized that physicians with greater clinical knowledge would stay more up-to-date on these guidelines and therefore respond to guideline changes.

The authors used the ABIM board certification database to identify general internal medicine physicians who had taken an MOC examination between 2008 and 2016. The researchers then linked those physicians to Medicare claims for lower back pain visits that took place during the year after those physicians’ examinations. After applying exclusion criteria, the study included 55,387 visits and 10,246 physicians.

Of all the included visits, 6697 (12.1%) involved patients from rural ZIP codes. The study population was 75.8% White, and 67.1% of participants were women. The mean age was 76.2 years. The study did not report any other race/ethnicity demographics.

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Physicians prescribed opioids after 11,978 (21.6%) visits for low back pain; 9759 (81.5%) of these prescriptions were of high dosage or long duration. Physicians in the highest knowledge quartile showed a statistically significant 4.4 percentage point (95% CI, -6.8 to -2.0 percentage point) decrease in adjusted prescribing when the early (2009-2011) and the late (2015-2017) periods were compared. Prescribing rates among lower-scoring physicians did not change significantly.

Because the study was limited to Medicare fee-for-service claims, it may not generalize to other populations. The researchers also cannot say whether the same results would apply to other clinical situations where opioids are more commonly prescribed. Unobserved confounding between examination performance and opioid prescribing could have biased results.

“Our findings suggest that performance on a knowledge examination is associated with clinically meaningful prescribing behavior,” the researchers concluded. “Physicians who score well on these examinations may be more responsive to changes in standards of care. However, continued prescribing of [opioids of high dosage or long duration] by physicians who scored high on the MOC examination suggests that general knowledge-based interventions, although helpful, may not be sufficient to address opioid overprescribing.”

Reference

Gray BM, Vandergrift JL, Weng W, Lipner RS, Barnett ML. Clinical knowledge and trends in physicians’ prescribing of opioids for new onset back pain, 2009-2017. JAMA Netw Open. Published online July 1, 2021. doi:10.1001/jamanetworkopen.2021.15328

The post Slight Decline Seen in Opioid Prescription Rates appeared first on Psychiatry Advisor.

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(512) 764-9858
767V+C7 Austin, Texas, United States
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Aura MD | Ashley Toutounchi, MD - Psychiatrist Austin - Online Telepsychiatry Texas
200 Lee Barton Dr #100, Austin, TX 78704, United States
https://auramd.com/locations/texas/austin
(512) 764-9858
767V+C7 Austin, Texas, United States
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Aura MD | Ashley Toutounchi, MD - Psychiatrist Austin - Online Telepsychiatry Texas
200 Lee Barton Dr #100, Austin, TX 78704, United States
https://auramd.com/locations/texas/austin
(512) 764-9858
767V+C7 Austin, Texas, United States
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Aura MD | Ashley Toutounchi, MD - Psychiatrist Austin - Online Telepsychiatry Texas
200 Lee Barton Dr #100, Austin, TX 78704, United States
https://auramd.com/locations/texas/austin
(512) 764-9858
767V+C7 Austin, Texas, United States
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Aura MD | Ashley Toutounchi, MD - Psychiatrist Austin - Online Telepsychiatry Texas
200 Lee Barton Dr #100, Austin, TX 78704, United States
https://auramd.com/locations/texas/austin
(512) 764-9858
767V+C7 Austin, Texas, United States
https://www.google.com/maps?cid=3470181752621453053
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Aura MD | Ashley Toutounchi, MD - Psychiatrist Dallas - Online Telepsychiatry Texas
3232 McKinney Ave #1160, Dallas, TX 75204, United States
https://auramd.com/locations/texas/dallas
+12143820103
R632+F5 Dallas, Texas, USA
hhttps://www.google.com/maps?cid=15000269503009271829
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