Aizawa Saeko, Terao Takeshi, Hatano Koji, Ishii Nobuyoshi
Faculty of Medicine, Oita University, Yufu, Japan.
BMJ Case Rep. 2014 Sep 24;2014:bcr2014206418. doi: 10.1136/bcr-2014-206418.
A 73-year-old woman outpatient with mild cognitive impairment, parasomnia and depressive state with musical hallucinations failed to respond to 400 mg/day of valproate. Once she was admitted to a university hospital, her musical hallucinations partially responded to 1 mg/day of clonazepam and sufficiently improved on 100 mg/day of carbamazepine. Two months after discharge, however, her musical hallucinations recurred probably as a consequence of psychological stress. The increase of carbamazepine from 100 to 200 mg/day completely remitted her musical hallucinations. This case suggests that musical hallucinations respond in a dose-dependent manner to increasing carbamazepine, and that gradual titration from small doses of carbamazepine is required because optimal doses appear to be smaller than those required for epilepsy and bipolar disorder. Further studies are warranted to determine the therapeutic levels of carbamazepine for musical hallucinations.
一名73岁的女性门诊患者，患有轻度认知障碍、异态睡眠和伴有音乐幻觉的抑郁状态，对每天400毫克丙戊酸盐无反应。她入住大学医院后，每天1毫克氯硝西泮使她的音乐幻觉有部分反应，每天100毫克卡马西平则使其充分改善。然而，出院两个月后，她的音乐幻觉可能由于心理压力而复发。将卡马西平剂量从每天100毫克增加到200毫克后，她的音乐幻觉完全消失。该病例表明，音乐幻觉对卡马西平剂量增加呈剂量依赖性反应，且由于最佳剂量似乎小于癫痫和双相情感障碍所需剂量，因此需要从小剂量卡马西平开始逐渐滴定。有必要进行进一步研究以确定卡马西平治疗音乐幻觉的水平。
