Charles-Bonnet Syndrome (Other PM Notes) Flashcards
Describe what is meant by Charles-Bonnet syndrome [3]
Charles-Bonnet syndrome (CBS) is characterised by persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness
- This is generally against a background of visual impairment (although visual impairment is not mandatory for a diagnosis).
- Insight is usually preserved.
Describe the clinical features of Charles-Bonnet Syndrome [1]2]
Well-formed complex visual hallucinations are thought to occur in 10-30 per cent of individuals with severe visual impairment.
- The most common ophthalmological conditions associated with this syndrome are age-related macular degeneration, followed by glaucoma and cataract.
- Prevalence of CBS in visually impaired people is thought to be between 11 and 15 per cent.
Around a third find the hallucinations themselves an unpleasant or disturbing experience.
Describe the management of CBS [
There is no treatment with proven benefit. For most patients, understanding that they do not have a mental illness seems to be the best treatment, as it improves their ability to cope with the hallucinations, although these can still interfere with daily life.
Interrupting vision for a short time by closing the eyes or blinking is sometimes helpful
- In some patients, eye movement can help dispel the hallucination.
- As the hallucinations tend to occur in similar situations (quiet activity), it may help to get up and do a distracting activity.
- Reducing social isolation and therefore increasing both sensory and cognitive stimulation can be helpful.7
Describe what is meant by Cotart syndrome [1]
Cotard syndrome is a rare mental disorder where the affected patient believes that they (or in some cases just a part of their body) is either dead or non-existent
- This delusion is often difficult to treat and can result in significant problems due to patients stopping eating or drinking as they deem it not necessary.
What is the difference between cotard syndrome and a nihilistic delusion? [1]
Cotard Syndrome, also known as Cotard’s Delusion or Walking Corpse Syndrome, is a rare neuropsychiatric disorder in which patients have the delusional belief that they are dead, do not exist, or have lost their vital organs. It was first described by Jules Cotard in 1880.
Nihilistic delusions, on the other hand, are a subtype of delusions where individuals deny existence of parts of their body or the world around them. They’re often associated with severe depression and psychosis.
While Cotard Syndrome is often characterised by nihilistic delusions (hence why they might be conflated), they are not synonymous. Nihilistic delusions can occur in several psychiatric disorders beyond Cotard syndrome including schizophrenia and severe depressive disorders.
The key difference lies in the specificity and severity of denial of existence seen in Cotard Syndrome. In this condition, patients typically believe they themselves or parts of their bodies are dead or non-existent.
Describe what is meant by De Clerambault’s syndrome [1]
De Clerambault’s syndrome, also known as erotomania, is a form of paranoid delusion with an amorous quality. The patient, often a single woman, believes that a famous person is in love with her.
Patients will DeCler their love
Describe what the following are: [4]
De Clerambault’s
Cotard syndrome
Othello syndrome
Capgras delusion
De Clerambault’s
- = erotomania
Cotard syndrome
- = believing you’re dead
Othello syndrome
- = delusional jealousy (usually of a partner)
Capgras delusion
- = believing a (close) acquaintance has been replaced by an imposter
When is electroconvulsive therapy indicated? [3]
What is the only absolute contraindication? [1]
Electroconvulsive therapy is a useful treatment option for patients with severe depression refractory to medication (e.g. catatonia) those with psychotic symptoms; europhoria (mania)
ECT indications mnemonic-
E- euphoria (mania)
C- catatonia
T- treatment resistant depression/ tearful- severe mental illness
The only absolute contraindications is raised intracranial pressure.
What are short term [5] and long term [4] side effects of ECT?
Short-term side-effects
* headache
* nausea
* short term memory impairment
* memory loss of events prior to ECT
* cardiac arrhythmia
Long-term side-effects
* some patients report impaired memory
Describe the 5 stages of grief [5]
Denial: this may include a feeling of numbness and also pseudohallucinations of the deceased, both auditory and visual. Occasionally people may focus on physical objects that remind them of their loved one or even prepare meals for them
Anger: this is commonly directed against other family members and medical professionals
Bargaining
Depression
Acceptance
DABDA - Denial, Anger, Bargaining, Depression, Acceptance
NB: It should be noted that many patients will not go through all 5 stages.
