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Costa OPF, Dalcim ML, Smaira SI, Lovadini GB. Musical hallucination or musical obsession? A differential diagnosis between two cases. Dement Neuropsychol 2024; 18:e20230073. [PMID: 38933080 PMCID: PMC11206231 DOI: 10.1590/1980-5764-dn-2023-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/21/2023] [Accepted: 03/09/2024] [Indexed: 06/28/2024] Open
Abstract
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.
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Affiliation(s)
- Octavio Pennella Fenelon Costa
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Neurologia, Psicologia e Psiquiatria, Botucatu SP, Brazil
| | - Maria Luiza Dalcim
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Neurologia, Psicologia e Psiquiatria, Botucatu SP, Brazil
| | - Sumaia Inaty Smaira
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Neurologia, Psicologia e Psiquiatria, Botucatu SP, Brazil
| | - Gustavo Bigaton Lovadini
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Neurologia, Psicologia e Psiquiatria, Botucatu SP, Brazil
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2
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Bakewell B, Johnson M, Lee M, Tchernogorova E, Taysom J, Zhong Q. Drug-induced musical hallucination. Front Pharmacol 2024; 15:1401237. [PMID: 38841376 PMCID: PMC11150696 DOI: 10.3389/fphar.2024.1401237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/02/2024] [Indexed: 06/07/2024] Open
Abstract
Musical hallucination is a rare perceptual phenomenon wherein individuals hear music in the absence of external auditory stimuli. This phenomenon occurs across diverse medical conditions and can be triggered by some drugs. The underlying mechanism of drug-induced hallucination is unknown. This study explores drug-induced musical hallucination through a literature review, aiming to investigate its pathophysiology and potential treatment modalities. A literature search was conducted until January 2024 using databases PubMed, WorldCat, Google Scholar, and DOAJ, with keywords "drugs induced musical hallucination" or "drugs" combined with "musical hallucination." The search yielded 24 articles which met inclusion criteria, encompassing 27 cases. The average patient age was 58.3 years, with 67.9% females. Prevalent conditions among cases included hearing impairments, psychiatric disorders, cancers, and neurodegenerative conditions. Common trigger drugs comprised antidepressants, opioids, anti-Parkinson drugs, ketamine, and voriconazole. Musical hallucination descriptions varied widely, and 6 patients reported concurrent visual hallucinations. The onset of symptoms ranged from 75 min to 240 days. Treatment strategies included termination of trigger drugs, dosage reduction, alteration of administration routes or formula, switching to similar drugs, or addition of antidepressants, sedatives, or atypical antipsychotic medications. Musical hallucinations completely disappeared in 24/27 (88.9%) patients but continued in 3/27 (11.1%) patients. The current study concludes that drug-induced musical hallucination may arise from altering neurotransmitter/receptor balance and intricate interactions between trigger drugs and underlying conditions.
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Affiliation(s)
| | | | | | | | | | - Qing Zhong
- Rocky Vista University College of Osteopathic Medicine, Ivins, UT, United States
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Kim JS, Hong SB, Park KW, Lee ATC. Psychotic Symptoms in Patients With Major Neurological Diseases. J Clin Neurol 2024; 20:153-165. [PMID: 38433485 PMCID: PMC10921039 DOI: 10.3988/jcn.2023.0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 03/05/2024] Open
Abstract
Neurological diseases often manifest with neuropsychiatric symptoms such as depression, emotional incontinence, anger, apathy and fatigue. In addition, affected patients may also experience psychotic symptoms such as hallucinations and delusions. Various factors contribute to the development of psychotic symptoms, and the mechanisms of psychosis are similar, but still differ among various neurological diseases. Although psychotic symptoms are uncommon, and have been less well investigated, they may annoy patients and their families as well as impair the patients' quality of life and increase the caregiver burden. Therefore, we need to appropriately identify and treat these psychotic symptoms in patients with neurological diseases.
