0816 Chronic insomnia secondary to severe nocturnal visual hallucinations in Charles Bonnet syndrome; a challenging case to manage

Abstract Introduction Over 1 million Americans are blind. Charles Bonnet syndrome (CBS), a parallel to phantom limb and also known as release hallucinations, describes visual hallucinations in patients with severe loss blindness. The prevalence of though likely underreported, is believed be 12 20% visually impaired persons. Report Cases: A 45-year-old male past medical history migraines presented the hospital what was determined ruptured pituitary macroadenoma result, lost complete function including pupillary reflexes. patient subsequently experienced both simple complex eventually diagnosed syndrome. Most disturbing which described bright white light honeycomb lattice predominately his right field lasted for hours. This not consistently associated any other symptoms could occur at time throughout 24-hour day. Nocturnal occurred approximately 50% nights caused onset/maintenance insomnia insufficient sleep duration. tried therapy addition proper hygiene without relief. He trialed on several medications only one able alleviate all but worst diazepam. GABA-A receptor agonist finally allowed an opportunity sleep. His then treated once nightly temazepam, needed Approximately nine years after losing vision, he transitioned from temazepam tricyclic antidepressant amitriptyline, offered improved relief lights causing insomnia. continues utilize amitriptyline diazepam breakthrough symptoms, still suffers significant impairment due Conclusion Treatment multifactorial includes maintaining optimal eye care, stimulating senses, psychosocial therapy, pharmacotherapy. Insomnia remains difficult manage, agonists have shown some Case reports atypical antipsychotics antidepressants, melperone agomelatine respectively, demonstrated ability improve hallucinations. Support (If Any) Syndrome FAQs. Foundation (Australia). https://www.charlesbonnetsyndrome.org/index.php/cbs/faq. Accessed December 15, 2021.Hsu HC, Huang YS, Fan WX, Chen TC. (CBS): Successful Visual Hallucinations Due Vision Loss Agomelatine Three Cases. European Psychiatry. 2017;41(S1):S172-S172. doi:10.1016/j.eurpsy.2017.01.2065Pelak VS. (Charles syndrome). UpToDate. Waltham, MA: UpToDate; June 7, 2016; https://www.uptodate.com/contents/visual-release-hallucinations-charles-bonnet-syndrome.