What is Charles Bonnet syndrome, the eye condition that causes hallucinations?



From shutterstock.com

Jason Yosar, The University of Queensland

Visual hallucinations, or seeing things that aren’t really there, can be frightening and distressing.

They may occur due to a large variety of physical and psychiatric conditions. But a lesser known cause is Charles Bonnet syndrome (pronounced bo-nay), named after the Swiss scientist who first described the condition in 1760.

Charles Bonnet syndrome (also called visual release hallucinations) refers to visual hallucinations in patients with severe vision loss due to eye, optic nerve or brain disease.

The syndrome is named after Swiss scientist Charles Bonnet.
Wikimedia commons

We don’t know the exact cause of Charles Bonnet syndrome. But the most commonly accepted theory is the loss of visual sensory signals to the brain (for example, when a person becomes blind) means the brain cannot put the brakes on excessive and unwanted brain activity.

This leads the part of the brain responsible for the sensation of vision (the visual cortex) to fire signals inappropriately. The person in turn perceives they are seeing something in the absence of a true stimulus – a visual hallucination.

If these symptoms are affecting you, a friend or family member who has become blind in one or both eyes, it’s important to understand it’s not a sign of “going mad”.




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What are Charles Bonnet hallucinations like?

The hallucinations may be “simple” (such as lines, shapes, or flashes of light) or “complex” (such as formed images of animals, like butterflies). Simple hallucinations are much more common.

They may occur for seconds or minutes to hours or continuously, and the frequency ranges from isolated episodes to multiple times a day. It’s normal for Charles Bonnet syndrome to last for years; some people will experience symptoms for the rest of their lives.

The nature of Charles Bonnet hallucinations is highly variable. That is, people who are affected often don’t see the same thing repeatedly, and one person with Charles Bonnet syndrome will see different things from the next person.

Charles Bonnet hallucinations often have little or no emotional meaning, allowing affected people to recognise they are not real. This is distinct from hallucinations associated with mental illness.




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Other features of visual hallucinations unique to Charles Bonnet syndrome include:

  • hallucinations only appear in the areas where vision is lost (for example, a person who is blind in their left eye will perceive hallucinations only in that eye)

  • hallucinations are more frequently seen with the eyes open than closed, and may disappear when the person closes their eyes or looks away

  • hallucinations are more common in settings of sensory deprivation (for example, at night time or in dim lighting, or during periods of inactivity).

Who is affected?

Most people with Charles Bonnet syndrome are older adults (usually over 70). This is probably because vision loss is most common in this age group. But any person of any age with acquired vision loss can develop Charles Bonnet syndrome.

The causes of blindness that lead to Charles Bonnet syndrome are usually macular degeneration, glaucoma, diabetes, stroke and injury – but any disease that leads to blindness may cause Charles Bonnet syndrome.

The syndrome does not occur in congenital blindness (people born blind from birth).

Charles Bonnet syndrome is most common in older people, but can present in anyone with acquired vision loss.
From shutterstock.com

We currently have no conclusive data on how many Australians have Charles Bonnet syndrome, although one study estimated more than 17% of people aged over 60 with impaired vision had it. In another study, as many as 57% of participants with vision loss reported perceived visual hallucinations.

Importantly, it may be more common than estimated because of lack of reporting. That is, people who are affected may not report their hallucinations due to fear of psychiatric disease or of being perceived to be “going mad”.

Further, people who do report their symptoms may be misdiagnosed with psychosis or dementia.




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Treatment options are limited

Seeing a general practitioner (often in conjunction with a neurologist and/or geriatrician) is an important first step to exclude other causes of hallucinations. These could include dementia, physical neurological conditions (for example, a brain tumour), epilepsy and delirium due to infections or medications. Your doctor may order blood tests and/or brain imaging to rule these out.

Treatment for Charles Bonnet syndrome is very limited, but many patients report reassurance is all they need, especially for infrequent hallucinations or those that don’t adversely affect quality of life.

Strategies to minimise the frequency and duration of hallucinations include frequent blinking or rapid eye movement, going to a lighter place or switching a light on, and increasing social interaction, which helps to counter inactivity.

For patients with debilitating symptoms, doctors may trial medications such as antidepressants, antipsychotics and antiepileptic drugs, though their efficacy is variable and may be outweighed by side effects.




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Hallucinations may disappear if the cause of vision loss can be corrected (for example, if severe cataracts were causing blindness and the patient has a cataracts operation).