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Affiliation(s)
- Jong S Kim
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
| | - Seung-Bong Hong
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keun-Woo Park
- Department of Neurology, Korea University Anam Hospital, Seoul, Korea
| | - Allen T C Lee
- Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
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Buijk MA, Lauw RF, Coebergh JAF, Bouachmir O, Linszen MMJ, Blom JD. Musical hallucinations, secondary delusions, and lack of insight: results from a cohort study. Front Psychiatry 2023; 14:1253625. [PMID: 37840806 PMCID: PMC10569219 DOI: 10.3389/fpsyt.2023.1253625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Although musical hallucinations do not tend to be accompanied by delusions, occasionally patients persistently accuse others of being responsible for causing the music they perceive, sometimes with severe social consequences such as frequently calling the police or moving house. In this study we seek to broaden our understanding of this rare type of musical hallucination that comes with secondary delusions and lack of insight, and to explore associations, underlying mechanisms, and treatment possibilities. Methods The present study is part of a cohort study on musical hallucinations carried out in the Netherlands from 2010 through 2023. Participants underwent testing with the aid of the MuHa Questionnaire, Launay-Slade Hallucinations Scale (LSHS), Schizotypal Personality Questionnaire (SPQ), Hamilton Depression Rating Scale (HDRS), and Mini Mental State Examination (MMSE). Additionally, they underwent a brain MRI, electroencephalogram, and audiological testing. Results Five patients out of a group of N = 81 (6%) lacked insight and presented with secondary delusions regarding the perceived music. They were all female, of advanced age, and hearing-impaired, and were diagnosed with cognitive impairment. In three patients (60%), risperidone was started. This had a positive effect on the hallucinations and secondary delusions. Conclusion The pathophysiological process underlying musical hallucinations is multifactorial in nature. We consider cognitive impairment the most likely contributing factor of the secondary delusions and lack of insight encountered in our patients, and antipsychotics the most beneficial treatment. On the basis of these small numbers, no definite conclusions can be drawn, so further research is needed to elucidate the underlying mechanisms and to develop evidence-based treatment methods for people experiencing this rare and debilitating combination of symptoms. Since the black box warning of risperidone cautions against the use of this drug in elderly persons with dementia, a proper comparison with the efficacy and safety of other antipsychotics for this group is paramount.
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Affiliation(s)
| | - René F. Lauw
- Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Jan Adriaan F. Coebergh
- Department of Neurology, Ashford/St. Peter’s Hospital, Chertsey, United Kingdom
- Department of Neurology, St. George’s Hospital, London, United Kingdom
| | | | - Mascha M. J. Linszen
- Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Jan Dirk Blom
- Parnassia Psychiatric Institute, The Hague, Netherlands
- Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
- Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
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Sakimoto H, Urata Y, Ishizuka T, Kimotsuki H, Kasugai M, Fukuhara R, Sano A, Nakamura M. Association of auditory Charles Bonnet syndrome with increased blood flow in the nondominant Brodmann area 22. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e92. [PMID: 38868153 PMCID: PMC11114281 DOI: 10.1002/pcn5.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/27/2023] [Accepted: 04/15/2023] [Indexed: 06/14/2024]
Abstract
Aim Auditory Charles Bonnet syndrome (aCBS) is characterized by musical hallucinations (MHs) that accompany acquired hearing impairments. This hallucination is the acoustic perception of music, sounds, or songs in the absence of an outside stimulus, and it may be associated with hyperactivity of the superior temporal lobes. Some studies have reported the possibility of improving MH with antiepileptics. To elucidate in detail the brain regions responsible for aCBS, we analyzed the regions that changed functionally after treatment. Methods Before and after treatment with carbamazepine (four cases), clonazepam (one case), and a hearing aid (one case), cerebral perfusion single-photon emission computed tomography (SPECT) and the Auditory Hallucination Rating Scale (AHRS) were applied to six patients with hearing-loss-associated MHs. Results Cerebral blood flow analysis using SPECT revealed hyperperfusion in Brodmann area (BA) 22-the posterior region of the superior temporal gyrus-in the nondominant hemisphere in all six patients in the pretreatment phase. After treatment, the hyperperfusion region improved in all patients. The area percentages with hyperperfusion in the nondominant BA22 were strongly positively correlated with the AHRS score. Conclusion The results suggest that aCBS, which was treatable with antiepileptics or hearing aids, was involved in hyperexcitement in BA22, and that MH strength was correlated with degree of excitement.
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Affiliation(s)
- Hitoshi Sakimoto
- Department of PsychiatryKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Yuka Urata
- Department of PsychiatryKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Takanori Ishizuka
- Department of PsychiatryKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Hiroshi Kimotsuki
- Department of PsychiatryKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
- Department of PsychiatryKagoshima City HospitalKagoshimaJapan
| | - Motofumi Kasugai
- Department of PsychiatryKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
- Kagoshima Prefecture Mental Health and Welfare CenterKagoshimaJapan
| | - Ryuji Fukuhara
- Department of PsychiatryKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Akira Sano
- Department of PsychiatryKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
- Kagoshima UniversityKagoshimaJapan
| | - Masayuki Nakamura
- Department of PsychiatryKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
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Hase T, Yasui-Furukori N, Yamaguchi S, Shimoda K. A case of musical hallucinations induced by tramadol. Neuropsychopharmacol Rep 2023; 43:160-162. [PMID: 36655496 PMCID: PMC10009407 DOI: 10.1002/npr2.12320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/20/2023] Open
Abstract
AIM Although tramadol has been suggested to have a higher risk of producing hallucinations than other opioids, reports of musical hallucinations are extremely rare. CASE PRESENTATION A 72-year-old woman came to our department complaining of auditory hallucinations. She had been diagnosed with lumbar spinal canal stenosis associated with herniated and slipped disks. Due to persistent back pain, tramadol was started, and the dose was increased to 300 mg/day. The next day, she began to hear nursery rhymes, songs of the Ministry of Education, and folk songs. The musical auditory hallucinations disappeared with the use of antipsychotics and the discontinuation of tramadol. No relapse of musical auditory hallucinations was observed after the discontinuation of antipsychotics. CONCLUSION Based on the clinical course, we concluded that the auditory hallucinations were musical hallucinations induced by tramadol.
