Musical Hallucinations

Abstract

Hallucinations may occur in any sensory modality. Auditory hallucinations, usually ascribed to psychiatric illness, take various forms including the perception of voices, cries, noises, or rarely, music. Formed musical hallucinations, (ie, the perception of either vocal or instrumental melodies), reported in the English literature to date have typically been associated with marked hearing loss, advanced age (average 67.8 years), female sex (71%), lack of response to treatment, and general lack of associated psychopathology. We have collected data on seven additional patients with musical hallucinations. The average age of these patients was 72.9 years; all were women. Six had significant hearing problems. All reported onset of musical hallucinations after the age of 60. Interestingly, all seven had major psychiatric illnesses. Four had major depression, two had late-onset schizophrenia, and one had multi-infarct dementia. Of the five who had CT scans, one was normal and the rest demonstrated varying degrees of brain pathology. Neuroleptics were used with varying results in three cases; antidepressants were used in two depressed patients and were temporally related to the onset of musical hallucinations in one patient. Electroconvulsive therapy (ECT) was very effective in treating depression and musical hallucinations in the three patients for whom it was used, usually providing relief from hallucinations after only two treatments. Our collection of cases demonstrates that musical hallucinations can occur in association with psychiatric illness, and perhaps unlike the hallucinations associated with isolated hearing loss, may respond to conventional treatments for the underlying psychiatric disorder. Hearing loss is neither a necessary nor sufficient condition for the occurrence of musical hallucinations.

Musical hallucinations and their relation with epilepsy

“…In three women, it was administered after the failure of antidepressants. In each case it was highly successful, with one of them leading to remission of the musical hallucinations after as few as two treatments [13].…”

“…In another study, three out of 16 individuals with musical hallucinations (17.6%) had changes in the EEG (two with epileptiform activity in the left temporal region or in the midline/bilateral parasagittal region, and one with slow waves at the posterior temporal/left occipital regions), even though none of them exhibited symptoms of epileptic seizures [12]. A final example stems from Wengel et al [13] who noted that three out of their five patients with musical hallucinations showed temporal-lobe abnormalities on the EEG (one slow, one sharp-wave, and one alpha and theta transients).…”

Musical hallucinations: review of treatment effects

“…We then excluded all reports of musical illusions, pseudohallucinations, palinacusis, hypnagogic or hypnopompic hallucinations, and obsessions (i.e., “earworms”); only rarely did our interpretation of obsession vs. hallucination (i.e., “earworm” vs. MH) differ from that of the original authors (e.g., Islam et al, 2014). A total number of 276 cases in 147 articles met these inclusion criteria (Colman, 1894; Penfield and Erickson, 1941; David et al, 1944; Mulder and Daly, 1952; Rozanski and Rosen, 1952; Arieff and Brooks, 1958; Rennie, 1964; Ross et al, 1975; Scott, 1975, 1979; Schiffter and Straschill, 1977; Miller and Crosby, 1979; Raghuram et al, 1980; Wieser, 1980; Gilchrist and Kalucy, 1983; Hammeke et al, 1983; Mackworth-Young, 1983; Aizenberg et al, 1986, 1987, 1991; Jonas, 1986; Cambier et al, 1987; Lanska et al, 1987; Patel et al, 1987; Keshavan et al, 1988, 1992; Duncan et al, 1989; Fenton and McRae, 1989; Wengel et al, 1989; Berrios, 1990; McLoughlin, 1990; Donnet and Régis, 1991; Fisman, 1991; Nevins, 1991; Podoll et al, 1991; Shapiro et al, 1991; Vallada and Gentil, 1991; Wagner and Gertz, 1991; Freeland and O'Reilly, 1992; Klostermann et al, 1992; Paquier et al, 1992; Erkwoh et al, 1993; Feehan and Birchwood, 1993; Fénelon et al, 1993; Gilbert, 1993; Inzelberg et al, 1993; Isaacson et al, 1993; Couper, 1994; Hosty, 1994; Murata et al, 1994; Terao, 1995; Wodarz et al, 1995; Baurier and Tuca, 1996; Gertz et al, 1996; Stephane and Hsu, 1996; Douen and Bourque, 1997; Marneros et al, 1997; Thorpe, 1997; Clark, 1998; Fernandez and Crowther, 1998; Fukunishi et al, 1998b, 1999; Terao and Tani, 1998; Baba and Hamada, 1999; Terao and M...…”

“…Four patients improved spontaneously and two did not want any intervention even thought there were significantly bothered by their MH (Podoll et al, 1991; Keshavan et al, 1992). Treating the underlying psychiatric disorder with ECT was helpful for MH in five patients, but not in all (Wengel et al, 1989; Stephane and Hsu, 1996; Janakiraman et al, 2006) and sometimes the effect was temporary (Colon-Rivera and Oldham, 2014). …”

“…ECT can clearly be helpful in patients with severe depression and MH (Wengel et al, 1989; Stephane and Hsu, 1996; Janakiraman et al, 2006), albeit sometimes relief of MH is only brief (Colon-Rivera and Oldham, 2014). …”