Unfortunately though, generally the causes of vision loss that lead to Charles Bonnet syndrome can’t be treated.The Conversation

Jason Yosar, Associate Lecturer, School of Medicine, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Bushfire smoke is bad for your eyes, too. Here’s how you can protect them



When the hazardous particles found in bushfire smoke come into contact with our eyes, this can cause inflammation.
From shutterstock.com

Katrina Schmid, Queensland University of Technology and Isabelle Jalbert, UNSW

As we continue to contend with smoke haze in various parts of the country, many Australians may find themselves with watery, burning, irritated or red eyes.

Data from countries with consistently poor air quality suggest there could also be a risk of longer term effects to our eyes, particularly with prolonged exposure to bushfire smoke.

Although P2/N95 masks can protect us from inhaling harmful particles, unfortunately they can’t protect our eyes.

But there are certain things you can do to minimise irritation and the risk of any longer term effects.




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Irritation in the short term

The eye’s surface is continuously exposed to the environment, except when our eyes are shut when we sleep.

Bushfire smoke contains dust, fumes (such as carbon monoxide and nitrogen oxides), and tiny particles called PM10 and PM2.5.

When the smoke comes into contact with our eyes, the fumes and small particles dissolve into our tears and coat the eye’s surface. In some people, this can trigger inflammation, and therefore irritation.




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The presence of a marker called matrix metalloproteinase-9, or MMP-9, indicates the eye is inflamed.

During periods of poor air quality from bushfires in the United States, MMP-9 was present in the eyes of more people than it ordinarily would be.

Longer term risks

We know very little about how pollution from bushfire smoke might affect our eyes over the longer term, or what damage repeated or chronic exposure might do.

But we do know people who live in areas with high levels of air pollution, such as China, are three to four times more likely to develop dry eye.

Dry eye is a condition where a person doesn’t have enough tears or they are of such poor quality they don’t lubricate and nourish the eye. We need high quality tears to maintain the health of the front surface of the eye and provide clear vision.

For people who already have dry eyes – often older people – poor air quality may increase the damage. The smoke and pollution may cause intense stinging and a feeling of grittiness to the point they can barely open their eyes.

Avoid rubbing your eyes, as this could make the irritation worse.
From shutterstock.com

While dry eye is a result of damage to the surface of the eyes, it’s also possible pollutants entering the blood stream after we breathe them in could affect the blood supply to the eye. This in turn could damage the fine vessels within the eye itself.

Research has suggested high levels of air pollution in Taiwan may increase the risk of age-related macular degeneration, which could be an example of this.

We need more research into the long-term effects on our eyes of prolonged poor air quality, particularly from bushfire smoke. But what we do know suggests it’s possible bushfire smoke could be causing subtle damage to the eyes, even in people without any symptoms.




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What can you do to protect your eyes from the smoke?

  • the best option is to avoid going outside when air quality is at is worst, where possible
  • wearing sunglasses or glasses when outside if you need them might stop some of the dust carried in the wind from contacting the eye’s surface (but it won’t stop the tiny particles getting in)
  • avoid wearing contact lenses if possible.

Some tips if your eyes are irritated

  • flush your eyes as often as you can, with over-the-counter lubricant eye drops if you have some on hand. If not, use sterile saline solution or clean bottled water
  • if your eyes are itchy, flush them and then place a cool face washer over your closed lids
  • don’t rub your eyes, as this could make the irritation worse.

If your eyes are red and sore and these steps don’t help, it’s best to see an eye care professional.




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The Conversation


Katrina Schmid, Associate Professor, Queensland University of Technology and Isabelle Jalbert, Associate Professor, School of Optometry and Vision Science, UNSW Sydney, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Hindu Extremists in India Beat Pastor Unconscious


Evangelist was traveling with sons from one village to another.

NEW DELHI, April 22 (CDN) — Hindu extremists beat a pastor and evangelist unconscious in front of his sons earlier this month in Madhya Pradesh state.

Ramesh Devda, 30, from Dhadhniya, Meghnagar district, said he was attacked on April 4 at about 11 a.m. after leading a prayer meeting in Chikklia village. He said he was on his way to Bhajidongra, at the border of Madhya Pradesh and Gujarat states, by motorcycle with his two sons, 10-year-old Elias, and 8-year-old Shimon, to lead another prayer meeting.

When he reached Raseda village, he said, suddenly three people on two motorcycles blocked his way and forced him to stop.

“Suddenly out of nowhere these three men appeared in two motorcycles – they blocked me and tilted my motorcycle,” Pastor Devda told Compass. “We fell down. They were carrying big bamboo sticks and clubs. They started beating me, and then they called and three more men came and started to attack me.”

