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Article ; Online: Psychosis in Parkinson's Disease.

Ffytche, Dominic H / Aarsland, Dag

2017 Volume 133, Page(s) 585–622

Abstract: Although illusions, hallucinations and delusions did not play a prominent role in James Parkinson's original clinical descriptions, the longitudinal view of disease progression he advocated has important lessons for the study of such symptoms today. A ... ...

Abstract	Although illusions, hallucinations and delusions did not play a prominent role in James Parkinson's original clinical descriptions, the longitudinal view of disease progression he advocated has important lessons for the study of such symptoms today. A focus on longitudinal progression rather than individual symptoms led to the concept of PD psychosis-a spectrum of positive symptoms in Parkinson's disease. The publication of criteria for PD psychosis in 2007 helped unify the disparate set of symptoms, raising their profile and resulting in a rapid expansion of literature focussing on clinical aspects, mechanisms, and treatment. Here we review this literature and the evolving view of PD psychosis. Adding to previous evidence of a prospective risk for dementia and the move to supervised care, key recent developments include: recognition of prevalence increase with disease duration; a broadening of symptoms included in PD psychosis; better characterization of higher visual and cognitive dysfunction risk factors; structural, functional, and neurotransmitter imaging biomarker evidence; and approval of pimavanserin in the United States for the treatment of PD psychosis. The accumulating evidence raises novel questions and directions for future research that promise a better understanding of the clinical management of PD psychosis and its role as a biomarker for PD stage and progression.
MeSH term(s)	Humans ; Parkinson Disease/complications ; Parkinson Disease/physiopathology ; Psychotic Disorders/drug therapy ; Psychotic Disorders/etiology ; Psychotic Disorders/physiopathology
Language	English
Publishing date	2017-06-16
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	209876-3
ISSN	2162-5514 ; 0074-7742
ISSN (online)	2162-5514
ISSN	0074-7742
DOI	10.1016/bs.irn.2017.04.005
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Article ; Online: A century of prosopometamorphopsia studies.

Blom, Jan Dirk / Ter Meulen, Bastiaan C / Dool, Jitze / Ffytche, Dominic H

Cortex; a journal devoted to the study of the nervous system and behavior

2021 Volume 139, Page(s) 298–308

Abstract: Prosopometamorphopsia is an extremely rare disorder of visual perception characterised by facial distortions. We here review 81 cases (eight new ones and 73 cases published over the past century) to shed light on the perception of face gestalts. Our ... ...

Abstract	Prosopometamorphopsia is an extremely rare disorder of visual perception characterised by facial distortions. We here review 81 cases (eight new ones and 73 cases published over the past century) to shed light on the perception of face gestalts. Our analysis indicates that the brain systems underlying the perception of face gestalts have genuine network properties, in the sense that they are widely disseminated and built such that spatially normal perception of faces can be maintained even when large parts of the network are compromised. We found that bilateral facial distortions were primarily associated with right-sided and bilateral occipital lesions, and unilateral facial distortions with lesions ipsilateral to the distorted hemifield and with the splenium of the corpus callosum. We also found tentative evidence for the involvement of the left frontal regions in the fusing of vertical hemi-images of faces, and of right parietal regions in the fusing of horizontal hemi-images. Evidence supporting the remarkable adaptability of the network comes from the relatively high recovery rates that we found, from the ipsilateral hemifield predominance of hemi-prosopometamorphopsia, and from a phenomenon called cerebral asthenopia (heightened visual fatigability) which points to the dynamic nature of compensatory mechanisms maintaining normal face perception, even in chronic cases of prosopometamorphopsia. Finally, our analysis suggests that specialised networks for the representation of face gestalts in familiar-versus-unfamiliar faces and for own-versus-other face may be present, although this is in need of further study.
Language	English
Publishing date	2021-03-12
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	280622-8
ISSN	1973-8102 ; 0010-9452
ISSN (online)	1973-8102
ISSN	0010-9452
DOI	10.1016/j.cortex.2021.03.001
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Article ; Online: Are stroke survivors with delirium at higher risk of post-stroke dementia? Current evidence and future directions.

Ojagbemi, Akin / Ffytche, Dominic H

International journal of geriatric psychiatry

2016 Volume 31, Issue 12, Page(s) 1289–1294

Abstract: Objectives: The idea that delirium is a risk factor for dementia, broadly defined, is derived from heterogeneous patient samples. We reviewed available evidence as to whether stroke survivors who developed delirium during the acute phase of treatment ... ...