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Affiliation(s)
- Tatsu Hase
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Shigeki Yamaguchi
- Department of Anesthesia and Pain Medicine, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
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Marschall TM, van Dijk P, Kluk K, Koops S, Linszen MMJ, Griffiths TD, Toh WL, Malicka AN, Kovačić D, Mulert C, Sommer IEC, Ćurčić-Blake B. Hallucinations in Hearing Impairment: How Informed Are Clinicians? Schizophr Bull 2023; 49:S33-S40. [PMID: 36840541 PMCID: PMC9960039 DOI: 10.1093/schbul/sbac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND HYPOTHESIS Patients with hearing impairment (HI) may experience hearing sounds without external sources, ranging from random meaningless noises (tinnitus) to music and other auditory hallucinations (AHs) with meaningful qualities. To ensure appropriate assessment and management, clinicians need to be aware of these phenomena. However, sensory impairment studies have shown that such clinical awareness is low. STUDY DESIGN An online survey was conducted investigating awareness of AHs among clinicians and their opinions about these hallucinations. STUDY RESULTS In total, 125 clinicians (68.8% audiologists; 18.4% Ear-Nose-Throat [ENT] specialists) across 10 countries participated in the survey. The majority (96.8%) was at least slightly aware of AHs in HI. About 69.6% of participants reported encountering patients with AHs less than once every 6 months in their clinic. Awareness was significantly associated with clinicians' belief that patients feel anxious about their hallucinations (β = .018, t(118) = 2.47, P < .01), their belief that clinicians should be more aware of these hallucinations (β =.018, t(118) = 2.60, P < .01), and with confidence of clinicians in their skills to assess them (β = .017, t(118) = 2.63, P < .01). Clinicians felt underequipped to treat AHs (Median = 31; U = 1838; PFDRadj < .01). CONCLUSIONS Awareness of AHs among the surveyed clinicians was high. Yet, the low frequency of encounters with hallucinating patients and their belief in music as the most commonly perceived sound suggest unreported cases. Clinicians in this study expressed a lack of confidence regarding the assessment and treatment of AHs and welcome more information.
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Affiliation(s)
- Theresa M Marschall
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, The Netherlands
- Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands
| | - Pim van Dijk
- Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Karolina Kluk
- Manchester Centre for Audiology and Deafness, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Sanne Koops
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, The Netherlands
- Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands
| | - Mascha M J Linszen
- Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Timothy D Griffiths
- Newcastle University Medical School, Newcastle upon Tyne, UK
- Wellcome Trust Centre for Neuroimaging, University College London, London, UK
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Wei Lin Toh
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychiatry, Alfred Health, Melbourne, Victoria, Australia
| | - Alicja N Malicka
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Damir Kovačić
- Faculty of Science, Department of Physics, Laboratory for Biophysics and Medical Neuroelectronics, University of Split, Split, Croatia
- The Center of Research Excellence for Science and Technology Integrating Mediterranean region (STIM), University of Split, Split, Croatia
| | - Christoph Mulert
- Center of Psychiatry, Justus-Liebig University, Giessen, Germany
| | - Iris E C Sommer
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, The Netherlands
- Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands
| | - Branislava Ćurčić-Blake
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, The Netherlands
- Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands
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A Case Report of Auditory Release Hallucinations in a Patient with Major Depression. J Acad Consult Liaison Psychiatry 2022; 63:408-410. [DOI: 10.1016/j.jaclp.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 11/23/2022]
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[Musical hallucinations in a 92-year-old woman with hearing impairment and social isolation in context of the corona pandemic]. DER NERVENARZT 2022; 93:1167-1169. [PMID: 36102928 PMCID: PMC9630227 DOI: 10.1007/s00115-022-01379-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 10/14/2022]
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10
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Canas-Simião H, Nascimento ST, Reis J, Freitas C. Complex auditory musical hallucinations with ambivalent feelings. BMJ Case Rep 2021; 14:e245397. [PMID: 34764093 PMCID: PMC8587600 DOI: 10.1136/bcr-2021-245397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/03/2022] Open
Abstract
A 78-year-old woman with hypertension, diabetes mellitus type 2 and bilateral sensorineural hearing loss was referenced to geriatric psychiatry consultation. She presented cognitive dysfunction, erotomanic delusion and complex musical hallucinations (MH), described as hearing her neighbour singing a familiar church song along with bells in the background, making comments and talking to her. A computed tomography (CT) of the brain detected small right nucleocapsular and bilateral external capsules hypodensities of presumed vascular aetiology during hospitalisation. MH are a rare phenomenon with heterogeneous aetiology. Most frequently, the cause is hearing impairment; other causes include social isolation, cognitive dysfunction, vascular risk factors and medication. Studies suggest that some brain areas related to musical memory circuitry might be related and not fully mapped. Auditory verbal hallucinations with a voice that either comments, talks or sings to the patient have never been described in the literature, making this clinical case attractive.