Describe the diffeerences between mania and hypomania
Mania
* Lasts for at least 7 days - Causes severe functional impairment in social and work setting
* May require hospitalization due to risk of harm to self or others
* May present with psychotic symptoms
Hypomania:
* A lesser version of mania
* Lasts for < 7 days, typically 3-4 days. Can be high functioning and does not impair functional capacity in social or work setting
* Unlikely to require hospitalization
* Does not exhibit any psychotic symptoms
Therefore, the length of symptoms, severity and presence of psychotic symptoms (e.g. delusions of grandeur, auditory hallucinations) helps differentiates mania from hypomania.
Which symptoms are seen in bith mania/hypomania with regards to mood [2]; speech and thought [3] and behaviour [3]
Mood
* predominately elevated
* irritable
Speech and thought
* pressured
* flight of ideas: characterised by rapid speech with frequent changes in topic based on associations, distractions or word play
* poor attention
Behaviour
* insomnia
* loss of inhibitions: sexual promiscuity, overspending, risk-taking
* increased appetite
Define insomnia
Acute insomnia is more typically related to a life event and resolves without treatment.
Chronic insomnia may be diagnosed if a person has trouble falling asleep or staying asleep at least three nights per week for 3 months or longer.
How do you Ix insomnia? [3]
- Diagnosis is primarily made through patient interview, looking for the presence of risk factors.
- Sleep diaries and actigraphy may aid diagnosis. Actigraphy is a non-invasive method for monitoring motor activity.
- Polysomnography is not routinely indicated. It may be considered in patients with suspected obstructive sleep apnoea or periodic limb movement disorder, or when insomnia is poorly responsive to conventional treatment.
Describe the mx of insomnia [+]
Short-term management of insomnia:
* Identify any potential causes e.g. mental/ physical health issues or poor sleep hygiene.
* Advise the person not to drive while sleepy.
* Advise good sleep hygiene: no screens before bed, limited caffeine intake, fixed bed times etc.
* ONLY consider use of hypnotics if daytime impairment is severe.
There is good evidence for the efficacy of hypnotic drugs in short-term insomnia
- short-acting benzodiazepines or non-benzodiazepines (zopiclone, zolpidem and zaleplon).
- Use the lowest effective dose for the shortest period possible.
- If there has been no response to the first hypnotic, do not prescribe another. You should make the patient aware that repeat prescriptions are not usually given.
- It is important to review after 2 weeks and consider referral for cognitive behavioural therapy (CBT).
Describe what is meant by a pseudohallucination [2]
ICD10 definition of hallucination: false sensory perception in the absence of an external stimulus. Maybe organic, drug-induced or associated with mental disorder.
An example of a pseudohallucination is a hypnagogic hallucination which occurs when transitioning from wakefulness to sleep. These are experienced vivid auditory or visual hallucinations which are fleeting in duration and may occur in anyone. These are pseudohallucinations as the affected person is able to determine that the hallucination was not real.
Describe what pyschosis [1+] is and what pyschotic features are [4]
Psychosis is a term used to describe a person experiencing things differently from those around them
For OSCE : sychosis refers to a collection of symptoms that affect the mind, where there has been some loss of contact with reality. During an episode of psychosis, a person’s thoughts and perceptions are disrupted and they may have difficulty recognizing what is real and what is not.
Features:
hallucinations (e.g. auditory)
delusions
thought disorganisation
* alogia: little information conveyed by speech
* tangentiality: answers diverge from topic
* clanging
* word salad: linking real words incoherently → nonsensical content
Which conditions might you see pyschotic features in? [+]
schizophrenia: the most common psychotic disorder
depression (psychotic depression, a subtype more common in elderly patients)
bipolar disorder
puerperal psychosis
brief psychotic disorder: where symptoms last less than a month
neurological conditions e.g. Parkinson’s disease, Huntington’s disease
prescribed drugs e.g. corticosteroids
certain illicit drugs e.g. cannabis, phencyclidine
A person has troublesome sleep paralysis. Which drug can be used to help manage? [1]
clonazepam
