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

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 be-ing diagnosed with a mental illness. Case report. We pre-sented four elderly patients, who were referred for psychiat-ric consultation due to visual hallucinations, with preserved insight, but with impaired vision. All four patients had complex, vivid, and colorful hallucinations consisting of re-alistic objects, people, animals, or scenery that tend to recur. Their emotional response and impact on quality of life dif-fered, and psychopharmacotherapy was determined accord-ing 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 im-portance in all cases. Conclusion. With the aging of the population, the number of patients with impaired vision al-so increases, and the importance of a multidisciplinary ap-proach in the diagnostic procedures and treatment of Charles Bonnet syndrome is emphasized. Increased aware-ness of clinical characteristics and therapeutic approaches is required among all physicians who are in contact with elder-ly and/or impaired vision patients.

Automated summary

Charles Bonnet syndrome is a condition characterized by complex visual hallucinations due to visual impairment, with retention of insight. It is often misdiagnosed as psychosis or early stages of dementia, and is underreported by patients due to fear of being diagnosed with a mental illness.