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Visual Hallucinations in Elderly People: Early Dementia, Psychosis or Charles Bonnet Syndrome? Review and Case Report

Published online by Cambridge University Press:  23 March 2020

M. García Moreno
Affiliation:
CSM Majadahonda, Hospital Universitario Puerta de Hierro Majadahonda, Psychiatry, Madrid, Spain
A. De Cos Milas
Affiliation:
CSM Móstoles, Hospital Universitario de Móstoles, Psychiatry, Madrid, Spain
B. Poza Cano
Affiliation:
CE San Carlos, Hospital Universitario El Escorial, Psychiatry, Madrid, Spain
L. Beatobe Carreño
Affiliation:
CSM Móstoles, Hospital Universitario de Móstoles, Psychiatry, Madrid, Spain

Abstract

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Introduction

Charles Bonnet Syndrome (CBS) is an uncommon disease that involves visual hallucinations in visually impaired individuals, in absence of cognitive impairment or psychiatric illness, although some authors propose CBS as an early maker of dementia.

Objectives

Show the importance of differential diagnosis in individuals with presence of visual hallucinations, with distinction of CBS from others psychiatric or organic disorders such as hypnogogic and hypnopompic hallucinations, epileptic phenomenon, Parkinson disease, dementia, delirum tremens or late-onset psychosis.

Methods

Literature review about visual hallucinations in people with psychiatric illness, dementia or in absence of these status, followed by a case report of a patient who met criteria for CBS.

Results

Eighty one-years-old female with no previous psychiatric illness, experience suddenly visual hallucinations (animals, insects) with secondary anxiety, fear and insomnia as well as disruptive behaviour (throw lye to kill the animals) and delusional interpretations of the hallucinations considering them as a divine proof. Clinical exam, neuroimaging tests and SPECT confirmed just a minimal cognitive impairment nor suggestive of dementia. She had personal history of cataracts and macular degeneration, with no other medical condition. Olanzapine was prescribed but it was withdrew because of adverse effects. Later, haloperidol was introduced with well tolerance and symptom's recovery ad integrum.

Conclusions

Charles Bonnet syndrome is a rare condition that may sometimes be the beginning of a dementia. Medical evaluation and complementary tests help differential diagnosis in order to reject others psychiatric/somatic disorders. Neuroleptic and anti-epileptic treatment should be useful to control symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
e-Poster viewing: Old age psychiatry
Copyright
Copyright © European Psychiatric Association 2017
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