Ishimaru Daiki, Kanemoto Hideki, Hotta Maki, Nagata Yuma, Koizumi Fuyuki, Satake Yuto, Taomoto Daiki, Ikeda Manabu
Department of Medical Technology, Osaka University Hospital, Suita, Japan.
Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan.
Front Psychiatry. 2024 Mar 15;15:1283156. doi: 10.3389/fpsyt.2024.1283156. eCollection 2024.
Visual hallucinations (VH) are associated with visual prediction error in patients with dementia with Lewy bodies (DLB). Given this relationship, environmental adjustments have been suggested, but detailed contents for implementing such environmental adjustments and assessments are poorly documented. This case report preliminarily demonstrates methods for improving VH through our experience with two patients with DLB. We conducted familial interviews to assess the phenomenological features of VH and reviewed photographs of patients' homes to identify the environmental triggers of VH, known as photo assessment of the living environment (PA-LE).
Patient 1 was a 78-year-old woman with a Mini-Mental State Examination (MMSE) score of 11/30. She experienced seeing a stranger, children, and cats at home, which frightened her. VH frequently occurred in the living room and bedroom. The PA-LE showed that several environmental features, such as cushions on a sofa, the pattern on a carpet under a table, and clothing on hangers, were suggestive triggers of VH. Patient 2 was an 88-year-old woman with a MMSE score of 5/30. She had seen strangers, children, and animals at home, some of which were linked to a theft delusion. VH frequently occurred in the living room and bedroom. The PA-LE found that several environmental features, such as clothing on hangers and dolls, were suggestive of VH triggers. Non-pharmacological approaches were tailored to the patients' environmental and psychological states using interviews and PA-LE. This included removing environmental triggers, reducing negative mood, and providing coping strategies for VH. This improved their VH and their caregivers' knowledge of VH.
Phenomenological assessments using photographs of the patient's home could identify the environmental triggers associated with VH in patients with DLB and assist in environmental adjustments.
视幻觉（VH）与路易体痴呆（DLB）患者的视觉预测误差有关。鉴于这种关系，有人提出了环境调整建议，但关于实施此类环境调整和评估的详细内容记录不足。本病例报告通过我们对两名DLB患者的经验初步展示了改善视幻觉的方法。我们进行了家庭访谈以评估视幻觉的现象学特征，并查看患者家中的照片以识别视幻觉的环境触发因素，即生活环境照片评估（PA - LE）。
患者1是一名78岁女性，简易精神状态检查表（MMSE）得分为11/30。她在家中看到陌生人、孩子和猫，这让她感到害怕。视幻觉频繁出现在客厅和卧室。PA - LE显示，一些环境特征，如沙发上的靠垫、桌子下面地毯的图案以及衣架上的衣服，是视幻觉的提示性触发因素。患者2是一名88岁女性，MMSE得分为5/30。她在家中看到陌生人、孩子和动物，其中一些与盗窃妄想有关。视幻觉频繁出现在客厅和卧室。PA - LE发现，一些环境特征，如衣架上的衣服和玩偶，提示为视幻觉触发因素。通过访谈和PA - LE，根据患者的环境和心理状态量身定制非药物方法。这包括消除环境触发因素、减轻负面情绪以及为视幻觉提供应对策略。这改善了他们的视幻觉以及他们的护理人员对视幻觉的认识。
使用患者家中照片进行现象学评估可以识别DLB患者中与视幻觉相关的环境触发因素，并有助于环境调整。
