Complex visual hallucinations with retention of insight: Four cases of Charles Bonnet syndrome

Abstract

Introduction. Complex visual hallucinations with retention of insight due to visual impairment are key symptoms of Charles Bonnet syndrome. The syndrome is a standalone diagnosis in ICD-11, but in clinical praxis is often misdiagnosed as psychosis or early stages of dementia and goes underreported by patients because of the fear being diagnosed with a mental illness. Case report. We present four cases of visual hallucinations in elderly patients with impaired vision who had retained insight and referred for psychiatric consultation. All four patients had complex, vivid and colorful hallucinations consisted of realistic objects, people, animals or scenery that tend to recur. Their emotional response and impact on quality of life differed, and psychopharmacotherapy was recommended depending on their psychological symptoms. Empathic explanation of the symptoms origin and reassurance of absence of mental illness for patients and caregivers are of vital importance in all cases. Conclusion. The aging of the population increase the consequence in the number of patients with impaired vision emphasize a multidisciplinary approach in Charles Bonnet syndrome diagnostic procedures and treatment. Increased awareness of clinical characteristic and therapeutic approaches is required among all physicians in contact with elderly and/or impaired vision patients.