Musical obsession or pseudohallucination: electrophysiological standpoint

Musical hallucination or musical obsession? A differential diagnosis between two cases

Musical hallucinations and musical obsessions are distinct phenomena. The first can be understood as a manifestation of the musical ear syndrome, which produces deafferentation auditory hallucinations, while the latter is an obsessive symptom of obsessive-compulsive disorders. Both symptoms are often poorly understood and mistaken for one another or for signs of psychotic disorders. We report two cases, one characterized by musical hallucinations and the other by musical obsessions, both with comorbid hearing impairment, which is the main confounding factor in their differential diagnosis. We critically compare the two cases and their key features, allowing diagnostic differentiation and a targeted therapeutic approach.

A Systematic Review of Scientific Studies and Case Reports on Music and Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a severe psychiatric disorder, which can be associated with music-related symptoms. Music may also be used as an adjunct treatment for OCD. Following the PRISMA guidelines, we performed a systematic literature review exploring the relationship between music and OCD by using three online databases: PubMed, the Web of Science, and PsycINFO. The search terms were "obsessive compulsive disorder", "OCD", "music", and "music therapy". A total of 27 articles were utilised (n = 650 patients/study participants) and grouped into three categories. The first category comprised case reports of patients with musical obsessions in patients with OCD. Most patients were treated with selective serotonin reuptake inhibitors (SSRIs) or a combination of an SSRI and another pharmacological or a non-pharmacological treatment, with variable success. Studies on the music perception of people with OCD or obsessive-compulsive personality traits represented the second category. People with OCD or obsessive-compulsive personality traits seem to be more sensitive to tense music and were found to have an increased desire for harmony in music. Three small studies on music therapy in people with OCD constituted the third category. These studies suggest that patients with OCD might benefit from music therapy, which includes listening to music.

"Radio Inside My Head": A Curious Case of Early Onset "Stuck Song Syndrome" or Obsessive-Compulsive Disorder with Predominant Musical Obsession

Musical obsessions also called "stuck song syndrome" is a topic of limited research. It is among the most poorly understood and rare phenomenology. There are only a few cases reported across the world which describes it. Subjects usually present with complaints of continuous play of a musical tune in the head which the subject is unable to remove. Because of its similarity in presentation with auditory musical hallucination, it presents a diagnostic dilemma to the clinician. Here, we present the case of a 25-year-old man who presented with this particular phenomenon, and the approach we took to manage it.

[Robert Schumann in the psychiatric hospital in Endenich near Bonn]

BACKGROUND

The composer Robert Schumann (1810-1856) spent the last two-and-a-half years of his life in the private psychiatric hospital in Endenich. His medical records emerged in 1991 and were published by Appel in 2006.

METHODS

Daily entries by the physicians were analyzed concerning psychopathology and organic signs as well as the illness-related correspondence of the people closest to Schumann.

RESULTS

The numerous entries reveal the treatment typical at that time for what was at first considered to be "melancholy with delusions": shielding from stimuli, physical procedures, and a dietary regimen. The feared, actual diagnosis, a "general (incomplete) paralysis," becomes a certainty in the course of the paranoid-hallucinatory symptoms with cerebro-organic characteristics and agitated states, differences in pupil size, and increasing speech disturbances.

CONCLUSION

In the medicine of the time, syphilis is just emerging as the suspected cause, and the term "progressive paralysis" is coined as typical for the course. Proof of Treponema pallidum infection was not available until 1905. Nevertheless, the clinical signs strongly refer to the course of neurosyphilis. People close to Robert, in particular his wife Clara and the circle of friends around Brahms and Joachim, cared intensively for him and suffered under the therapeutic isolation. The medical records and disease-related letters contradict the theory that Schumann was disposed of by being put into the psychiatric hospital; they show the concern of all during the unfavorable illness course.

Musical obsessions: a case report and review of literature

The phenomenon of musical obsessions is scantly researched and poorly established. Here we present a case with musical obsessions in addition to body dysmorphophia and severe depression and review the available literature for musical obsessions.