He said he was thankful that his sons were spared from beating, though his older son sustained a leg injury in the course of the attack.

“They were angry at me and were threatening to kill me and were warning me not to come to their area again,” he said. “My sons were screaming at the top of their voices, and they were afraid. One of the men hit me on my forehead with a big bamboo stick, cracking my skull. The others were also beating me on my body, especially my back with bamboo sticks.”

A blow to the forehead temporarily blinded him, he said.

“My eyes were darkened, and I fell down, and they proceeded to beat me even more,” he said. “The men were also abusive in the foulest language that I had heard, and they were drunk.”

People passing by heard the two boys crying out and came to help, and the attackers fled, he said, leaving the unconscious pastor and his sons.

“I do not know who helped me, as I was unconscious,” Pastor Devda said. “But I came to know later that local Christians also came in and called the emergency helpline. As a result, an ambulance came, which then took me to the hospital.”

He was taken to Anita Surgical Hospital on Station Road in Dahod, Gujarat. There a physician identified only as Dr. Bharpoda told him that he had fractured his skull.

“I am being treated for my wounds now, but there is still a lot of pain,” Pastor Devda said.

A Christian for 15 years, Pastor Devda has been in Christian leadership for 11 years and now serves with the Christian Reformed Fellowship of India. He has two other children, Ashish and 4-year-old Sakina, and his wife Lalita, 28, is active with him in Christian service.

Pastor Devda leads congregations in Chikklia, Bhajidongra and Dhadhniya villages.

“I have heard that I was attacked because the people of Chikklia did not like me conducting the Sunday service there,” he said. “The people who beat me up do belong to a Hindu fundamentalist outfit, and some believers in Chikklia know them. I can recognize them if I see them again.”

He said, however, that he does not want to file a First Information Report (FIR) with police.

“There is no one supporting me or standing with me in my village or my mission, and I am myself fearful, as I have to continue to minister to these very people,” Pastor Devda said. “I know my attack was pre-planned, but I do not want to report it to the police.”

A Christian co-worker from Rajasthan was also attacked about a month ago in equally brutal fashion, he said, but also refrained from filing an FIR because of fear of repercussions.

Vijayesh Lal, secretary of the Evangelical Fellowship of India’s Religious Liberty Commission, said the tribal belt that extends to the border areas of Madhya Pradesh, Gujarat and Rajasthan, has been a hot spot for anti-Christian activity since the late 1990s.

“Only recently a 65-year-old evangelist was beaten and stripped by Hindu extremists,” he said. “It is a worrisome trend, and one that should be dealt with not only by the government but by the secular media and civil society in general.”

Report from Compass Direct News
http://www.compassdirect.org

Christian Woman Freed from Muslim Kidnappers in Pakistan


Captors tried to force mother of seven to convert to Islam.

LAHORE, Pakistan, March 11 (CDN) — A Christian mother of seven here who last August was kidnapped, raped, sold into marriage and threatened with death if she did not convert to Islam was freed this week.

After she refused to convert and accept the marriage, human traffickers had threatened to kill Shaheen Bibi, 40, and throw her body into the Sindh River if her father, Manna Masih, did not pay a ransom of 100,000 rupees (US$1,170) by Saturday (March 5), the released woman told Compass.   

Drugged into unconsciousness, Shaheen Bibi said that when she awoke in Sadiqabad, her captors told her she had been sold and given in marriage.

“I asked them who they were,” she said. “They said that they were Muslims, to which I told them that I was a married Christian woman with seven children, so it was impossible for me to marry someone, especially a Muslim.”

Giving her a prayer rug (musalla), her captors – Ahmed Baksh, Muhammad Amin and Jaam Ijaz – tried to force her to convert to Islam and told her to recite a Muslim prayer, she said.

“I took the musalla but prayed to Jesus Christ for help,” she said. “They realized that I should be returned to my family.”

A member of St. Joseph Catholic Church in Lahore, Shaheen Bibi said she was kidnapped in August 2010 after she met a woman named Parveen on a bus on her way to work. She said Parveen learned where she worked and later showed up there in a car with two men identified as Muhammad Zulfiqar and Shah. They offered her a job at double her salary and took her to nearby Thokar Niaz Baig.

There she was given tea with some drug in it, and she began to fall unconscious as the two men raped her, she said. Shaheen Bibi was unconscious when they put her in a vehicle, and they gave her sedation injections whenever she regained her senses, she said.

