[Complex visual hallucinations in partially sighted elderly: Charles Bonnet syndrome]

In two patients, women aged 85 and 80 years, who suffered from visual hallucinations involving living creatures, cars and buildings, Charles Bonnet syndrome was diagnosed. Both were worried that these signs were an indication of a severe psychiatric condition. In diagnosing the Charles Bonnet syndrome the following criteria can be used: presence of complex visual hallucinations, retention of insight, absence of hallucinations in other sensory modalities and absence of delusions. Hallucinations in dementia, delirium, migraine, epilepsy, or in extreme states of exhaustion or sensory deprivation, as well as hallucinations due to psychedelic drugs, hallucinations of widowhood and hypnagogic and hypnopompic hallucinations must be excluded. Patient education and reassurance are the cornerstones of treatment. Other possible treatments are: improving visual acuity and the general physical condition, stopping medication with hallucinogenic side effects, activating the patient, coaching the patient in avoiding hallucination-triggering situations and using stopping strategies, and (still experimental) pharmacological treatment with carbamazepine, valproate, ondansetron or cisapride.