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 the International Classification of Diseases, 11th Revision. Nevertheless, in clinical praxis, it is often misdiagnosed as psychosis or early stages of dementia, and it goes underreported by patients because of the fear of being diagnosed with a mental illness. Case report. We presented four elderly patients, who were referred for psychiatric consultation due to visual hallucinations, with preserved insight, but with impaired vision. All four patients had complex, vivid, and colorful hallucinations consisting of realistic objects, people, animals, or scenery that tend to recur. Their emotional response and impact on quality of life differed, and psychopharmacotherapy was determined according to their psychological symptoms. Empathic explanation of the symptoms’ origin and reassurance of the absence of mental illness for patients and caregivers were of vital importance in all cases. Conclusion. With the aging of the population, the number of patients with impaired vision also increases, and the importance of a multidisciplinary approach in the diagnostic procedures and treatment of Charles Bonnet syndrome is emphasized. Increased awareness of clinical characteristics and therapeutic approaches is required among all physicians who are in contact with elderly and/or impaired vision patients.