When she awoke in Sadiqabad, Baksh, Amin and Ijaz informed her that she had been sold into marriage with Baksh. They showed her legal documents in which she was given a Muslim name, Sughran Bibi daughter of Siddiq Ali. After Baksh had twice raped her, she said, his mother interjected that she was a “persistent Christian” and that therefore he should stay away from her.

Shaheen Bibi, separated from an abusive husband who had left her for another woman, said that after Baksh’s mother intervened, her captors stopped hurting her but kept her in chains.

 

Release

Her father, Masih, asked police to take action, but they did nothing as her captors had taken her to a remote area between the cities of Rahim Yar Khan and Sadiqabad, considered a “no-go” area ruled by dangerous criminals.

Masih then sought legal assistance from the Community Development Initiative (CDI), a human rights affiliate of the European Center for Law & Justice. With the kidnappers giving Saturday (March 5) as a deadline for payment of the ransom, CDI attorneys brought the issue to the notice of high police officials in Lahore and on March 4 obtained urgent legal orders from Model Town Superintendent of Police Haidar Ashraf to recover Shaheen, according to a CDI source.

The order ultimately went to Assistant Sub-Inspector (ASI) Asghar Jutt of the Nashtar police station. Police accompanied by a CDI field officer raided the home of a contact person for the captors in Lahore, Naheed Bibi, the CDI source said, and officers arrested her in Awami Colony, Lahore.

With Naheed Bibi along, CDI Field Officer Haroon Tazeem and Masih accompanied five policemen, including ASI Jutt, on March 5 to Khan Baila, near Rahim Yar Khan – a journey of 370 miles, arriving that evening. Area police were not willing to cooperate and accompany them, telling them that Khan Baila was a “no-go area” they did not enter even during daytime, much less at night.

Jutt told area police that he had orders from high officials to recover Shaheen Bib, and that he and Tazeem would lead the raid, the CDI source said. With Nashtar police also daring them to help, five local policemen decided to go with them for the operation, he said.

At midnight on Sunday (March 6), after some encounters and raids in a jungle area where houses are miles apart, the rescue team managed to get hold of Shaheen Bibi, the CDI source said. The captors handed over Shaheen Bibi on the condition that they would not be the targets of further legal action, the CDI source said.

Sensing that their foray into the danger zone had gone on long enough, Tazeem and Jutt decided to leave but told them that those who had sold Shaheen Bib in Lahore would be brought to justice.

Fatigued and fragile when she arrived in Lahore on Monday (March 7), Shaheen Bibi told CDN through her attorneys that she would pursue legal action against those who sold her fraudulently into slavery and humiliation.

She said that she had been chained to a tree outside a house, where she prayed continually that God would help her out of the seemingly impossible situation. After the kidnappers gave her father the March 5 deadline last week, Shaheen Bibi said, at one point she lifted her eyes in prayer, saw a cross in the sky and was comforted that God’s mighty hand would release her even though her father had no money to pay ransom.

On four previous occasions, she said, her captors had decided to kill her and had changed their mind.

Shaheen Bibi said there were about 10 other women in captivity with her, some whose hands or legs were broken because they had refused to be forcibly given in marriage. Among the women was one from Bangladesh who had abandoned hope of ever returning home as she had reached her 60s in captivity.

Masih told CDN that he had prayed that God would send help, as he had no money to pay the ransom. The day before the deadline for paying the ransom, he said, he had 100 rupees (less than US$2) in his pocket.

Report from Compass Direct News

Pakistani Mother Condemned for ‘Blasphemy’ Stunned, Shattered


First woman sentenced to die for speaking ill of Muhammad says she never got to defend herself.

SHEIKHUPURA, Pakistan, November 17 (CDN) — Ashiq Masih, with his stooped posture, frail body and dull yellow eyes, stands in a small compartment in the Sheikhupura District Jail with his three daughters – Sidra, Eesha and Eeshum. The girls are weeping silently.

On the other side of a metal grille is Asia Noreen, the birth mother of two of the girls and the first woman in Pakistan to receive the death sentence on charges of blaspheming Islam’s prophet. Eeshum, 12-years-old and mentally disabled, whines like a baby for her mother, asking her when she will be back.

“I will be back,” she says to her daughters, as they feel their mother’s fingers through the gaps in the grille. “Don’t you worry, now.” But tears run down her face, too.

Arrested on June 19, 2009, Asia (alternatively spelled Aaysa) Noreen was accused of blaspheming Muhammad and defaming Islam. A judge under pressure from area Islamists convicted her under Pakistan’s widely condemned blasphemy statutes on Nov. 8.

