Dr. Gupta Replies

We appreciate the issues raised by Dr. Segers. 1 We also agree that there are no uniformly accepted criteria for the Charles Bonnet syndrome as they have mentioned and literature differs in the presentation of the cases. In our manuscript, we have described the behavioral response of the patient to the visual hallucinations. 2 Negative or positive emotional reactions to the Charles Bonnet syndrome have been described in the past also. 3 – 5 However, literature is silent about the emotional and behavioral aspects of the Charles Bonnet syndrome and emphasizes only upon the preserved insight. 6 – 8 There is ample literature to suggest that behavior and emotions are intimately related though they may also be affected by cognitive processes, especially in humans. 9 Despite extensive literature search, we could not find any literature describing behavioral responses to hallucinations (with preserved insight) in Charles Bonnet syndrome. Preserved insight is a cognitive process which does not have entire control of the behavior, especially in the presence of negative emotions. 9 Hence, we feel that it is extremely difficult to differentiate “true” Charles Bonnet syndrome from complex visual hallucinations with the presently available information and further research is required.