He’s been making new ‘friends’
Mr. B, age 91, describes seeing “friends” who talk to him and sing and dance. He knows these friends aren’t real and he has no other psychiatric symptoms. How would you treat Mr. B?
TREATMENT Education
After discussion with Mr. B and his family, he is started on risperidone, 1 mg at bedtime, and the psychiatric team provides information about the nature of Charles Bonnet syndrome. Mr. B reportedly takes this medication for a few days and then stops because he does not want the visual hallucinations to go away.
The psychiatry team sees Mr. B before discharge. He and his family are educated about the benign nature of the syndrome, the need for continued family support, and the fact that hallucinations will have minimal or no implications for his life.
The authors’ observations
It is important to remember that a visual description of hallucinations in Charles Bonnet syndrome can be quite vivid, and that the patient might not identify his hallucinations as such or consider them as a problem. Be careful not to dismiss the patient’s complaints as a primary psychiatric condition. It also is important to be mindful of the patient’s concerns with a psychiatric diagnosis; detailed discussion with the patient is helpful in most cases. A more comprehensive and empathetic approach to care could go a long way to sustain quality of life for these patients.
Bottom Line
Charles Bonnet syndrome is characterized by visual hallucinations in patients with visual impairment who have intact insight and an absence of mental illness. Taking a thorough history can help rule out medical and psychiatric causes of visual hallucinations. Educate patients and family about the nature of the hallucinations. In some cases, a psychotropic may be indicated.
Related Resources
• Nguyen ND, Osterweil D, Hoffman J. Charles Bonnet syndrome: treating nonpsychiatric hallucinations. Consult Pharm. 2013;28(3):184-188.
• Lapid MI, Burton MC, Chang MT, et al. Clinical phenomenology and mortality in Charles Bonnet syndrome. J Geriatr Psychiatry Neurol. 2013;26(1):3-9.
Drug Brand Names
Carbamazepine • Tegretol Mirtazapine • Remeron
Gabapentin • Neurontin Olanzapine • Zyprexa
Haloperidol • Haldol Risperidone • Risperdal
Lisinopril • Prinivil, Zestril Valproic acid • Depakene
Lovastatin • Mevacor Venlafaxine • Effexor
Metoprolol • Lopressor
Acknowledgement
The authors acknowledge Barry Liskow, MD, Vice Chair of Psychiatry, Kansas University Medical Center, Kansas City, Kansas, for providing both insight into the topic and useful feedback on the manuscript.
Disclosures
The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
