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PubMedDate not supplied

Complex visual hallucinations in the visually impaired: the Charles Bonnet Syndrome.

Visually impaired patients may experience complex visual hallucinations, a condition known as the Charles Bonnet Syndrome. Patients usually possess insight into the unreality of their visual experiences, which are commonly pleasant but may sometimes cause distress. The hallucinations consist of well-defined, organized, and clear images over which the subject has little control. It is believed that they represent release phenomena due to de-afferentation of the visual association areas of the cerebral cortex, leading to a form of phantom vision. Cognitive defects, social isolation, and sensory deprivation have also been implicated in the etiology of this condition. This condition, which is most common in the elderly, frequently goes unrecognized in clinical practice, due to both lack of awareness among doctors and patients' reluctance to admit to hallucinatory experiences, for fear of being labeled mentally unstable. Furthermore, patients who comprehend the unreality of their hallucinations may be distressed by the real fear of imminent insanity. Sensitive and sympathetic history taking is essential to ascertain the existence of hallucinations. Reassurance and explanation that the visions are benign and do not signify mental illness have a powerful therapeutic effect. Hallucinatory activity may terminate spontaneously, on improving visual function or on addressing social isolation. There is no universally effective drug treatment but anticonvulsants may play a limited role in aborting the hallucinations. Physician awareness and empathy are the cornerstones of management.

Anticonvulsants↗
PubMedDate not supplied

An artist with a color vision defect: Charles Meryon.

Charles Meryon, an important artist of the 19th century, had a congenital defect in color vision. Meryon recognized this defect during his study of art, and he gradually gave up painting in favor of etching. This biographical article includes reproductions of some of Meryon's etchings and one oil painting. "Ghost Ship." Two palates display the principal colors of the spectrum, as seen normally and as seen with a color vision defect. "Ghost Ship" reveals the color-defective artist's typical preference for blue and yellow.

Art↗
PubMed1997

Sir Charles James Martin MB FRS: Australian serpents and Indian plague, one-hundred years ago.

In 1891 as Demonstrator in Physiology at the University of Sydney, Charles Martin began the first systematic study of the chemical and physiological properties of the venoms of the Australian elapid species, Pseudechis porphyriacus and Notechis scutatus. Two major constituents were detected: a large coagulable protein which was associated with intravascular clotting, and a small proteinaceous molecule, an albumose, associated with neurotoxicity. Martin designed and constructed a high-pressure gelatin membrane ultrafilter for fractionation of venom. His studies indicated that certain physiological actions and clinical symptoms were related to the faster rate of diffusion within the tissue space of a neurotoxic constituent relative to a clotting constituent. Extending this work to toxin-antitoxin relationships, Martin provided evidence that antitoxin was a large molecule with slow diffusibility in tissue and advised the administration of curative serum (including diphtheria antitoxin) by intravenous injection. In 1903, Martin returned to London as Director of the Lister Institute of Preventive Medicine. He was soon involved in the planning of scientific work to be undertaken by the Commission for Investigation of Plague in India as the disease continued to ravage the subcontinent. Detailed epidemiological studies of possible factors involved in the spread of Pasteurella pestis showed, unequivocally, that infected rat fleas were the vector of transmission from rats to humans.

Australia↗
PubMed1996

Visual hallucinations in psychologically normal people: Charles Bonnet's syndrome.

BACKGROUND: Charles Bonnet's Syndrome (CBS), characterised by the presence of complex visual hallucinations in psychologically normal people, was considered for a long time to be rare. Systematic research on CBS has been limited. However, it has been realised that CBS occurs frequently in elderly, visually handicapped patients, and we have been able to study the syndrome in a large number of patients. METHODS: After screening 505 visually handicapped patients, 60 were found to meet proposed diagnostic criteria for CBS (generally, the existence of hallucinations without delusions or loss of insightful cognition.) Psychopathological characteristics, personal meaning, and the emotional impact of hallucinations, as well as factors influencing the hallucinations, were analysed. FINDINGS: Although diagnostic criteria demand merely "partial insight", all patients had full insight into the unreal nature of their hallucinations. Other characteristics varied. In 46 (77%) patients, hallucinations lacked a personal meaning. Sensory deprivation and a low level of arousal seemed to favour the occurrence of hallucinations. CBS caused considerable distress in only 17 (28%) patients. However, all patients were glad to be told that their hallucinations were not due to mental disease. The proper diagnosis had been made in only one of the 16 patients who had consulted a doctor. INTERPRETATION: Although largely unrecognised in clinical practice, CBS should be considered as a diagnosis in patients who complain of hallucinations and who meet defined diagnostic criteria. There is no proven treatment, but many patients will benefit from reassurance that their hallucinations do not imply mental illness.