Abstract	Objectives: The idea that delirium is a risk factor for dementia, broadly defined, is derived from heterogeneous patient samples. We reviewed available evidence as to whether stroke survivors who developed delirium during the acute phase of treatment are at a higher prospective risk of incident post-stroke cognitive impairment or dementia. Design: We searched 8721 records in the Cochrane database for reviews or protocols dealing with the study objective, Medline, EMBASE, PsycInfo and CINAHL for observational studies in the general adult population and PubMed for in-process articles. Additional searches of the reference lists of retrieved articles were also undertaken. Qualitative syntheses and meta-analysis were conducted according to conventional guidelines. Results: Twelve relevant articles were fully appraised. Four out of these studies, comprising 743 stroke survivors, including 199 with delirium, met criteria for qualitative syntheses. Overall, the studies presented low to moderate level evidence suggesting an association between post-stroke delirium and dementia. Conclusions: There is a need for further studies to investigate the association of post-stroke delirium and dementia using well-defined cohorts of patients and controlling for factors such as pre-stroke cognition, stroke severity and location and the presence of persistent delirium. Such studies will help understand the place of delirium identification and prevention in reducing the risk of dementia after stroke. © 2016 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons Ltd.
Language	English
Publishing date	2016-12
Publishing country	England
Document type	Review ; Journal Article
ZDB-ID	806736-3
ISSN	1099-1166 ; 0885-6230
ISSN (online)	1099-1166
ISSN	0885-6230
DOI	10.1002/gps.4506
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Article ; Online: Transcranial Direct Current Stimulation in the Treatment of Visual Hallucinations in Charles Bonnet Syndrome: A Randomized Placebo-Controlled Crossover Trial.

daSilva Morgan, Katrina / Schumacher, Julia / Collerton, Daniel / Colloby, Sean / Elder, Greg J / Olsen, Kirsty / Ffytche, Dominic H / Taylor, John-Paul

Ophthalmology

2022 Volume 129, Issue 12, Page(s) 1368–1379

Abstract: Objective: To investigate the potential therapeutic benefits and tolerability of inhibitory transcranial direct current stimulation (tDCS) on the remediation of visual hallucinations in Charles Bonnet syndrome (CBS).: Design: Randomized, double- ... ...

Abstract	Objective: To investigate the potential therapeutic benefits and tolerability of inhibitory transcranial direct current stimulation (tDCS) on the remediation of visual hallucinations in Charles Bonnet syndrome (CBS). Design: Randomized, double-masked, placebo-controlled crossover trial. Participants: Sixteen individuals diagnosed with CBS secondary to visual impairment caused by eye disease experiencing recurrent visual hallucinations. Intervention: All participants received 4 consecutive days of active and placebo cathodal stimulation (current density: 0.29 mA/cm Main outcome measures: Ratings of visual hallucination frequency and duration following active and placebo stimulation, accounting for treatment order, using a 2 × 2 repeated-measures model. Secondary outcomes included impact ratings of visual hallucinations and electrophysiological measures. Results: When compared with placebo treatment, active inhibitory stimulation of visual cortex resulted in a significant reduction in the frequency of visual hallucinations measured by the North East Visual Hallucinations Interview, with a moderate-to-large effect size. Impact measures of visual hallucinations improved in both placebo and active conditions, suggesting support and education for CBS may have therapeutic benefits. Participants who demonstrated greater occipital excitability on electroencephalography assessment at the start of treatment were more likely to report a positive treatment response. Stimulation was found to be tolerable in all participants, with no significant adverse effects reported, including no deterioration in preexisting visual impairment. Conclusions: Findings indicate that inhibitory tDCS of visual cortex may reduce the frequency of visual hallucinations in people with CBS, particularly individuals who demonstrate greater occipital excitability prior to stimulation. tDCS may offer a feasible intervention option for CBS with no significant side effects, warranting larger-scale clinical trials to further characterize its efficacy.
MeSH term(s)	Humans ; Charles Bonnet Syndrome/complications ; Charles Bonnet Syndrome/therapy ; Transcranial Direct Current Stimulation/adverse effects ; Transcranial Direct Current Stimulation/methods ; Cross-Over Studies ; Hallucinations/therapy ; Hallucinations/diagnosis ; Hallucinations/etiology ; Vision, Low/etiology
Language	English
Publishing date	2022-07-09
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	392083-5
ISSN	1549-4713 ; 0161-6420
ISSN (online)	1549-4713
ISSN	0161-6420
DOI	10.1016/j.ophtha.2022.06.041
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Article ; Online: Drug and Disease Effects in Parkinson's Psychosis: Revisiting the Role of Dopamine.

