Charles Bonnet Syndrome; presenting as “innocent spirits within": a case report

Abstract

Charles Bonnet syndrome (CBS) is an under-recognized and under-reported disorder that involves visual hallucinations in visually impaired individuals. These patients have intact cognition, do not have hallucinations in any other sensory modalities, and retain insight into the unreal nature of their hallucinations. In most developing countries like Botswana where mental health and ophalmology professionals are scarce, cases like Charles Bonnet Syndrome are likely to be misdiagnosed for psychosis/’madness’ with consequent inappropriate biological interventions . Our patient, a 90 year old blind widow pensioner, with no prior psychiatric history, complained to family members that she was seeing people without heads and sometimes without limbs following her. She felt tortured as these people followed her everywhere. She consulted her pastor about these visual hallucinations, and was told not to worry about them as ‘’they were harmless spirits within her’. When she was eventually brought to the Hospital she was given a diagnosis of Charles Bonnet Syndrome and showed marked improvement after being given assurance about her sanity and antidepressants.There is need to increase awareness of rare psychiatric syndromes in the elderly like the Charles Bonnet Syndrome amongst clinicians since they can be easily missed or inappropriately managed more so since the population of the elderly is increasing in Botswana and many other sub-Sahara countries.