Auditory hallucinations in adults with hearing impairment: a large prevalence study.

BACKGROUND: Similar to visual hallucinations in visually impaired patients, auditory hallucinations are often suggested to occur in adults with hearing impairment. However, research on this association is limited. This observational, cross-sectional study tested whether auditory hallucinations are associated with hearing impairment, by assessing their prevalence in an adult population with various degrees of objectified hearing impairment. METHODS: Hallucination presence was determined in 1007 subjects aged 18-92, who were referred for audiometric testing to the Department of ENT-Audiology, University Medical Center Utrecht, the Netherlands. The presence and severity of hearing impairment were calculated using mean air conduction thresholds from the most recent pure tone audiometry. RESULTS: Out of 829 participants with hearing impairment, 16.2% (n = 134) had experienced auditory hallucinations in the past 4 weeks; significantly more than the non-impaired group [5.8%; n = 10/173; p < 0.001, odds ratio 3.2 (95% confidence interval 1.6-6.2)]. Prevalence of auditory hallucinations significantly increased with categorized severity of impairment, with rates up to 24% in the most profoundly impaired group (p < 0.001). The corrected odds of hallucination presence increased 1.02 times for each dB of impairment in the best ear. Auditory hallucinations mostly consisted of voices (51%), music (36%), and doorbells or telephones (24%). CONCLUSIONS: Our findings reveal that auditory hallucinations are common among patients with hearing impairment, and increase with impairment severity. Although more research on potential confounding factors is necessary, clinicians should be aware of this phenomenon, by inquiring after hallucinations in hearing-impaired patients and, conversely, assessing hearing impairment in patients with auditory hallucinations, since it may be a treatable factor.

[Complex visual hallucinations in partially sighted elderly: Charles Bonnet syndrome]. / Complexe visuele hallucinaties bij slechtziende ouderen: syndroom van Charles Bonnet.

In two patients, women aged 85 and 80 years, who suffered from visual hallucinations involving living creatures, cars and buildings, Charles Bonnet syndrome was diagnosed. Both were worried that these signs were an indication of a severe psychiatric condition. In diagnosing the Charles Bonnet syndrome the following criteria can be used: presence of complex visual hallucinations, retention of insight, absence of hallucinations in other sensory modalities and absence of delusions. Hallucinations in dementia, delirium, migraine, epilepsy, or in extreme states of exhaustion or sensory deprivation, as well as hallucinations due to psychedelic drugs, hallucinations of widowhood and hypnagogic and hypnopompic hallucinations must be excluded. Patient education and reassurance are the cornerstones of treatment. Other possible treatments are: improving visual acuity and the general physical condition, stopping medication with hallucinogenic side effects, activating the patient, coaching the patient in avoiding hallucination-triggering situations and using stopping strategies, and (still experimental) pharmacological treatment with carbamazepine, valproate, ondansetron or cisapride.

The relationship between depression and mortality in elderly subjects with less severe dementia.

BACKGROUND: Little is known about the effects of depression on the mortality rates of elderly subjects with dementia. METHODS: Logistic regression analysis, adjusting for possible confounders, was used to study the associations between GMS-AGECAT derived syndrome and symptom measures and 12-month mortality rates in a cohort of 73 elderly subjects who met the DSM-III-R criteria of dementia with a median MMSE score of 19. RESULTS: Twenty-three subjects (32%) died within the 12 month follow-up period. A baseline diagnosis of syndromal or subsyndromal depression was associated with increased mortality. At the symptom level mortality was predicted by higher scores on the factor 'mood symptoms'. The effects of interactions between depression measures and severity of dementia were not significant. CONCLUSIONS: Short-term mortality in elderly subjects with less severe dementia is predicted by the presence of (sub) syndromal depression and by mood symptoms. The effects of depression and severity of dementia on the mortality rates seem to be largely independent.

Social and psychological characteristics of elderly visually handicapped patients with the Charles Bonnet Syndrome.