Obsessive-compulsive disorder presenting with musical obsessions in otosclerosis: a case report

Introduction

Musical obsessions consist of intrusive recollections of music fragments that are experienced as unwanted. Otosclerosis is caused by an abnormal bone homeostasis of the otic capsule and represents a frequent cause of hearing impairment. Many conditions causing hearing loss have been associated with musical hallucinations, but the association between musical obsessions and hearing loss is frequently overlooked.

Case presentation

We present the case of a 51-year-old Caucasian woman with a history of obsessive-compulsive disorder who developed musical obsessions soon after being diagnosed with otosclerosis. She was referred to our obsessive-compulsive disorder outpatient unit by her general psychiatrist. At the time of our first evaluation, she had severe musical obsessions that interfered with her social functioning and made her unable to follow conversations. She was started on 40mg of paroxetine and 2.5mg of aripiprazole, which led to significant improvement of her symptoms and of her social and work functioning.

Conclusions

To the best of our knowledge, this is the first report of musical obsessions in a patient with hearing loss due to otosclerosis and a history of obsessive-compulsive disorder. This case suggests that a differential diagnosis of obsessive-compulsive disorder should be carefully considered in patients with hearing impairment who complain of involuntary musical imagery, especially in those patients who have a previous history of obsessive-compulsive disorder.

Musical obsessions: a comprehensive review of neglected clinical phenomena

Intrusive musical imagery (IMI) consists of involuntarily recalled, short, looping fragments of melodies. Musical obsessions are distressing, impairing forms of IMI that merit investigation in their own right and, more generally, research into these phenomena may broaden our understanding of obsessive-compulsive disorder (OCD), which is phenomenologically and etiologically heterogeneous. We present the first comprehensive review of musical obsessions, based on the largest set of case descriptions ever assembled (N=96). Characteristics of musical obsessions are described and compared with normal IMI, musical hallucinations, and visual obsessional imagery. Assessment, differential diagnosis, comorbidity, etiologic hypotheses, and treatments are described. Musical obsessions may be under-diagnosed because they are not adequately assessed by current measures of OCD. Musical obsessions have been misdiagnosed as psychotic phenomena, which has led to ineffective treatment. Accurate diagnosis is important for appropriate treatment. Musical obsessions may respond to treatments that are not recommended for prototypic OCD symptoms.

Psychiatry and music

Vocal and/or instrumental sounds combined in such a way as to produce beauty of form, harmony and expression of emotion is music. Brain, mind and music are remarkably related to each other and music has got a strong impact on psychiatry. With the advent of music therapy, as an efficient form of alternative therapy in treating major psychiatric conditions, this impact has been further strengthened. In this review, we deliberate upon the historical aspects of the relationship between psychiatry and music, neural processing underlying music, music's relation to classical psychology and psychopathology and scientific evidence base for music therapy in major psychiatric disorders. We highlight the role of Indian forms of music and Indian contribution to music therapy.

Treatment of anxiety from musical obsessions with a cognitive behaviour therapy tool

Musical obsessions and hallucinations are disturbing experiences of repeating internal music. Antipsychotic medication can sometimes reduce these symptoms but can also trigger or augment them. We report the case of a female patient with schizophrenia with drug-resistant obsessive musical hallucinations. The patient volunteered to participate in a 9-month pilot study to follow the development of the condition using an involuntary music and mood inventory. The patient perceived benefits from the intervention, including reduced anxiety, increased feeling of being in control and understanding the condition better. Findings from this case study suggest that cognitive therapy can be a useful complementary method of care for persons with musical obsessions. The presented tool requires further investigations among those with this rare condition.

Earworms (stuck song syndrome): towards a natural history of intrusive thoughts

Two studies examine the experience of 'earworms', unwanted catchy tunes that repeat. Survey data show that the experience is widespread but earworms are not generally considered problematic, although those who consider music to be important to them report earworms as longer, and harder to control, than those who consider music as less important. The tunes which produce these experiences vary considerably between individuals but are always familiar to those who experience them. A diary study confirms these findings and also indicates that, although earworm recurrence is relatively uncommon and unlikely to persist for longer than 24 h, the length of both the earworm and the earworm experience frequently exceed standard estimates of auditory memory capacity. Active attempts to block or eliminate the earworm are less successful than passive acceptance, consistent with Wegner's theory of ironic mental control.