Dave, Sonali / Weintraub, Daniel / Aarsland, Dag / Ffytche, Dominic H

Movement disorders clinical practice

2019 Volume 7, Issue 1, Page(s) 32–36

Abstract: Background: Levodopa and dopamine agonists (dopamine replacement therapy [DRT]) are implicated in Parkinson's disease psychosis (PDP), but the relationship between DRT and neurotransmitter dysfunction inherent to PD remains unclear.: Objectives: To ... ...

Abstract	Background: Levodopa and dopamine agonists (dopamine replacement therapy [DRT]) are implicated in Parkinson's disease psychosis (PDP), but the relationship between DRT and neurotransmitter dysfunction inherent to PD remains unclear. Objectives: To examine the relationship between baseline striatal dopamine transporter (DAT) binding in drug-naïve idiopathic PD, introduction of DRT, or dose change and incident early-onset PDP. Methods: Baseline DAT binding was compared between patients with and without incident psychosis (defined here as hallucinations or delusions), controlling for age, sex, baseline cognition, and prospective DRT in the Parkinson's Progression Markers Initiative cohort. Incident illusions were not considered psychosis symptoms. Results: Of 386 patients, 30 (8%) developed PDP (predominantly hallucinations, mean onset 42 months) and 355 (92%) had either no PDP symptoms (mean follow-up 64 months) or reported illusions only (111/355, 31%). Incident PDP was associated with reduced baseline striatal DAT binding, controlling for confounders ( Conclusion: The findings highlight the role of disease-related dopamine mechanisms in the pathophysiology of hallucinations in Parkinson's disease alongside medication. It remains to be determined how dopamine mechanisms, medication, and other neurotransmitter systems implicated in PDP interact.
Language	English
Publishing date	2019-11-11
Publishing country	United States
Document type	Journal Article
ISSN	2330-1619
ISSN (online)	2330-1619
DOI	10.1002/mdc3.12851
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Article ; Online: On visual hallucinations and cortical networks: a trans-diagnostic review.

Carter, Rowena / Ffytche, Dominic H

Journal of neurology

2015 Volume 262, Issue 7, Page(s) 1780–1790

Abstract: Our current clinical approach to visual hallucinations is largely derived from work carried out by Georges de Morsier in the 1930s. Now, almost a century after his influential papers, we have the research tools to further explore the ideas he put forward. ...

Abstract	Our current clinical approach to visual hallucinations is largely derived from work carried out by Georges de Morsier in the 1930s. Now, almost a century after his influential papers, we have the research tools to further explore the ideas he put forward. In this review, we address de Morsier's proposal that visual hallucinations in all clinical conditions have a similar neurological mechanism by comparing structural imaging studies of susceptibility to visual hallucinations in Parkinson's disease, Alzheimer's disease, Dementia with Lewy bodies and schizophrenia. Systematic review of the literature was undertaken using PubMed searches. A total of 18 studies across conditions were identified reporting grey matter differences between patients with and without visual hallucinations. Grey matter changes were categorised into brain regions relevant to current theories of visual hallucinations. The distribution of cortical atrophy supports de Morsier's premise that visual hallucinations are invariably linked to aberrant activity within visual thalamo-cortical networks. Further work is required to determine by what mechanism these networks become predisposed to spontaneous activation, and whether the frontal lobe and hippocampal changes identified are present in all conditions. The findings have implications for the development of effective treatments for visual hallucinations.
MeSH term(s)	Cerebral Cortex/pathology ; Cognition Disorders/etiology ; Hallucinations/etiology ; Hallucinations/pathology ; Humans ; Lewy Body Disease/complications ; Magnetic Resonance Imaging ; Parkinson Disease/complications
Language	English
Publishing date	2015-03-13
Publishing country	Germany
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
ZDB-ID	187050-6
ISSN	1432-1459 ; 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
ISSN (online)	1432-1459
ISSN	0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
DOI	10.1007/s00415-015-7687-6
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Article ; Online: From tones in tinnitus to sensed social interaction in schizophrenia: how understanding cortical organization can inform the study of hallucinations and psychosis.