Aged↗
PubMed1986

"Professor" Charles Tyrrell and his ideal sight restorer.

Charles A. Tyrrell was a masseur who obtained his MD degree at age 57 in 1900. In addition to his private practice he was editor of several pseudomedical magazines. He also owned two proprietary ventures that he conducted on a mail order basis. One of these involved production and sale of the The Ideal Sight Restorer, a U-shaped device consisting of a rubber bulb at the base, from which on both sides arose an arm of rubber tubing capped by an ivory eye piece. The eye cups were applied to the closed eyelids and the intermittent suction produced by squeezing the rubber bulb was claimed to provide a form of ocular massage capable of curing serious eye diseases (eg. cataract and glaucoma), as well as doing away with the need for spectacles. Although his fraudulent activities and deceptive advertising practices were described on several occasions in the Journal of the American Medical Association, Dr. Tyrrell persisted in his enterprises until he died in 1918.

Advertising↗
PubMed2006

[Adaptation to central scotoma. III. Visual hallucinations and Charles Bonnet syndrome].

Patients with low vision due to central scotoma may experience complex visual hallucinations, referred to as Charles Bonnet syndrome. The present review reports the current literature on this syndrome and details its frequency, predisposing circumstances, the nature of the hallucinations, and treatments. It also reports the possible occurrence of the syndrome immediately after macular treatments using laser photocoagulation and photodynamic therapy. Patients should be reassured when they experience this syndrome, which is not severe but may be the cause of patient concern.

Adaptation, Physiological↗
PubMed1998

The death of King Charles XII--the forensic verdict.

King Charles XII of Sweden was killed in 1718 during his siege of the Danish fortress of Fredriksten. For 276 years, it remained an open question whether the lethal bullet came from the enemy or from a Swedish assassin. Now, a treatise published by a Swedish historian finally proves that the King's death was a case of political murder. Ballistic circumstances and the Danish ammunition then available are incompatible with a random shot from enemy quarters. Major-general Carl Cronstedt possessed the expertise needed to make an assassination look like a war casualty. It appears that the King was shot with a makeshift jacketed bullet long before jacketed bullets came into common use.

Famous Persons↗
PubMed1998

Charles Bonnet syndrome in children.

Charles Bonnet syndrome (CBS) is characterized by the presence of complex visual hallucinations in psychologically healthy but visually impaired people. It has been well described in the adult population but has been less well characterized in children. This report describes CBS in 2 children, both of whom had diagnoses of cone-rod dystrophy. After previously normal visual experience, each underwent rapid visual deterioration between 6 and 8 years old. Formed visual hallucinations were noted shortly after loss of vision. The children's symptoms were identical to those described by adults with CBS. Formed visual phenomena included geometric shapes, people, and buildings. Images, which were both stationary and in motion, were described as interesting or entertaining and only rarely as frightening. No other senses were affected (no auditory component). Sixteen additional children with diseases of the eye or optic nerves were questioned about symptoms of CBS, including children with congenitally decreased vision, children with slowly progressive visual loss but current vision better than 20/200, and children with early normal vision who had profound vision loss before 4 years old; all these children denied hallucinations.

Blindness↗
PubMed2002

Life and death of the people of London: a historical GIS of Charles Booth's inquiry.

Social reformer Charles Booth undertook a massive survey into the social and economic conditions of the people of London at the end of the 19th century. An important innovation of his Inquiry was the construction of large, detailed maps displaying social class of inner London on a street-by-street basis. These provide a detailed and vivid picture of the geography of poverty and affluence at this time. These maps have been digitised, georeferenced and linked to contemporary ward boundaries allowing Booth's measurement of social class to be matched to the measurement of social class in the 1991 census of population and standardised mortality ratios derived for all causes of death in the survey area between 1991 and 1995. The social class data were used to derive an index of relative poverty for both time periods and a comparison of the geographies of relative poverty and their relationship with contemporary mortality was made. Although the overall standard of living had increased, the geography of poverty at the end of the 19th century was very similar to that at the end of the 20th century. Moreover, the geography of all causes of death for people over the age of 65 was more strongly related to the geography of poverty in the late 19th century than contemporary patterns of poverty. This relationship was also true for mortality for specific diseases that are related to deprivation in early life. The paper concludes that the spatial patterns of poverty in inner London are extremely robust and a century of change has failed to disrupt it.

