幻視に対してtrazodoneが奏効したレビー小体型痴呆の2症例

Effective Treatment of Visual Hallucination with Trazodone in Two Cases of Dementia with Lewy Bodies

抄録

　レビー小体型痴呆(DLB)の幻視に対してtrazodoneが奏効した2症例(糖尿病合併例と高度のparkinsonism合併例)を経験した。幻視に対して通常投与される非定型抗精神病薬については，2症例ともneuroleptic sensitivityがあり重篤な副作用が出現しやすいと考えられ，慎重にならざるを得なかった。特に，高度のparkinsonism合併例ではいっそうの慎重さが求められた。また，最も推奨されるquetiapineは，糖尿病合併例では投与禁忌であった。幻視の発現にセロトニン(5-HT)系の関与が指摘されており，本経験から，DLBの幻視に対して5-HT2受容体遮断薬であるtrazodoneは，効果，安全性の両面で試みる価値があると考えられた。今後も抗精神病薬以外の薬物療法の蓄積が期待される。

Summary

　We treated visual hallucination effectively with trazodone in two cases of dementia with Lewy bodies (DLB).

　Case 1 was a 71-year-old woman with diabetes mellitus (DM), and case 2 was a 71-year-old woman with severe parkinsonism.

　Atypical antipsychotics are usually used for the treatment of visual hallucination, but we could not use them for various reasons in these cases. Firstly, each DLB patient showed neuroleptic sensitivity, so even atypical antipsychotics would have caused severe adverse effect, especially in case 2 with severe parkinsonism. Secondly, in case 1 with DM, we could not use quetiapine which is the most recommended pharmacotherapy.

　Serotonin (5-HT) is pointed out to be associated with visual hallucination. Trazodone, 5-HT2 receptor antagonist, was effective and safe in these two cases.

　For the treatment of visual hallucination in DLB with neuroleptic sensitivity, it is necessary to consider pharmacotherapy other than antipsychotics.