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Affiliation(s)
- Hugo Canas-Simião
- Department of Psychiatry, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| | | | - João Reis
- Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
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11
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Spontaneous brain activity underlying auditory hallucinations in the hearing-impaired. Cortex 2021; 136:1-13. [PMID: 33450598 DOI: 10.1016/j.cortex.2020.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/09/2020] [Accepted: 12/05/2020] [Indexed: 11/22/2022]
Abstract
Auditory hallucinations, the perception of a sound without a corresponding source, are common in people with hearing impairment. Two forms can be distinguished: simple (i.e., tinnitus) and complex hallucinations (speech and music). Little is known about the precise mechanisms underlying these types of hallucinations. Here we tested the assumption that spontaneous activity in the auditory pathways, following deafferentation, underlies these hallucinations and is related to their phenomenology. By extracting (fractional) Amplitude of Low Frequency Fluctuation [(f)ALFF] scores from resting state fMRI of 18 hearing impaired patients with complex hallucinations (voices or music), 18 hearing impaired patients with simple hallucinations (tinnitus or murmuring), and 20 controls with normal hearing, we investigated differences in spontaneous brain activity between these groups. Spontaneous activity in the anterior and posterior cingulate cortex of hearing-impaired groups was significantly higher than in the controls. The group with complex hallucinations showed elevated activity in the bilateral temporal cortex including Wernicke's area, while spontaneous activity of the group with simple hallucinations was mainly located in the cerebellum. These results suggest a decrease in error monitoring in both hearing-impaired groups. Spontaneous activity of language-related areas only in complex hallucinations suggests that the manifestation of the spontaneous activity represents the phenomenology of the hallucination. The link between cerebellar activity and simple hallucinations, such as tinnitus, is new and may have consequences for treatment.
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Abstract
have been reported in association with psychiatric diseases, brain stem strokes, deafness, degenerative diseases, intoxications, pharmacologic agents, and epilepsy. We present a patient who in the absence of these disorders developed musical hallucinations from an infarction of the right hemisphere that primarily injured his right frontal and anterior temporal lobes. This report discusses some of the possible mechanisms for this patient's presentation. Although the mechanism of his musical hallucinations remains unclear, recognition of this uncommon syndrome is important when structuring rehabilitation and management for patients with stroke who have this disorder.
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Affiliation(s)
- Natalie Buchwald
- Department of Neurology, University of Florida , Gainesville, Fl, USA
| | - Adam Kelly
- Department of Neurology, University of Rochester , Rochester, New York, USA
| | - Kenneth M Heilman
- Distinguished Professor Emeritus, Department of Neurology, University of Florida College of Medicine & Neurologist-Geriatric Research, Education, and Clinical Center Malcom Randall Veterans Affairs Medical Center , Gainesville, Florida, USA
| | - Alexis N Simpkins
- Vascular Neurology, Department of Neurology, University of Florida Gainesville, USA
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Zein M, Sher Y. Musical Memories-Musical Hallucinations in a Lung Transplant Recipient: Case Report and Literature Review. J Acad Consult Liaison Psychiatry 2020; 62:140-149. [PMID: 32977990 DOI: 10.1016/j.psym.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Mira Zein
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
| | - Yelizaveta Sher
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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14
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Abstract
PURPOSE OF REVIEW The association between hallucinations and sensory loss, especially vision- and hearing-impairment, has been firmly established over the past years. The deafferentation theory, a decrease of the threshold for activation in the brain and the consequential imbalance between excitatory and inhibitory brain networks, is hypothesized to underly this relationship. Here we review the studies investigating this theory with a focus on the most recent literature to better understand the contribution of sensory loss to hallucinations. RECENT FINDINGS A large cross-sectional study has recently confirmed the relationship between auditory impairment and deafferentation. However, the underlying mechanisms of deafferentation are still under debate, with hyperexcitability and deviations in bottom-up and top-down processes being the most likely explanations. Social isolation following sensory impairment increases the risk for hallucinations. Better knowledge and awareness about the contribution of deafferentation and loneliness would benefit diagnosis and treatment of hallucinations. SUMMARY Studies imply activity in higher order areas, corresponding to the functional mapping of sensory system, and a general state of higher excitability as neurobiological explanation. Auditory deafferentation, tinnitus and other auditory hallucinations, likely lie on a continuum. Social isolation mediates psychotic symptoms in sensory-impaired individuals. Currently, there is no standard treatment for deafferentation hallucinations.