Ffytche, Dominic H / Wible, Cynthia G

Schizophrenia bulletin

2014 Volume 40 Suppl 4, Page(s) S305–16

Abstract: The content, modality, and perceptual attributes of hallucinations and other psychotic symptoms may be related to neural representation at a single cell and population level in the cerebral cortex. A brief survey of some principles and examples of ... ...

Abstract	The content, modality, and perceptual attributes of hallucinations and other psychotic symptoms may be related to neural representation at a single cell and population level in the cerebral cortex. A brief survey of some principles and examples of cortical representation and organization will be presented together with evidence for a correspondence between the neurobiology of brain areas activated at the time of a hallucination and the content of the corresponding hallucinatory and psychotic experiences. Contrasting the hallucinations of schizophrenia with other conditions, we highlight phenomenological aspects of hallucinations that are ignored in clinical practice but carry potentially important information about the brain regions and dysfunctions underlying them. Knowledge of cortical representation and organization are being used to develop animal models of hallucination and to test treatments that are now beginning to translate to the clinical domain.
MeSH term(s)	Brain Mapping ; Cerebral Cortex/physiopathology ; Hallucinations/physiopathology ; Humans ; Interpersonal Relations ; Neural Pathways/physiopathology ; Psychotic Disorders/physiopathology ; Schizophrenia/physiopathology ; Tinnitus/physiopathology
Language	English
Publishing date	2014-06-16
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S. ; Review
ZDB-ID	439173-1
ISSN	1745-1701 ; 0586-7614
ISSN (online)	1745-1701
ISSN	0586-7614
DOI	10.1093/schbul/sbu041
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Article ; Online: Negative outcome Charles Bonnet syndrome.

Cox, Thomas M / ffytche, Dominic H

The British journal of ophthalmology

2014 Volume 98, Issue 9, Page(s) 1236–1239

Abstract: Background: Charles Bonnet Syndrome (CBS) is widely considered a transient condition without adverse consequence, questioning the need for treatment. Yet, while this view may be true of the majority of people with CBS, it is recognised that some have ... ...

Abstract	Background: Charles Bonnet Syndrome (CBS) is widely considered a transient condition without adverse consequence, questioning the need for treatment. Yet, while this view may be true of the majority of people with CBS, it is recognised that some have negative experiences and outcomes. Here, we attempt to better understand negative outcome CBS and the factors that influence it. Methods: 4000 members of the Macular Society were sent a structured questionnaire covering the phenomenology of CBS, its prognosis and impact, symptom reporting, patient knowledge and sources of information. Results: 492 people with CBS were identified. Kaplan-Meier analysis suggested 75% had CBS for 5 years or more. Thirty-two per cent had negative outcome. Factors associated with negative outcome were: (1) frequent, fear-inducing, longer-lasting hallucination episodes, (2) one or more daily activities affected, (3) attribution of hallucinations to serious mental illness, (4) not knowing about CBS at the onset of symptoms. Duration of CBS or the type of content hallucinated were not associated with negative outcome. Conclusions: CBS is of longer duration than previously suspected with clinically relevant consequences in a third of those affected. Interventions that reduce the frequency, duration or fear of individual hallucination episodes and education prior to hallucination onset may help reduce negative outcome.
MeSH term(s)	Activities of Daily Living ; Databases, Factual ; Emotions ; Female ; Hallucinations/diagnosis ; Hallucinations/epidemiology ; Hallucinations/etiology ; Hallucinations/psychology ; Health Knowledge, Attitudes, Practice ; Humans ; Kaplan-Meier Estimate ; Macular Degeneration/epidemiology ; Macular Degeneration/psychology ; Male ; Prognosis ; Syndrome ; Time Factors ; United Kingdom/epidemiology ; Vision Disorders/diagnosis ; Vision Disorders/epidemiology ; Vision Disorders/etiology ; Vision Disorders/psychology
Language	English
Publishing date	2014-05-13
Publishing country	England
Document type	Journal Article
ZDB-ID	80078-8
ISSN	1468-2079 ; 0007-1161
ISSN (online)	1468-2079
ISSN	0007-1161
DOI	10.1136/bjophthalmol-2014-304920
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Article ; Online: Art and the brain: a view from dementia.

