Typically hallucinations are associated with conditions such as schizophrenia, dementia, delirium (acute confusional state), or side effects from medications or street drugs. In many cases hallucinations require treatment with antipsychotic medications. However, there are some circumstances where treatment with such medications is unnecessary.
One such example is the visual hallucinations that occur in the Charles Bonnet Syndrome. Patients with this syndrome are typically elderly and losing their vision from age-related macular degeneration, glaucoma, or cataracts.
Photo by jurvetson
Although they experience vivid visual hallucinations that seem very real, they are not psychotic. They have insight into their “visions.”
Additionally, Bonnet Syndrome is not associated with dementia. Although dementia patients losing their vision could theoretically develop this syndrome, usually the hallucinations that dementia patients experience are directly related to the dementia and in some cases may need to be treated with medication.
Since antipsychotic medications are not indicated in the Charles Bonnet Syndrome, what is the treatment? There is no known treatment. Reassurance that the patient is not mentally ill is usually the best approach.
I learned about this syndrome in my geriatric psychiatry fellowship and have since found that most physicians are not aware of its existence. The unfortunate result is that many who suffer from it may unnecessarily end up on antipsychotic medications, all of which are associated with significant potential side effects.
Below is a TEDTalks video of Oliver Sacks, a well-known neurologist and storyteller, describing Charles Bonnet Syndrome in his own patients. At the end he reveals a relevant secret about himself as well. (You’ll have a lot better “feel” for the syndrome if you watch the video.)
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