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Shoham N, Lewis G, Hayes J, McManus S, Kiani R, Brugha T, Bebbington P, Cooper C. Psychotic symptoms and sensory impairment: Findings from the 2014 adult psychiatric morbidity survey. Schizophr Res 2020; 215:357-364. [PMID: 31481335 PMCID: PMC7613093 DOI: 10.1016/j.schres.2019.08.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/07/2019] [Accepted: 08/26/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE Hearing and visual impairment have been associated with psychosis. Mechanisms behind this are poorly understood. We tested whether i) self-reported hearing and visual impairments are associated with psychotic symptoms in the 2014 UK Adult Psychiatric Morbidity Survey; ii) the odds of having psychotic symptoms vary with self-perceived degree of impairments; and iii) reduced social functioning partially explains these associations. METHODS We analysed cross-sectional data using logistic regression. Hearing and visual impairment were the exposures, and screening positive on the Psychosis Screening Questionnaire was the outcome. We used structural equation modelling to assess mediation by social functioning, measured by the Social Functioning Questionnaire. RESULTS Psychotic symptoms were strongly associated with visual impairment (Adjusted Odds Ratio (AOR) 1.81, 95% Confidence Intervals (CI) 1.33 to 2.44), especially moderate visual impairment (AOR 2.75, 95% CI 1.78 to 4.24, p < .001). Psychotic symptoms were associated with a severe degree of hearing impairment (AOR 4.94, 95% CI 1.66 to 14.67, p = .004), and weakly associated with hearing impairment overall (AOR 1.50, 95% CI 1.10 to 2.04, p = .010). Social functioning accounted for approximately 50% of associations with both types of sensory impairment, but the confidence intervals around these estimates were broad. CONCLUSIONS Our findings suggest an association between psychosis and visual impairment, with the strongest evidence for moderate visual impairment; the findings also support a linear relationship between psychosis and degree of hearing impairment. Social functioning may mediate these relationships and be a potential target for intervention, alongside sensory correction. These should be investigated longitudinally.
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Affiliation(s)
- Natalie Shoham
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7BN, United Kingdom of Great Britain and Northern Ireland.
| | - Gemma Lewis
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7BN, United Kingdom of Great Britain and Northern Ireland
| | - Joseph Hayes
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7BN, United Kingdom of Great Britain and Northern Ireland
| | - Sally McManus
- NatCen Social Research, 35 Northampton Square, London EC1V 0AX, United Kingdom of Great Britain and Northern Ireland
| | - Reza Kiani
- University of Leicester, Centre for Medicine, University Road, Leicester LE1 7RH, United Kingdom of Great Britain and Northern Ireland
| | - Traolach Brugha
- University of Leicester, Centre for Medicine, University Road, Leicester LE1 7RH, United Kingdom of Great Britain and Northern Ireland
| | - Paul Bebbington
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7BN, United Kingdom of Great Britain and Northern Ireland
| | - Claudia Cooper
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7BN, United Kingdom of Great Britain and Northern Ireland
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Transient Musical Hallucinations in a Young Adult Male Associated with Alcohol Withdrawal. Case Rep Psychiatry 2019; 2019:6546451. [PMID: 31781460 PMCID: PMC6875172 DOI: 10.1155/2019/6546451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/11/2019] [Indexed: 11/17/2022] Open
Abstract
We present the case of a 25-year-old male who presented to A&E with isolated musical hallucinations, in the absence of audiological or neurological disease. The patient had a history of recreational drug use and a family history of psychosis. Hallucinations, which were preceded by discontinuation of alcohol and reinitiation of citalopram for depression, resolved spontaneously after three days. Aetiological factors are discussed alongside the existing literature. Whilst the underlying mechanisms underpinning musical hallucinations remain elusive, the case illustrates the potential role of alcohol withdrawal, serotonin toxicity, recreational drug use, and genetic vulnerability.