Cause of Death↗
PubMed2005

When things don't talk: knowledge and belief in the inter-war humanism of Charles Singer (1876-1960).

The science historian Charles Singer might seem to have shared with positivists a widely held commitment to observation as the foundation of knowledge. Yet in fact Singer's historiography was peculiarly unconcerned with instruments, models and other artefacts. Such tools might have been expected to present crucial empirical evidence for the historical arguments and ideal material for the didactics which pioneers such as Singer associated with their mission of a 'scientific humanism'. In their hands, physical things did not translate into epistemic things. This was deliberate. Yet while the configuration of science history which would distance it from material objects seems to speak of a shift from the visual to texts, the ocular technologies deployed in Singer's histories rather point to a co-existence of different kinds of visuality in that period's scholarship. As the academic and the museological aspects of science history pulled apart, the visuality of the museum came to be complemented by texts that vitally relied on images. The function of such images was to create proximity with the cognitive desires around whose traffic these histories became paper theatres of knowing. In bypassing material theatres and crafting realities that he understood to be empirically undemonstrable, Singer purposefully developed the story of understanding nature not as entailing obedience to its established results, but instead as embodying an attitude of continuing enquiry.

Historiography↗
PubMed1982

The Charles Bonnet syndrome in perspective.

The clinical condition occurring in the elderly with preserved intellectual functions, characterized by vivid, elaborate and dynamic recurrent visual pseudo-hallucinatory phenomena of a pleasant or neutral nature and often associated with ocular pathology - the Charles Bonnet Syndrome - is described. Its main clinical features are illustrated and the aetiology discussed. Two new cases are presented and areas for future research are outlined.

Age Factors↗
PubMed2001

From arctic lemmings to adaptive dynamics: Charles Elton's legacy in population ecology.

We shall examine the impact of Charles S. Elton's 1924 article on periodic fluctuations in animal populations on the development of modern population ecology. We argue that his impact has been substantial and that during the past 75 years of research on multi-annual periodic fluctuations in numbers of voles, lemmings, hares, lynx and game animals he has contributed much to the contemporary understanding of the causes and consequences of population regulation. Elton was convinced that the cause of the regular fluctuations was climatic variation. To support this conclusion, he examined long-term population data then available. Despite his firm belief in a climatic cause of the self-repeating periodic dynamics which many species display, Elton was insightful and far-sighted enough to outline many of the other hypotheses since put forward as an explanation for the enigmatic long-term dynamics of some animal populations. An interesting, but largely neglected aspect in Elton's paper is that it ends with speculation regarding the evolutionary consequences of periodic population fluctuations. The modern understanding of these issues will also be scrutinised here. In population ecology, Elton's 1924 paper has spawned a whole industry of research on populations displaying multi-annual periodicity. Despite the efforts of numerous research teams and individuals focusing on the origins of multi-annual population cycles, and despite the early availability of different explanatory hypotheses, we are still lacking rigorous tests of some of these hypotheses and, consequently, a consensus of the causes of periodic fluctuations in animal populations. Although Elton would have been happy to see so much effort spent on cyclic populations, we also argue that it is unfortunate if this focus on a special case of population dynamics should distract our attention from more general problems in population and community dynamics.

Adaptation, Physiological↗
PubMed2002

A biographical sketch of Charles F. Yocum: ;;It's the biochemistry, stupid''.

Charles F. Yocum has been a leader in the applications of biochemical techniques to the resolution and reconstitution of Photosystem II. His formal science education began as an undergraduate in biochemistry at Iowa State University and continued with graduate work in photosynthesis, first at the Illinois Institute of Technology and later at Indiana University. Following postdoctoral work at Cornell University, he joined the faculty of the University of Michigan where he has remained throughout his academic career. Charlie's contributions to a biochemical understanding of photosynthesis, particularly Photosystem II have been considerable, but most notably include his initial isolation of the first highly active oxygen-evolving particle from higher plant chloroplasts, the well-known and widely utilized 'BBY particles'. In the aftermath of that isolation, Charlie's research further resolved these particles into ever finer and simpler, but active, Photosystem II complexes. In addition, Charlie's research has provided significant insight into the roles of both Cl(-) and Ca(2+) as required cofactors in photosynthetic oxygen evolution.

