Journal of psychiatric practice
-
Review Case Reports
Charles Bonnet syndrome: are medications necessary?
Charles Bonnet syndrome (CBS) is a clinical entity in which patients develop vivid visual hallucinations in the absence of psychiatric illness. In the great majority of cases, a decline in visual acuity precedes the development of CBS. ⋯ We present the case of a 79-year-old man who presented with the onset of vivid visual hallucinations after developing cataracts. We also review previous case reports of CBS and discuss treatment options.
-
Comment Review Case Reports
Commentary on visual hallucinations and Charles Bonnet syndrome.
The authors comment on two case reports of visual hallucinations due to non-psychiatric disorders: retinal detachment in a patient with schizophrenia, and Charles Bonnet syndrome. The physiology of visual misperception is reviewed, based on abnormalities along various points from the eye to the optic tracts to the occipital cortex. The approach to patients with visual hallucinations should include not only an evaluation for psychiatric disorders, but also an appreciation of possible non-psychiatric causes that may have major ramifications for care and potentially for preservation of sight.
-
Review Comparative Study
Use and safety of antipsychotic drugs during pregnancy.
The incidence of schizophrenia in the general population ranges from about 1% to 2%. Schizophrenia affects men and women equally, occurring in all cultures and socioeconomic classes. The peak age of onset in women is 25 to 35 years, which are also the peak childbearing years, and women with psychotic illnesses are likely to have more unplanned pregnancies than women without a psychotic illness. ⋯ However, there is a paucity of information, with a lack of large, well designed, prospective comparative studies. The information presented here should therefore not be interpreted as conclusive with regard to the safety of these drugs, as more research is needed. Women who require treatment should always discuss the risks and benefits of pharmacotherapy with their physician and, if it is felt that treatment should be continued during pregnancy, the evidenced-based information presented here will be of help in this important decision.
-
Review Case Reports
New onset delusions in the aftermath of the September 11th terrorist attacks.
-
Insomnia is one of the most common complaints faced in clinical practice. The limited pharmacological options available make the treatment of this complaint a challenge. All of the available benzodiazepines and non-benzodiazepine hypnotics have the potential to induce addiction, cause withdrawal symptoms, or trigger rebound insomnia. ⋯ Based on this review, it appears that more placebo-controlled trials are indicated before valid judgments concerning the efficacy of both melatonin and ramelteon can be made. In the meantime, there is some support for the use of melatonin for the treatment of insomnia, and findings concerning ramelteon also appear promising. Nevertheless, clinicians who prescribe melatonin or ramelteon should be cautious and carefully monitor both potential benefits and adverse effects, since data on melatonin are based on studies with multiple limitations and only three controlled trials have been done with ramelteon.