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17
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Abstract
Psychotic and compulsive symptoms in Parkinson disease are highly prevalent and associated with poor outcomes and greater caregiver burden. When acute, delirium should be ruled out or treated accordingly. When chronic, comorbid systemic illnesses, dementia, and psychiatric disorders should be considered. Reduction and discontinuation of anticholinergics, amantadine, dopamine agonists, and levodopa as tolerated, as well as adjunctive clozapine or quetiapine are frequently effective to manage Parkinson disease psychosis. Pimavanserin appears effective but is not widely available, and more experience is needed. Dopamine agonist discontinuation is usually successful for impulse control disorders, but requires frequent monitoring, documentation, and caregiver involvement.
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18
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Song CI, Jung YE. Musical Hallucination Caused by Ceftazidime in a Woman with a Hearing Impairment. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2019; 17:326-328. [PMID: 30905135 PMCID: PMC6478083 DOI: 10.9758/cpn.2019.17.2.326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 06/09/2023]
Abstract
Musical hallucinations remain a poorly understood clinical phenomenon, possibly because these types of hallucination have multiple causes and are rarely the focus of published reports. Here, the case of a 51-year-old female patient with a hearing impairment who developed musical hallucinations during treatment with ceftazidime, a third-generation cephalosporin, is presented. She responded to the discontinuation of ceftazidime and the initiation of low-dose olanzapine treatment. Musical hallucinations associated with ceftazidime are very rare, and the mechanisms underlying its occurrence remain unknown. Further studies will be necessary to determine the pathophysiology of adverse psychiatric reactions associated with ceftazidime.
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Affiliation(s)
- Chan Il Song
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul,
Korea
| | - Young-Eun Jung
- Department of Psychiatry, Jeju National University School of Medicine, Jeju,
Korea
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19
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Coebergh JAF, Lauw RF, Sommer IEC, Blom JD. Musical hallucinations and their relation with epilepsy. J Neurol 2019; 266:1501-1515. [PMID: 30972497 PMCID: PMC6517562 DOI: 10.1007/s00415-019-09289-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 02/05/2023]
Abstract
Musical hallucinations are poorly understood phenomena. Their relation with epilepsy was first described over a century ago, but never systematically explored. We, therefore, reviewed the literature, and assessed all descriptions of musical hallucinations attributed to epileptic activity. Our search yielded 191 articles, which together describe 983 unique patients, with 24 detailed descriptions of musical hallucinations related to epilepsy. We also describe six of our own patients. Based on the phenomenological descriptions and neurophysiological data, we distinguish four subgroups of epilepsy-related musical hallucination, comprising auras/ictal, inter-ictal and post-ictal phenomena, and phenomena related to brain stimulation. The case descriptions suggest that musical hallucinations in epilepsy can be conceptualised as lying on a continuum with other auditory hallucinations, including verbal auditory hallucinations, and—notably—tinnitus. To account for the underlying mechanism we propose a Bayesian model involving top-down and bottom-up prediction errors within the auditory network that incorporates findings from EEG and MEG studies. An analysis of phenomenological characteristics, pharmacological triggers, and treatment effects suggests wider ramifications for understanding musical hallucinations. We, therefore, conclude that musical hallucinations in epilepsy open a window to understanding these phenomena in a variety of conditions.
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Affiliation(s)
- J A F Coebergh
- Department of Neurology, Haga Hospital, The Hague, The Netherlands.,Department of Neurology, Ashford and St. Peter's Hospital, Chertsey, UK.,Department of Neurology, St. George's Hospital NHS Foundation Trust, Tooting, London, England, UK
| | - R F Lauw
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - I E C Sommer
- Department of Psychiatry, University of Groningen, Groningen, The Netherlands
| | - J D Blom
- Parnassia Psychiatric Institute, The Hague, The Netherlands. .,Department of Psychiatry, University of Groningen, Groningen, The Netherlands. .,Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands.
