看不清的“小人”:Charles Bonnet综合征一例并文献复习

目的 分析Charles Bonnet综合征（CBS）的诊治要点,提高临床医师对该病的诊治水平。方法 报道1例CBS病例,并以 “Charles Bonnet综合征”“邦纳综合征”“Charles Bonnet syndrome”“幻视/ visual hallucination”为检索词,对以下数据库的相关论文进行检索:PubMed、中国生物医学文献服务系统（SinoMed）、CNKI、万方数据知识服务平台、维普中文科技期刊数据库、中华医学期刊全文数据库,收集并分析检索到的病例资料。结果 该例患者以幻视为首发症状,自述家中出现“小人”,但可以感知此为幻觉。患者精神评估未见异常,有自知力,无其他幻觉,明确诊断为CBS。予患者心理治疗,提高其对该病的认知水平,减轻其心理负担。检索文献收集到CBS病例14例,幻视表现多种多样,尚无明确有效的药物可以改善幻视。结论 CBS诊断困难,无明确有效的治疗药物,临床医师应注意提高对该病的诊治水平,降低误诊与误治率。

The invisible small-sized man: a case of Charles Bonnet syndrome and literature review

ObjectiveTo analyze the highlights of diagnosis and treatment of Charles Bonnet syndrome （CBS） and improve the level of diagnosis and treatment of CBS. MethodsOne case of CBS was reported. Literature review was conduced from PubMed, SinoMed,CNKI, Wanfang Data, Chongqing VIP and CMAPH using the searching words of “Charles Bonnet syndrome”, “hallucination” and “visual hallucination” in English and Chinese. Clinical data of retrieved cases were collected and analyzed. Results The patient presented with visual hallucination as the initial manifestation and complained of seeing “an invisible small-sized man” at home, whereas the patient understood that it was visual hallucination. No abnormality was found in mental assessment. The patient’s insight was not impaired and no other patterns of hallucination were found. The diagnosis of CBS was eventually confirmed. Cognitive therapy was given to this patient to deepen the understanding of CBS and reduce psychological burden. Fourteen CBS cases were retrieved by literature review, and they developed different patterns of visual hallucination. No effective drugs were available for visual hallucination. Conclusions It is difficult to make a diagnosis of CBS, there is no clear and effective treatment for it. Clinicians should pay more attention to improve the ability of diagnosis and treatment of CBS and lower the rates of misdiagnosis and mistreatment.