Charles Bonnet Syndrome: Next Step When Education and Behavioural Strategies Have Not Reduced Hallucinations
This protocol applies when a patient with Charles Bonnet syndrome continues to experience frequent or distressing visual hallucinations after a full first-line approach has been completed.
The initial step — patient education and reassurance that CBS is a recognised, benign, non-psychiatric consequence of visual loss; behavioural strategies such as eye movements, blinking, distraction tasks, and relaxation techniques; and environmental modifications including increased ambient lighting, with signposting to peer-support resources — did not achieve the target goals of reduced frequency or intensity of visual hallucinations and minimal distress.
When reassurance and behavioural measures have proved insufficient, the next clinical step involves referral for psychological support — including talking therapies — alongside a structured review of the patient's current medications in collaboration with their general practitioner. The complete protocol details the specific interventions to consider, how to prioritise them, and the clinical context in which each applies.