Gretton, Cosima / ffytche, Dominic H

International journal of geriatric psychiatry

2014 Volume 29, Issue 2, Page(s) 111–126

Abstract: Objective: Art making encompasses a range of perceptual and cognitive functions involving widely distributed brain systems. The dementias impact on these systems in different ways, raising the possibility that each dementia has a unique artistic ... ...

Abstract	Objective: Art making encompasses a range of perceptual and cognitive functions involving widely distributed brain systems. The dementias impact on these systems in different ways, raising the possibility that each dementia has a unique artistic signature. Design: Here we use a review of the visual art of 14 artists with dementia (five Alzheimer's disease, seven fronto-temporal dementia and two dementia with Lewy bodies) to further our understanding of the neurobiological constituents of art production and higher artistic function. Results: Artists with Alzheimer's disease had prominent changes in spatial aspects of their art and attributes of colour and contrast. These qualities were preserved in the art of fronto-temporal dementia, which was characterised by perseverative themes and a shift towards realistic representation. The art of dementia with Lewy Bodies was characterised by simple, bizarre content. Conclusions: The limitations of using visual aspects of individual artworks to infer the impact of dementia on art production are discussed with the need for a wider perspective encompassing changes in cognition, emotion, creativity and artistic personality. A novel classificatory scheme is presented to help characterise neural mechanisms of higher artistic functions in future studies.
MeSH term(s)	Alzheimer Disease/psychology ; Art ; Creativity ; Frontotemporal Dementia/psychology ; Humans ; Lewy Body Disease/psychology ; Neurobiology ; Visual Perception/physiology
Language	English
Publishing date	2014-02
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	806736-3
ISSN	1099-1166 ; 0885-6230
ISSN (online)	1099-1166
ISSN	0885-6230
DOI	10.1002/gps.3975
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Article ; Online: Visual hallucinations in eye disease.

ffytche, Dominic H

Current opinion in neurology

2008 Volume 22, Issue 1, Page(s) 28–35

Abstract: Purpose of review: The literature related to visual hallucinations in ophthalmological settings from 2007 to 2008 is presented as a review of recent developments and trends.: Recent findings: Acuity, contrast sensitivity, age and sex emerge as ... ...

Abstract	Purpose of review: The literature related to visual hallucinations in ophthalmological settings from 2007 to 2008 is presented as a review of recent developments and trends. Recent findings: Acuity, contrast sensitivity, age and sex emerge as significant and consistent risk factors for visual hallucinations, together with new evidence to suggest that up to 40% of patients have long-term hallucinations. Scotoma size and specific eye pathology do not influence hallucination risk. Induced hallucinations in normal individuals provide a model for those in eye disease, revealing a shift in thalamocortical circuitry and neurophysiological links to states of drowsy wakefulness. Serotonergic therapy emerges as a potential treatment. Two ophthalmological interventions are added to the list of procedures provoking hallucinations. Historical accounts of Charles Bonnet, his syndrome and two novel visual syndromes highlight ongoing difficulties of case definition and the wider clinical context in which visual hallucinations occur. Summary: Current research into visual hallucination is predominantly ophthalmology-led, with increasing recognition of the phenomena, their prevalence and prognosis within the specialty. Deafferentation remains the best available pathophysiological account, although it fails to explain the absence of hallucinations in the majority of patients with eye disease. Whether hallucinations require treatment and, if so, what that treatment should be remains unclear.
MeSH term(s)	Age Factors ; Eye Diseases/complications ; Eye Diseases/diagnosis ; Eye Diseases/physiopathology ; Eye Diseases/therapy ; Hallucinations/diagnosis ; Hallucinations/etiology ; Hallucinations/physiopathology ; Hallucinations/therapy ; Humans ; Photic Stimulation ; Prognosis ; Review Literature as Topic ; Risk Factors ; Syndrome
Language	English
Publishing date	2008-11-24
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1182686-1
ISSN	1473-6551 ; 1350-7540
ISSN (online)	1473-6551
ISSN	1350-7540
DOI	10.1097/wco.0b013e32831f1b3f
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