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Visual hallucinations in the elderly: a case series and discussion of aetiology and treatment

Published online by Cambridge University Press:  13 July 2015

C. Concannon ,
P. Reynolds  and
A. M. Meaney
C. Concannon*
Affiliation:
North Lee Mental Health Service, Mercy University Hospital, Cork, Ireland
P. Reynolds
Affiliation:
Department of Old Age Psychiatry, Seanoira Day Hospital, St. Camillus’s Hospital, Limerick, Ireland
A. M. Meaney
Affiliation:
Department of Old Age Psychiatry, Seanoira Day Hospital, St. Camillus’s Hospital, Limerick, Ireland
*
*Address for correspondence: Dr C. Concannon, St. Michael’s Unit, Mercy University Hospital, Cork, Ireland. (Email: Ciaran.concannon@hotmail.com)
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Abstract

Background

Visual hallucinations are a common phenomenon, among the older adult population. They can be functional or organic in aetiology. However, new onset visual hallucinations in this population are strongly suggestive of organic brain disease. Visual impairment, cerebrovascular disease and Parkinson’s disease are three causes of visual hallucinations, considered in this case series. The evidence in the literature, for the treatment of these conditions is scant at best. There is a paucity of randomised controlled trials available concerning possible therapeutic options.

Aims/Methods

We describe three case reports of visual hallucinations due to diverse underlying aetiologies. We then discuss the aetiologies of visual hallucinations in general and then in these particular cases and finally include results of a literature search examining the available evidence for any therapeutic options proposed.

Results

Our three cases have different, underlying aetiologies. One case is of Charles Bonnet syndrome. The next is of visual hallucinations associated with vascular dementia. The final case is of visual hallucinations associated with Parkinson’s disease. The first two cases are of particular interest due to the efficacy of Amisulpride in both clinical scenarios.

Conclusions

Visual hallucinations are a common phenomenon in the elderly population

They can be due to a myriad of underlying causes. There are a number of neurochemical factors and neuroanatomical structures implicated. The evidence for psychopharmacological interventions is scanty. Randomised controlled trials are lacking in the area. An interesting finding in this case series, was of the clinical utility of Amisulpiride. Given this agent’s unique psychopharmacological profile it is possible that it may be efficacious in other cases of visual hallucinations associated with particular neurochemical factors.

Keywords

AetiologyCharles Bonnet syndromeolder adultParkinson’s diseasepsychopharmacologytreatmentvascular dementiavisual hallucinations
Type
Case Report
Information
Irish Journal of Psychological Medicine , Volume 33 , Issue 1 , March 2016 , pp. 33 - 41
Copyright
© College of Psychiatrists of Ireland 2015 

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