title: Escitalopram for antipsychotic nonresponsive visual hallucinosis: eight patients suffering from Charles Bonnet syndrome.
abstract: BACKGROUND
  The Charles Bonnet syndrome (CBS) is characterized by distinct visual hallucinations and ocularpathology causing visual impairment in patients with insight and the absence of psychiatric comorbidity. The number of reported cases of CBS is expanding as the population ages and the prevalence of vision disorders increases. Antipsychotic medications are often prescribed. However, their efficacy in CBS has been based on sketchy evidence. The use of serotonin selective reuptake inhibitor (SSRI) for CBS was anecdotally reported. We herein describe effectiveness of escitalopram in a series of patients suffering from CBS who were unresponsive to antipsychotic treatment.
  
  
  METHODS
  Eight consecutive patients suffering from CBS who did not respond to standard antipsychotic treatment were switched to escitalopram. CBS severity prior to escitalopram treatment was quantified using the Clinical Global Impression (CGI) scale and again after eight weeks of treatment. All had undergone brain CT and cognitive assessment. Brain CT imaging was normal except for an incidental finding of a small frontal meningioma in one patient. All had Mini-Mental Status Examination scores of ≥ 27/30.
  
  
  RESULTS
  There were four men and four women, with a mean age of 81.7 ± 7.3 years. Previous antipsychotic treatment was mostly with risperidone, 1.0 to 3.0 mg/daily. Mean CGI-severity upon switching to escitalopram treatment was 5.7. This was significantly reduced to 1.8 (p < 0.001) after eight weeks of escitalopram treatment (mean dose: 11.8 mg/daily). There were no side effects, nor any adverse events were reported.
  
  
  CONCLUSIONS
  This is the first case-series to show that SSRI is an effective and well-tolerated treatment for visual hallucinations associated with vision impairment such as in CBS.
authors.affiliation: Tirat HaCarmel Mental Health Center and the Institute of Technology, Technion, Haifa, Israel.
authors.forename: Yoseph
authors.initials: Y
authors.lastname: Bergman
authors.forename: Yoram
authors.initials: Y
authors.lastname: Barak
mesh_terms: D000369:Aged, 80 and over; D015283:Citalopram / Q000008:administration & dosage / Q000627:therapeutic use*; D005128:Eye Diseases / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D005260:Female; D006212:Hallucinations / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000150:complications / Q000188:drug therapy; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013577:Syndrome; D016896:Treatment Outcome; D014786:Vision Disorders / Q000150:complications* / Q000188:drug therapy / Q000209:etiology / Q000523:psychology
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors