Musical hallucinations: review of treatment effects

Abstract

Background: Despite an increased scientific interest in musical hallucinations over the past 25 years, treatment protocols are still lacking. This may well be due to the fact that musical hallucinations have multiple causes, and that published cases are relatively rare.Objective: To review the effects of published treatment methods for musical hallucinations.Methods: A literature search yielded 175 articles discussing a total number of 516 cases, of which 147 articles discussed treatment in 276 individuals. We analyzed the treatment results in relation to the etiological factor considered responsible for the mediation of the musical hallucinations, i.e., idiopathic/hypoacusis, psychiatric disorder, brain lesion, and other pathology, epilepsy or intoxication/pharmacology.Results: Musical hallucinations can disappear without intervention. When hallucinations are bearable, patients can be reassured without any other treatment. However, in other patients musical hallucinations are so disturbing that treatment is indicated. Distinct etiological groups appear to respond differently to treatment. In the hypoacusis group, treating the hearing impairment can yield significant improvement and coping strategies (e.g., more acoustic stimulation) are frequently helpful. Pharmacological treatment methods can also be successful, with antidepressants being possibly more helpful than antiepileptics (which are still better than antipsychotics). The limited use of acetylcholinesterase inhibitors has looked promising. Musical hallucinations occurring as part of a psychiatric disorder tend to respond well to psychopharmacological treatments targeting the underlying disorder. Musical hallucinations experienced in the context of brain injuries and epilepsy tend to respond well to antiepileptics, but their natural course is often benign, irrespective of any pharmacological treatment. When intoxication/pharmacology is the main etiological factor, it is important to stop or switch the causative substance or medication.Conclusion: Treatments for musical hallucinations tend to yield favorable results when they target the main etiological factor of these phenomena. There is a need to establish the natural course of musical hallucinations, their response to non-pharmacological treatments, and their effects on the patient's quality of life. There is also a need to standardize the assessment of treatment responses, and document long-term follow up.

Musical hallucinations: a brief review of functional neuroimaging findings

“…4 The physiological basis for MHs involves diverse mechanisms, including "release" from normal sensory or inhibitory inputs as well as stimulation during seizures. 5 Functional or structural disorders in diverse cortical and subcortical areas can produce MHs. 6 However, in some cases, neither a localized lesion nor a functional disorder can be identified.…”

Two cases of musical hallucination successfully treated with quetiapine

“…Older women with auditory difficulties also report hearing familiar songs. Despite a view of limited therapeutic effects of antipsychotics for this condition, two patients with MH, reported herein, were successfully treated with quetiapine. The patients gave informed consent to publish this letter and their anonymity has been preserved.…”

Musical Hallucinations Treated with Atypical Antipsychotics in a Geriatric Population – A Case Series

“…As previously mentioned, the study performed by Coebergh et al stratified subgroups of patients based on medical and psychiatric illness and postulated that in the psychiatric groups it appeared that the type of disorder was the most important guide as to the choice of treatment. 12 In our cases the most closely associated symptom was psychosis, thereby the choice to utilize atypical antipsychotics was made for this reason.…”

“…Their findings showed that while the two previously mentioned classes of medications do have higher efficacy than most, other classes such as antipsychotics may be more beneficial in patients exhibiting acute psychotic symptoms. 12 Our study builds on the current literature by presenting two complex patients who were successfully treated with aripiprazole and quetiapine for this reason.…”