（１８０）前立腺がん治療中の幻視

父の幻視の原因は老人性の痴呆か、前立腺がんの治療薬の副作用か？
幻視のよく現れるmassage chair マッサージチェア

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商品名：ゾラデックス３．６ｍｇデポ

一般名：酢酸ゴセレリンキット
製造メーカー：アストラゼネカ
用法：ゴセレリンとして３．６ｍｇを前腹部に４週（２８日）ごとに１回皮下投与する。
効能：１．前立腺癌。
副作用：［前立腺癌の場合］
承認時までの調査及び使用成績調査における総症例３，８７２例中
２．その他の副作用
６）．精神神経系［前立腺癌の場合］：（０．１％未満）感覚異常（しびれ等）、幻覚、妄想。

ゾラデックスLA10.8mgデポ
Zoladex LA 10.8mg depot

ゴセレリン酢酸塩デポ
通常、成人には本剤1筒(ゴセレリンとして10.8mg含有)を前腹部に12～13週ごとに1回皮下投与する。
前立腺癌
副作用
国内臨床試験及び「使用実態における特別調査」、「蓄積性に関する特別調査」における総症例3,037例中
その他の副作用

精神神経系：

0.1％未満

**感覚異常(しびれ等)、幻覚、妄想

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商品名：カソデックス錠８０ｍｇ
一般名：ビカルタミド錠
薬効：前立腺癌
副作用：精神神経性の副作用の記述見当たらず

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レビー小体型痴呆（ＤＬＢ：dementia with Lewy body）か?

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幻視の治療薬
リスペリドン錠１（オーハラ）
一般名リスペリドン（Risperidone）
神経に興奮を伝達する物質（ドパミン、セロトニン）の働きを抑制することにより興奮を抑え、気分を安定させます。
通常、統合失調症の治療に用いられます。
ドーパミンとセロトニンという２つの神経伝達物質をおさえることです。２つをおさえることで、統合失調症の陽性症状（幻覚、妄想、興奮）と陰性症状（無感情、意欲低下、自閉）の両方によい効果を発揮します。

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漢方薬の効果が注目され、中でも抑肝散（よくかんさん）は認知症の幻覚、興奮・攻撃性、焦燥感・易刺激性、異常行動において効果が期待できます。

 

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幻視の記録
20 Sep., 2009 Visual Hallucination:
He saw one man on his massage chair and another man crouching under the chair. He wanted to use it but they had occupied it. He could not use it at that time. He got very angry to them because they used it without his permission.

21 Sep., 2009 Visual Hallucination:
He saw people inside house by the eastern windows. They are men and women, sometimes with children. They don't speak.  They switched the light of the room. All of them are strangers. Some used his personal computer. The computer is very old and broken though. He got also angry to them. As he reached them, they disappeared. He had asked them not to come today because his important guest would come. He found them standing at the entrance. They were hesitated to enter the house. He asked me if I saw them. I told him that I could not see them. They are hallucination. He said one of them was trying to stand on his head.

In the western room was his massage chair. He asked me if I could see the animals, maybe a mother dog and its puppy under the massage-chair. He explained what is under the chair precisely. I listened to him carefully. I found that what he said breast of dog was a cable covered with black cloth between foot gear and seat of the chair, and white puppy was a shining sticker on the seat of it. To him a mother dog delivered its puppy under the chair and milked it. He said keeping dogs in the kitchen is not hygienic. He is with some cataracts. His hallucination often appeared 5, 6 meters far from him. He sometimes saw a half disappeared man, too.

At the back-yard he asked me if those birds could do such things. He is looking up the next house's wall. I could not see anything on the wall of three-story house. All I could see was black venting holes with covers. To his eyes black bird like crows pecked the venting holes and moved them. He didn't seem to believe what he had seen.

He saw a hallucination of a man with a red flag from a real basket with a red ribbon. He saw a bird's hallucination from a shadow of brim of a hat placed in distance.

23 Sep., 2009 Visual Hallucination:
He talked with me on the phone about 4 or 5 rude strangers entered his house. He couldn't stand this situation any more. They are under the massage-chair. He asked me to inform somebody, such as police or relatives, of their unlawful entry. I said Okay and asked him to sleep without doing anything to them tonight. To other family members they are not visible and no harm. Please go to the doctor next morning and ask him to do something to this hallucination. He  understood then.  

24 Sep., 2009 Risperidone 0.5mg No change
25 Sep., 2009 Risperidone 0.5mg