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20
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Linszen MMJ, van Zanten GA, Teunisse RJ, Brouwer RM, Scheltens P, Sommer IE. Auditory hallucinations in adults with hearing impairment: a large prevalence study. Psychol Med 2019; 49:132-139. [PMID: 29554989 DOI: 10.1017/s0033291718000594] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Similar to visual hallucinations in visually impaired patients, auditory hallucinations are often suggested to occur in adults with hearing impairment. However, research on this association is limited. This observational, cross-sectional study tested whether auditory hallucinations are associated with hearing impairment, by assessing their prevalence in an adult population with various degrees of objectified hearing impairment. METHODS Hallucination presence was determined in 1007 subjects aged 18-92, who were referred for audiometric testing to the Department of ENT-Audiology, University Medical Center Utrecht, the Netherlands. The presence and severity of hearing impairment were calculated using mean air conduction thresholds from the most recent pure tone audiometry. RESULTS Out of 829 participants with hearing impairment, 16.2% (n = 134) had experienced auditory hallucinations in the past 4 weeks; significantly more than the non-impaired group [5.8%; n = 10/173; p < 0.001, odds ratio 3.2 (95% confidence interval 1.6-6.2)]. Prevalence of auditory hallucinations significantly increased with categorized severity of impairment, with rates up to 24% in the most profoundly impaired group (p < 0.001). The corrected odds of hallucination presence increased 1.02 times for each dB of impairment in the best ear. Auditory hallucinations mostly consisted of voices (51%), music (36%), and doorbells or telephones (24%). CONCLUSIONS Our findings reveal that auditory hallucinations are common among patients with hearing impairment, and increase with impairment severity. Although more research on potential confounding factors is necessary, clinicians should be aware of this phenomenon, by inquiring after hallucinations in hearing-impaired patients and, conversely, assessing hearing impairment in patients with auditory hallucinations, since it may be a treatable factor.
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Affiliation(s)
- M M J Linszen
- Department of Psychiatry and Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht University,Utrecht,The Netherlands
| | - G A van Zanten
- Department of Otorhinolaryngology and Head & Neck Surgery and Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht University,Utrecht,The Netherlands
| | - R J Teunisse
- Department of Geriatric Psychiatry,Dimence, Deventer,The Netherlands
| | - R M Brouwer
- Department of Psychiatry and Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht University,Utrecht,The Netherlands
| | - P Scheltens
- Alzheimer Center and Department of Neurology,Neuroscience Campus Amsterdam,VU University Medical Center,Amsterdam,The Netherlands
| | - I E Sommer
- Department of Psychiatry and Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht University,Utrecht,The Netherlands
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21
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Kitamura H, Saito M, Someya T. Two cases of musical hallucination successfully treated with quetiapine. Psychiatry Clin Neurosci 2017; 71:789. [PMID: 28853197 DOI: 10.1111/pcn.12564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 07/24/2017] [Accepted: 08/22/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Hideaki Kitamura
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Mami Saito
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshiyuki Someya
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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22
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Abstract
Musical hallucinations are uncommon phenomena characterized by intrusive and frequently distressful auditory musical percepts without an external source, often associated with hypoacusis, psychiatric illness, focal brain lesion, epilepsy, and intoxication/pharmacology. Their physiological basis is thought to involve diverse mechanisms, including "release" from normal sensory or inhibitory inputs as well as stimulation during seizures, or they can be produced by functional or structural disorders in diverse cortical and subcortical areas. The aim of this review is to further explore their pathophysiology, describing the functional neuroimaging findings regarding musical hallucinations. A literature search of the PubMed electronic database was conducted through to 29 December 2015. Search terms included "musical hallucinations" combined with the names of specific functional neuroimaging techniques. A total of 18 articles, all clinical case reports, providing data on 23 patients, comprised the set we reviewed. Diverse pathological processes and patient populations with musical hallucinations were included in the studies. Converging data from multiple studies suggest that the superior temporal sulcus is the most common site and that activation is the most common mechanism. Further neurobiological research is needed to clarify the pathophysiology of musical hallucinations.
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Robles Bayón A, Tirapu de Sagrario M, Gude Sampedro F. Auditory hallucinations in cognitive neurology. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2015.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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24
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Alvarez Perez P, Garcia-Antelo MJ, Rubio-Nazabal E. "Doctor, I Hear Music": A Brief Review About Musical Hallucinations. Open Neurol J 2017; 11:11-14. [PMID: 28567134 PMCID: PMC5420178 DOI: 10.2174/1874205x01711010011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/10/2017] [Accepted: 01/26/2017] [Indexed: 11/22/2022] Open
Abstract
Auditory hallucinations are defined as the abnormal perception of sound in the absence of an external auditory stimulus. Musical hallucinations constitute a complex type of auditory hallucination characterized by perception of melodies, music, or songs. Musical hallucinations are infrequent and have been described in 0.16% of a general hospital population. The auditory hallucinations are popularly associated with psychiatric disorders or degenerative neurological diseases but there may be other causes in which the patient evolves favorably with treatment. With this clinical case we want to stress the importance of knowing the causes of musical hallucinations due to the unpredictable social consequences that they can have.
