P0009 VISUAL HALLUCINATIONS- A RATHER PLEASANT EXPERIENCE! CHARLES BONNET SYNDROME

Introduction: -Visual hallucinations are generally unpleasant and distressing especially when they are part of a complex psychiatric condition. However, when it occurs as a sole manifestation in the presence of normal insight, it is often non distressing. Visual hallucination in the presence of normal insight and cognition is Charles Bonnet Syndrome (CBS). Although it commonly occurs in patients with visual impairment it is not a prerequisite for diagnosis. Objectives: To illustrate different types of visual hallucinations in CBS, its management and explore the literature. Materials & methods: We report 3 cases of Charles Bonnet Syndrome and discuss the details of associated visual hallucination Results: Case one 93 year old lady presented with one week history of seeing images of her friends and relatives and sometimes pleasant images like angels. These images were stereotyped, recurrent, occurring mostly when she was alone in the evenings. She had full insight of her hallucinations and therefore she was not frightened of them. She had marked visual impairment. The clinical examination and investigations did not reveal any other cause. A diagnosis of CBS was made and she was managed successfully. Case two A 92 year old women presented with the history of recurrent episodes of seeing the images of her son-in-law walking around her house. She had complete insight and started to ignore them from the onset. Clinical examination revealed no evidence of cognitive impairment. Importantly, she had no visual impairment. CT head scan showed changes consistent with small vessel disease only. Her management was based on reassurance that this was not a psychiatric condition and she became free of hallucinations within a month. Case three A 75 year women had an episode of seeing a ‘jagged edge box’ with ‘wavy lines’. She experienced this in both eyes simultaneously but was not perturbed. Her cognitive status and neurological examination were normal. Although she appeared stressed, she did not display evidence of depression. Neuro imaging and blood tests were also normal. She was reassured about the nature of her visual hallucination and her symptom did not recur during the follow up over the next one year. Discussion & conclusion: A careful history and consideration of CBS as a possible cause of visual hallucination can lead to reduction of unnecessary investigations and associated anxiety. Unlike those associated with psychiatric symptoms, visual hallucination in CBS responds adequately to reassurance alone.