Visual hallucinations in neurological and ophthalmological disease: pathophysiology and management.

Content Provider	Europe PMC
Author	O'Brien, John Taylor, John Paul Ballard, Clive Barker, Roger A Bradley, Clare Burns, Alistair Collerton, Daniel Dave, Sonali Dudley, Rob Francis, Paul Gibbons, Andrea Harris, Kate Lawrence, Vanessa Leroi, Iracema McKeith, Ian Michaelides, Michel Naik, Chaitali O'Callaghan, Claire Olsen, Kirsty Onofrj, Marco Pinto, Rebecca Russell, Gregor Swann, Peter Thomas, Alan Urwyler, Prabitha Weil, Rimona Sharon ffytche, Dominic
Copyright Year	2020
Abstract	Visual hallucinations are common in older people and are especially associated with ophthalmological and neurological disorders, including dementia and Parkinson’s disease. Uncertainties remain whether there is a single underlying mechanism for visual hallucinations or they have different disease-dependent causes. However, irrespective of mechanism, visual hallucinations are difficult to treat. The National Institute for Health Research (NIHR) funded a research programme to investigate visual hallucinations in the key and high burden areas of eye disease, dementia and Parkinson’s disease, culminating in a workshop to develop a unified framework for their clinical management. Here we summarise the evidence base, current practice and consensus guidelines that emerged from the workshop.Irrespective of clinical condition, case ascertainment strategies are required to overcome reporting stigma. Once hallucinations are identified, physical, cognitive and ophthalmological health should be reviewed, with education and self-help techniques provided. Not all hallucinations require intervention but for those that are clinically significant, current evidence supports pharmacological modification of cholinergic, GABAergic, serotonergic or dopaminergic systems, or reduction of cortical excitability. A broad treatment perspective is needed, including carer support. Despite their frequency and clinical significance, there is a paucity of randomised, placebo-controlled clinical trial evidence where the primary outcome is an improvement in visual hallucinations. Key areas for future research include the development of valid and reliable assessment tools for use in mechanistic studies and clinical trials, transdiagnostic studies of shared and distinct mechanisms and when and how to treat visual hallucinations.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC7231441&blobtype=pdf
ISSN	00223050
Journal	Journal of Neurology, Neurosurgery, and Psychiatry [J Neurol Neurosurg Psychiatry]
Volume Number	91
DOI	10.1136/jnnp-2019-322702
PubMed Central reference number	PMC7231441
Issue Number	5
PubMed reference number	32213570
e-ISSN	1468330X
Language	English
Publisher	BMJ Publishing Group
Publisher Date	2020-03-25
Publisher Place	BMA House, Tavistock Square, London, WC1H 9JR
Access Restriction	Open
Rights License	This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
Subject Keyword	parkinson's disease dementia hallucinations
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Surgery Psychiatry and Mental Health