Charles bonnet syndrome, management with simple behavioral technique

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Abstract

ABSTRACT

Charles Bonnet syndrome occurs in visually impaired but cognitively normal individuals. This report describes a condition of vivid visual hallucination (phantom images) in an 85‑year‑old conscious man, who had been blind by bilateral progressively worsening glaucoma. This common, but rarely reported, condition was managed by behavioral approach of repeated blinking, intermittent eyes closure, and reassurance. While emotional, mood and cognitive disorders need to be ruled out, the condition, though frightening to the afflicted, is benign and remediable with simple, inexpensive approach. Health workers managing people with terminal blindness should always ask for the presence of hallucinations from their patients to forestall a preventable distress resulting from wrong perception without visual stimulus.

Keywords

Hallucination

impaired vision

management

old age

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Conflicts of interest

None declared

REFERENCES

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Meyer C. H., Fleckensstein M, Rodrigues E. B., Mennel S, . Incidence and regression of Charles Bonnet syndrome in vascular age-related macular degeneration. Br J Ophthalmol. 2011;95:1137-74.
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[1] Berrios G. E., Brook P, . The Charles Bonnet syndrome and the problem of visual perceptual disorders in the elderly. Age Ageing. 1982;11:17-23.
[Google Scholar]

[2] Menon G. J., . Complex visual hallucinations in the visually impaired: A structured history-taking approach. Arch Ophthalmol. 2005;123:349-55.
[Google Scholar]

[3] De Mossier G, . Le syndrome de Charles Bonnet: Hallucinations visual hallucinations in elderly without mental impairment. Ann Med Psychol (Paris). 1967;125:667-702.
[Google Scholar]

[4] Madill S. A., Ffytche D. H., . Charles Bonnet syndrome in patients with glaucoma and good acuity. Br J Ophthalmol. 2005;89:785-6.
[Google Scholar]

[5] Wikipedia , . Charles Bonnet. Available from [Last accessed on 2012 Jan 26]
[Publisher] [Google Scholar]

[6] Terao T, . The present state of Charles Bonnet syndrome. Psychogeriatrics. 2002;2:6-14.
[Google Scholar]

[7] Teunisse R. J., Cruysberg J. R., Hoefnagels W. H., Verbeek A. L., Zitman F. G., . Visual hallucinations in psychologically normal people: Charles Bonnet’s syndrome. Lancet. 1996;347:794-7.
[Google Scholar]

[8] Paulig M, Mentrup H, . Charles Bonnet’s syndrome: Complete remission of complex visual hallucinations treated by gabapentin. J Neurol Neurosurg Psychiatry. 2001;70:813-4.
[Google Scholar]

[9] Chaudhuri A, . Charles Bonnet syndrome: An example of cortical dissociation syndrome affecting vision? J Neurol Neurosurg Psychiatry. 2000;69:704-5.
[Google Scholar]

[10] Vukicevic M, . Frightening visual hallucinations: A typical presentation of Charles Bonnet syndrome triggered by the Black Saturday bushfires. Med J Aust. 2010;193:181-2.
[Google Scholar]

[11] Tan C. S., Lim V. S., Ho D. Y., Yeo E, Ng B. Y., Au Eong K. G., . Charles Bonnet syndrome in Asian patients in a tertiary ophthalmic centre. Br J Ophthalmol. 2004;88:1325-9.
[Google Scholar]

[12] Schultz G, Melzack R, . The Charles Bonnet syndrome: Phantom visual images. Perception. 1991;20:809-25.
[Google Scholar]

[13] Terao T, . Effects of carbamazepineand clonazepam combination on Charles Bonnet syndrome: A case report. Hum Psychopharmacol Clin Exp. 1998;13:451-3.
[Google Scholar]

[14] Lang U. E., Stokowski D, Schulze D, Domula M, Schmidt E, Linat J. G., et al. . Charles Bonnet syndrome: Successful treatment of visual hallucinations due to vision loss with selective serotonin reuptake inhibitors. J Psychopharmacol. 2007;21:553-7.
[Google Scholar]

[15] Hartney K. E., Catalano G, Catalano M, . Charles Bonnet Syndrome: Are medications necessary? J Psychiatr Pract. 2011;17:137-41.
[Google Scholar]

[16] Hughes D. F., . Charles Bonnet syndrome: A literature review into diagnostic criteria, treatment and implications for nursing practice. J Psychiatr Ment Health Nurs Available from [Last accessed on 2012 sept 28]
[Publisher] [Google Scholar]

[17] Fernandez A, Lichtshein G, Vieweg W. V., . The Charles Bonnet syndrome: A review. J Nerv Ment Dis. 1997;185:195-200.
[Google Scholar]

[18] Vukicevic M, Fitzmaurice K, . Butterflies and black lacy patterns: The prevalence and characteristics of Charles Bonnet hallucinations in an Australian population. Clin Experiment Ophthalmol. 2008;36:659-65.
[Google Scholar]

[19] Singh A, Sorensen T. L., . Charles Bonnet syndrome improves when treatment is effective in age-related macular degeneration. Br J Ophthalmol. 2011;95:291-2.
[Google Scholar]

[20] Meyer C. H., Fleckensstein M, Rodrigues E. B., Mennel S, . Incidence and regression of Charles Bonnet syndrome in vascular age-related macular degeneration. Br J Ophthalmol. 2011;95:1137-74.
[Google Scholar]

[21] Manford M, Andermann F, . Complex visual hallucinations. Clinical and neurobiological insights. Brain. 1998;121:1819-40.
[Google Scholar]

[22] Menon G. J., Rahman I, Menon S. J., Dutton D. G., . Complex visual hallucinations in the visually impaired: The Charles Bonnet Syndrome. Surv Ophthalmol. 2003;48:58-72.
[Google Scholar]

[23] Brucki S. M., Takada L. T., Nitrini R, . Charles Bonnet syndrome: Case series. Dement Neuropsychol. 2009;3:61-7.
[Google Scholar]