“I don’t know why – when I walked into court that day, I just knew,” she said, tears returning to her eyes and her voice shaking. “And when the judge announced my death sentence, I broke down crying and screaming. In the entire year that I have spent in this jail, I have not been asked even once for my statement in court. Not by the lawyers and not by the judge. After this, I have lost hope in any kind of justice being given to me.”

In an interview with Compass at the jail northwest of Lahore, Punjab Province, Noreen said the triggering incident resulted from a “planned conspiracy” to “teach her a lesson,” as villagers in Ittanwali, near Nankana Sahib about 75 kilometers (47 miles) from Lahore, resented her and her family because of a few mishaps.

“What my village people have accused me of is a complete lie,” she said. “I had previously had a row over a trivial issue of water running out of my house onto the street, and a man called Tufail verbally abused me. On June 14, when I was out picking falsas [a type of berry] with about 30 women, they again asked me to convert to Islam.”

Noreen said the women of the village frequently asked her to renounce Christianity while they worked in the fields, and that she refused each time.

“This time, too, I said that I saw no reason why I should leave my own religion,” she said. “They then asked me about Jesus Christ, and I told them to go and ask the local mullah and not to bother me with those questions.”

Meantime, one of the women asked her for water, she said. After she had fetched it, the others told the woman not to drink water brought by an “untouchable” and “dirty woman,” Noreen said.

“I asked them if Christians were not human …why the discrimination?” she said. “This annoyed them, and they started verbally abusing me. We were soon engaged in a heated argument.”

She said that five days later, a mob led by Qari (one who has memorized the Quran) Muhammad Saalim burst upon her after some of the women told him about the incident in the fields. The mob pressured her to admit that she had blasphemed.

“They have been saying that I confessed to my crime, but the fact is that I said I was sorry for any word that I may have said during the argument that may have hurt their feelings,” she said.

Police arrived as they were beating her and took Noreen into custody, where they registered a case under Section 295-C of the blasphemy laws against her based on the complaint of the imam.

“They [police] registered a false complaint, because the complainant [Saalim] was never present at the scene,” she said.

Noreen said she has been heart-broken and shattered since the conviction. Her husband immediately tried to console her.

“Everything will be just fine, you just have to stay steadfast in your faith,” Masih told her. “All of us are here beside you. Everyone is praying for you.”

His words seemed to give her some hope, but she turned and asked Compass a question that no one has been able to answer for her.

“How can an innocent person be accused, have a case in court after a false FIR [First Information Report], and then be given the death sentence, without even once taking into consideration what he or she has to say?”

A pastor from Sharing Life Ministry who has been ministering to Noreen during her confinement and was present at all hearings told Compass that the judge had retired to his chambers three times before announcing the verdict.

“He was visibly tense,” the pastor said. “The presence of a mob outside the courtroom was instrumental in the delivery of this harsh verdict.”

Sidra, about 15 years old and one of three children born to Masih from a previous marriage, indicated she was traumatized by the attack on her step-mother.

“I saw that mob burst upon my mother, slap her and beat her up,” she said, her eyes both sad and fearful. “I saw them push her hard against a wall and tear her clothes. They were abusing her. I went to free her from their grip, and I heard them say to my mother, ‘Admit that you said derogatory things about prophet Muhammad, and we will leave you alone.’ Why would my mother ever do anything like that?”

Noreen broke in, “Why was an FIR filed against me by Qari Saalim? Who is he? He doesn’t even know what I said or did.”

Noreen’s lawyers filed an appeal against the Nankana sessions court’s verdict in the Lahore High Court on Friday (Nov. 12), and the court is likely to take up the case soon.

Sidra said Muslim villagers have bullied her and others in the family. She said a man who has two children of his own beat Eesha.

Noreen said police have not harmed her, unusual for Pakistani suspects in blasphemy cases.

“I was never even mentally harassed by the police,” she said, adding that fellow inmates were also treating her well.

Sohail Johnson of the Sharing Life Ministry, which has been following the case from the onset, said authorities may have been aware that the sensitive nature of the case would instantly bring it into public light.

Noreen said she has not lost faith in Jesus.

“He will rescue me from this fake case and I will return home – please ask everyone to pray for me,” she said as two prison guards arrived in the barrack to escort her back to her cell.

In spite of international attention, there has been little response from the government of Pakistan or civil society. No local organization has planned demonstrations to protest the verdict, which could set a dangerous precedent.

Shahbaz Bhatti, federal minister for minorities and a Christian, has written to the Punjab Province government requesting protection for Noreen and her family, both inside and outside jail. During the visit to Sheikhupura, however, Compass observed no special security measures for her family.

Report from Compass Direct News