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Charles Bonnet Syndrome: Complete Remission of Visual Hallucinations with Trazodone

Author(s): Ricardo Krause Martinez de Souza, Rodrigo Tomazini Martins, Pedro Andre Kowacs

Charles Bonnet syndrome (CBS) is a neuro-ophthalmic condition that affects elderly people
with visual impairment related to ophthalmological pathologies. It is characterized by
complex visual hallucinations with insight into the unreality of the perceptions and preserved
cognitive status. Its mechanism involves spontaneous neuronal discharges of the visual cortex
secondary to deafferentation of visual input. Treatment should address to its ophthalmologic
etiology but pharmacological management of visual hallucinations may be done as well. We
report a case of an 86-year-old woman with a characteristic clinical picture of CBS that had
complete remission of her visual hallucinations with trazodone treatment. Perhaps trazodone
effect on blocking neuronal plasticity through its action at 5-HT2C receptors may control
visual hallucinations. Its prescription should be considered as one of the first steps in the
management of Charles Bonnet syndrome.

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