Journal Article↗
PubMed2003

Charles W. Dohner, PhD: an evaluator and mentor in medical education.

As one of the first generation medical education pioneers, Charles W. Dohner, PhD established the ninth office of medical education at the University of Washington (UW) where he served as chairman from 1967-1996. With a background in education and measurement, he focused his work on evaluation of educational programs and faculty development. The Department of Medical Education went through three distinct stages of development: pathfinding 1967-1972 focused on developing working relationships with the faculty and clarifying identity, integration into academic affairs 1972-1980, and direct leadership by department faculty 1980-1996. Dohner helped to create and evaluate the WAMI program, a regional medical education program for the states of Washington, Alaska, Montana, and Idaho. He served as a consultant to a specialty board, the founding president of the Society of Directors of Research in Medical Education, and a frequent consultant in international medical education. Dohner identified three important innovations in medical education: educators in academic medicine, simulations and performance assessment, and community-based medical education. Success factors for professional education include technical competence in education, interpersonal communication and collaboration skills, a plan for personal growth, and use of mentors. Future trends in medical education will involve information technology, professionalism, wellness and complementary medicine, and performance assessment. He has been a passionate spokesman for excellence in medical education and most noted for his roles as an evaluator, program developer, and mentor of academic leaders.

Education, Medical↗
PubMed2000

Hyperperfusion in the lateral temporal cortex, the striatum and the thalamus during complex visual hallucinations: single photon emission computed tomography findings in patients with Charles Bonnet syndrome.

We report the findings of single photon emission computed tomography using 123I-IMP and magnetic resonance image studies of five patients with Charles Bonnet syndrome (CBS) while they were having visual hallucinations. All patients developed complex visual hallucinations after suffering from eye disease. The mean age at onset of CBS was 71.6 years. Single photon emission computed tomography studies in all patients disclosed hyperperfusion areas with some asymmetrical appearances in the lateral temporal cortex, striatum and thalamus. These results suggest that when elderly people suffer from eye disease, subsequent excessive cortical compensation in the lateral temporal cortex, striatum and thalamus may precipitate the development of visual hallucinations.

Aged↗
PubMed2000

[Visual hallucinations in Parkinson and Charles Bonnet Syndrome patients. A phenomenological and pathogenetic comparison].

UNLABELLED: Visual hallucinations (VH) are seen in about a third of all patients with Parkinson's disease (PD) and are usually considered to be an early marker or clinical component of a dopaminergic psychosis. Their peculiar phenomenology has not yet been studied in a systematic manner. METHODS: A semi-structured interview was performed twice in 62 PD patients. Different motoric and cognitive disease scales were used. The patients were not demented or depressed and had no other psychotic features other than hallucinations. Their visions was at least 0.6. RESULTS: 22 patients (36%) reported complex visual hallucinations or illusions in both interviews. These patients were not different from the non-hallucinating patients in terms of age, duration and stage of the disease, dosage and type of medication and frequency of cataracts. VH were diurnal in 41% of the patients, nocturnal in 18% of the patients and mixed in 41 patients. They were seen at least once weekly in 67% and they lasted always less than an hour. VH most frequently involved adults, children and pets. They were often mobile and had normal size and physiognomy. Notable emotional reactions were only reported by 18% of the patients. DISCUSSION: The phenomenology of VH in PD differs from VH in exogenous or endogenous psychoses, but is similar to the Charles Bonnet-syndrome (CBS), appearing in elderly patients with different visual deficits. As PD patients suffer regularly from visual deficits of contrast and color perception, a similar pathogenesis to CBS can be hypothesized, with these "minor" and benign VH being due to "release phenomena" in relation to partial visual deprivation. The lack of multimodality hallucinations and of secondary paranoia as well as the clear sensorium are helpful features in distinguishing them from toxic psychosis.

Aged↗
PubMed1992

[Visual hallucinations in elderly patients with reduced vision: Charles Bonnet syndrome].

The authors report on a 81-year-old-lady with Charles Bonnet-syndrome. This syndrome is a special form of a visual hallucinosis, which affects typically otherwise healthy, elderly people, who mostly suffer from reduced vision. Ophthalmologic and psychiatric findings are demonstrated in detail, in particular a reduced left-occipital perfusion in this syndrome is shown with a spect (single photon computed tomography) and discussed with the published literature.

Aged↗