The Charles Bonnet syndrome (CBS) is characterized by the presence of complex visual hallucinations in psychologically normal people. The syndrome occurs predominantly in the visually handicapped elderly. Little is known about its etiology and pathogenesis. The aim of this study was to examine the associations of CBS with psychological and social determinants. All subjects were patients older than 64 years from a low-vision unit. Using a case-control approach, 50 patients with CBS and 80 patients without visual hallucinations were interviewed about their educational level, social circumstances, number of social contacts, and ability to cope with visual handicap. Loneliness was measured with the De Jong-Gierveld-Kamphuis loneliness scale, and personality traits were examined with the Dutch-language short version of the Minnesota Multiphasic Personality Inventory ([MMPI] Nederlandse Verkorte MMPI [NVM]). Compared with the control group, significantly more CBS patients were lonely. Mean scores on the NVM shyness scale and extraversion scale were significantly higher and lower, respectively, in CBS patients. In multiple logistic regression analysis for the three determinants simultaneously, loneliness and low extraversion were significant predictors for CBS, but shyness was not. It is concluded that loneliness, low extraversion, and shyness are risk indicators for CBS in elderly visually handicapped people. The findings suggest that CBS is associated with a low quality of social contacts.

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.

[Standardized behavior assessment plays a minor role in arriving at indications for admission to a psychogeriatric nursing home]. / Gestandaardiseerde gedragsbeoordeling speelt een betrekkelijk geringe rol bij de indicatiestelling voor opname in een psychogeratrisch verpleeghuis.

To investigate the role which standardised, patient related data play in indicated admission to a psychogeriatric nursing home, we compared the data of 120 indicated with those of 68 not-indicated patients. High scores on subscales 'helplessness' and 'inactivity' of the Dutch version of the Stockton Geriatric Rating Scale were the best predictors of indicated admission to a certain extent (21.6%). Furthermore a history of cardiac diseases and the state of being unmarried increased the probability of indicated admission to a small degree. Only a limited percentage of the variance in the decision of the indication committee could be explained. The limited availability of data which are collected in a standardised way, especially data concerning the caregiving system and the absence of valid and reliable instruments for the investigation of indicated admission are the most probable causes of this fact.

The Charles Bonnet syndrome: a large prospective study in The Netherlands. A study of the prevalence of the Charles Bonnet syndrome and associated factors in 500 patients attending the University Department of Ophthalmology at Nijmegen.

BACKGROUND: The aims were to determine the prevalence of the Charles Bonnet syndrome (CBS) in low-vision patients and analyse possible associated ophthalmic and sociodemographic factors. METHOD: A semi-structured interview on visual hallucinations was given to 300 adult low-vision patients and 200 elderly general ophthalmic patients. Positive cases were examined with the Geriatric Mental State Schedule and the Mini Mental State Examination. Diagnostic criteria were as follows: complex, persistent, or repetitive visual hallucinations; full or partial retention of insight; no hallucinations in other modalities; and no delusions. Ophthalmic and sociodemographic data were gathered for all patients. RESULTS: The prevalence of CBS in low-vision patients was 11%. CBS was significantly associated with an age over 64 years and a visual acuity in the best eye of 0.3 or less. No significant associations with ophthalmic diagnoses, patient sex, marital status, or social circumstances were found. CONCLUSION: Our findings support association of CBS with sensory deprivation and advanced age.

Clinical evaluation of 14 patients with the Charles Bonnet syndrome (isolated visual hallucinations).

A group of 14 patients with isolated visual hallucinations who met the criteria proposed by Gold and Rabins for Charles Bonnet syndrome (with the exception of the criterion "hallucinations are stereotyped") underwent psychiatric, neurologic, and ophthalmologic tests. Additional common characteristics of the hallucinations included the absence of personal meaning of the content of the hallucinations and the disappearance of the hallucinations when the patients closed their eyes. There was no evidence for a relationship of the syndrome to psychiatric disorders. In the majority of cases, ocular pathology and neurologic disturbances were diagnosed. There was also evidence that most patients were suffering from social isolation. From these data it is concluded that a combination of factors is probably responsible for the Charles Bonnet syndrome.