Musical Hallucinations in Schizophrenia

Abstract

There have been many reports of musical hallucinations in deafness, organic brain disease and epilepsy, but few reports of their occurrence in schizophrenia. Musical hallucinations tend to be regarded as specific manifestations of deafness and organic brain disease rather than of schizophrenia. However, since schizophrenic musical hallucinations are less distressing to schizophrenic patients than verbal hallucinations and psychiatrists have little interest in them, they may be missed. We treated schizophrenic patients who experienced musical hallucinations and traced the symptomatic changes. They exhibited semeiological changes similar to the changes in verbal hallucinations. Musical hallucinations are clearly a symptom of schizophrenia. By reporting these cases, we encourage concern about this symptom, which may be missed when psychiatrists interview patients.

The clinical spectrum of musical hallucinations

“…We excluded musical pseudohallucinations in schizophrenia [72] but included 31 cases describing psychiatric patients suffering from purely musical hallucinations, but not from productive psychosis, in which the psychiatric disease can be assumed as the main cause of this perception, 19 of these cases were new ones [28,32,34,36,56,59,60,[73][74][75][76][77][78][79][80], another 12 had been already described by Keshavan et al [2,12,51,54,55]. In 16 further cases, we found psychiatric disorders as a concomitant factor [2,12,30,33,34,39,40,42,44,50,70,81,82].…”

“…Much more often, the musical hallucinations are considered as frightening and negative rather than pleasant or just positive or neutral. In schizophrenic patients, psychotic music perception often occurs as pseudohallucinations originating in memory representations [72]. These cases were not considered in this review.…”

“…Except one patient being connoisseur of music and composer [8] and another professional musician [89], all the others were reported not to be of extraordinary musical skills. In detail, they were reported not to be musical [27], having little musical training in life [96], playing the piano [75], enjoying listening to music but cannot read music or play a musical instrument [35], playing the piano in former days and nowadays listening to music [59], singing in a choir and singing in an immaculate way [28]. Interestingly, in the connoisseur of music it was a left-sided infarction causing the musical hallucinations.…”

“…Roberts et al [93] described the case of a 61-year-old woman in whom musical hallucinations disappeared after clipping of two small aneurysms. In depressed people or patients suffering from schizophrenia, antidepressive or neuroleptic medication sometimes cured the hallucinations [9,33,70,75,79,82]; even electroconvulsive therapy seemed to help in a distinct case [73]. In a few cases, treatment with fluvoxamine [39], clomipramine [80], olanzapine [40], quetiapine [38], carbamazepine [34,39,60,74], or valproate [63], the latter two drugs not given for epilepsy or mood-altering, was successful.…”

Is hemispheric language dominance relevant in musical hallucinations?

“…It is most commonly seen in subjects with moderate or severe acquired loss of hearing ability or deafness, and as such it may represent an auditory analogon of the Charles Bonnet syndrome (Griffiths 2000). Furthermore, it can be found as a manifestation of epilepsy, in particular in patients showing abnormal EEG pattern in temporal brain areas (Keshavan et al 1992), and as a concomitant phenomenon in psychiatric illnesses such as severe depression or schizophrenia (Keshavan et al 1992, Aizenberg et al 1986, Baba and Hamada 1999. Focal brain lesions (Gordon 1997), in particular those involving the temporal cortex (Erkwoh et al 1992), general brain atrophy (Aizenberg et al 1986, Gilchrist andKalucy 1983), and toxic states (Allen 1985) are further conditions found to be linked with musical hallucinations (for review see Berrios 1990and 1991, Keshavan et al 1992.…”