Visual hallucinations in a geriatric psychiatry clinic: prevalence and associated diagnoses

Visual hallucinations are associated with a variety of psychiatric, medical, neurologic, and ophthalmologic disorders. One hundred forty outpatients presenting to a geriatric psychiatric clinic were screened for visual hallucinations and assessed on a number of descriptive variables, medical history, ophthalmologic history, psychiatric diagnosis, and cognitive score. The data revealed that 14 patients (10%) experienced visual hallucinations. Presence of visual hallucinations was significantly associated with diagnoses of dementia or delirium, living in a nursing home, lower cognitive score, and presence of auditory hallucinations and delusions. There was no association to number of medications, age, gender, or presence of eye disease. No patient had "insight' into their visual hallucinations. Despite the numerous disorders that are associated with visual hallucinations, the most common causes in a geriatric psychiatry clinic are dementia and delirium. Clinicians assessing older patients with visual hallucinations should first carefully evaluate for these disorders.