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Affiliation(s)
| | - Maria Jose Garcia-Antelo
- Degree in Medicine and Surgery, Servicio de Neurología (Department of Neurology). Hospital Universitario A Coruña. A Coruña. Spain
| | - Eduardo Rubio-Nazabal
- Degree in Medicine and Surgery, Servicio de Neurología (Department of Neurology). Hospital Universitario A Coruña. A Coruña. Spain
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25
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Persistent Interictal Musical Hallucination in a Patient With Mesial Temporal Sclerosis-Related Epilepsy: First Case Report and Etiopathological Hypothesis. Cogn Behav Neurol 2017; 29:217-221. [PMID: 27984260 DOI: 10.1097/wnn.0000000000000111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Musical hallucination is a disorder of complex sound processing of instrumental music, songs, choirs, chants, etc. The underlying pathologies include moderate to severe acquired hearing loss (the auditory equivalent of Charles Bonnet syndrome), psychiatric illnesses (depression, schizophrenia), drug intoxication (benzodiazepines, salicylate, pentoxifylline, propranolol), traumatic lesions along the acoustic pathways, and epilepsy. The hallucinations are most likely to begin late in life; 70% of patients are women. Musical hallucination has no known specific therapy. Treating the underlying cause is the most effective approach; neuroleptic and antidepressant medications have only rarely succeeded.Musical hallucination in epilepsy typically presents as simple partial seizures originating in the lateral temporal cortex. To our knowledge, no formal report of musical hallucination in the interictal state has been published before. In contrast, other interictal psychotic features are a relatively common complication, especially in patients with long-standing drug-resistant epilepsy.We describe a 62-year-old woman with a long history of mesial temporal lobe epilepsy whose musical hallucination was solely interictal. We speculate on the possible link between temporal epilepsy and her hallucination. We hypothesize that, as a result of her epileptic activity-induced damage, an imbalance developed between the excitatory and inhibitory projections connecting the mesial temporal cortex to the other auditory structures. These structures may have generated hyperactivity in the lateral temporal cortex through a "release" mechanism that eventually resulted in musical hallucination.
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26
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Gandhi R, Narang P, Lippmann S. Are Musical and Auditory Hallucinations Related? PSYCHOSOMATICS 2016; 57:442-3. [PMID: 27283253 DOI: 10.1016/j.psym.2016.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/07/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Raghu Gandhi
- Psychiatry Residency Program, Hennepin County Medical Center, Minneapolis, MN
| | - Puneet Narang
- University of Minnesota, Minneapolis, MN; Regions Hospital, St. Paul, MN.
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Robles Bayón A, Tirapu de Sagrario MG, Gude Sampedro F. Auditory hallucinations in cognitive neurology. Neurologia 2016; 32:345-354. [PMID: 26968826 DOI: 10.1016/j.nrl.2015.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 12/15/2015] [Accepted: 12/16/2015] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Different types and localisations of neurological lesions can produce tinnitus and verbal or musical hallucinations (VMH). METHOD These symptoms were screened for in 1,000 outpatients at a cognitive neurology clinic, and epidemiological and neuroimaging data were recorded. RESULTS Tinnitus was present in 6.9% of the total and VMH in 0.9%. The paracusia group was predominantly female but the difference was not statistically significant. Patients with tinnitus were younger and those with VMH were older than the rest of the sample (mean ages). Hearing loss was more prevalent in the paracusia group (difference was significant in VMH subgroup). There were no intergroup differences in the prevalence of psychotic and obsessive-compulsive disorders, or of leukoaraiosis. Treatment with acetylsalicylic acid was more frequent in the VMH group, whereas other non-opioid analgesics and benzodiazepines were more commonly prescribed to patients with tinnitus. The suspected cause of VMH was dementia with Lewy bodies (n=2, one with vascular disease), Alzheimer disease (n=2, one with vascular disease), isolated cerebrovascular disease (n=3), traumatic brain injury (n=1), and surgical brainstem lesion (n=1). All VMH cases displayed an underlying factor that might prompt this symptom, eg, hearing loss (n=6), a predisposing drug (n=9), and polypharmacy (n=9). CONCLUSIONS Treatment with benzodiazepines and non-opioid analgesics was more frequent in the tinnitus group, whereas the VMH group showed a higher prevalence of hearing loss and treatment with acetylsalicylic acid. The causes of VMH were dementia with Lewy bodies, Alzheimer disease, and focal lesions in the mesencephalon, pons, left temporal lobe, or left claustrum.
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Affiliation(s)
- A Robles Bayón
- Unidad de Neurología Cognitiva, Hospital La Rosaleda, Santiago de Compostela, A Coruña, España.
| | | | - F Gude Sampedro
- Unidad de Epidemiología Clínica, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, España
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28
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Griffiths MD, Ortiz de Gortari AB. Commentary: Musical hallucinations: review of treatment effects. Front Psychol 2015; 6:1885. [PMID: 26696943 PMCID: PMC4673341 DOI: 10.3389/fpsyg.2015.01885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/22/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mark D Griffiths
- International Gaming Research Unit, Psychology Division, Nottingham Trent University Nottingham, UK
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