Charles bonnet syndrome plus: Complex visual hallucinations of charles bonnet syndrome type in late paraphrenia

AbstractEighteen of a series of 101 late paraphrenic patients experienced complex, prolonged and repetitive visual hallucinations that resemble the characteristic experiences of individuals with the Charles Bonnet syndrome. The Charles Bonnet syndrome itself is a rare and heterogeneous disorder and the appearance of Charles Bonnet syndrome‐like hallucinations in association with functional psychoses in the elderly has been hitherto largely unrecognized. Cases were predominantly female (reflecting the overall sex ratio described in late paraphrenia), 50% had accompanying auditory hallucinations, 42% were visually impaired and only one patient had insight into the hallucinatory nature of the experiences. Late paraphrenics who experienced these phenomena had significantly lower scores on the MMSE than those who did not. The hallucinations disappeared in 53% of the patients who were treated with antipsychotic medication. Eight of the patients underwent MR brain imaging and in four of these structural abnormalities of the midbrain were found.