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Escitalopram for antipsychotic nonresponsive visual hallucinosis: eight patients suffering from Charles Bonnet syndrome

Published online by Cambridge University Press:  16 May 2013

Yoseph Bergman  and
Yoram Barak
Yoseph Bergman
Affiliation:
Tirat HaCarmel Mental Health Center and the Institute of Technology (Technion), Haifa, Israel
Yoram Barak*
Affiliation:
Abarbanel Mental Health Center and the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
*
Correspondence should be addressed to: Prof. Yoram Barak, MD, MHA, Psychogeriatric Department, Abarbanel Mental Health Center, 15 KKL Street, Bat-Yam 59100, Israel. Phone: +972-3-5552738; Fax: +972-3-5552738. Email: mdybarak@gmail.com.
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Abstract

Background: The Charles Bonnet syndrome (CBS) is characterized by distinct visual hallucinations and ocularpathology causing visual impairment in patients with insight and the absence of psychiatric comorbidity. The number of reported cases of CBS is expanding as the population ages and the prevalence of vision disorders increases. Antipsychotic medications are often prescribed. However, their efficacy in CBS has been based on sketchy evidence. The use of serotonin selective reuptake inhibitor (SSRI) for CBS was anecdotally reported. We herein describe effectiveness of escitalopram in a series of patients suffering from CBS who were unresponsive to antipsychotic treatment.

Methods: Eight consecutive patients suffering from CBS who did not respond to standard antipsychotic treatment were switched to escitalopram. CBS severity prior to escitalopram treatment was quantified using the Clinical Global Impression (CGI) scale and again after eight weeks of treatment. All had undergone brain CT and cognitive assessment. Brain CT imaging was normal except for an incidental finding of a small frontal meningioma in one patient. All had Mini-Mental Status Examination scores of ≥ 27/30.

Results: There were four men and four women, with a mean age of 81.7 ± 7.3 years. Previous antipsychotic treatment was mostly with risperidone, 1.0 to 3.0 mg/daily. Mean CGI-severity upon switching to escitalopram treatment was 5.7. This was significantly reduced to 1.8 (p < 0.001) after eight weeks of escitalopram treatment (mean dose: 11.8 mg/daily). There were no side effects, nor any adverse events were reported.

Conclusions: This is the first case-series to show that SSRI is an effective and well-tolerated treatment for visual hallucinations associated with vision impairment such as in CBS.

Keywords

Charles Bonnet syndromecomplex visual hallucinationsescitalopram
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 9 , September 2013 , pp. 1433 - 1436
Copyright
Copyright © International Psychogeriatric Association 2013 

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