SEARCH

SEARCH BY CITATION

Keywords:

  • elderly;
  • musical hallucinosis;
  • psychosis

Abstract

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. CASE REPORTS
  5. DISCUSSION
  6. CONCLUSION
  7. REFERENCES

Abstract  Musical hallucinosis is a rare and poorly understood clinical phenomenon. While an association appears to exist between this phenomenon and organic brain pathology, aging and sensory impairment the precise association remains unclear. The authors present two cases of musical hallucinosis, both in elderly patients with mild–moderate cognitive impairment and mild–moderate hearing loss, who subsequently developed auditory hallucinations and in one case command hallucinations. The literature in reference to musical hallucinosis will be reviewed and a theory relating to the development of musical hallucinations will be proposed.


INTRODUCTION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. CASE REPORTS
  5. DISCUSSION
  6. CONCLUSION
  7. REFERENCES

Musical hallucinations are rarely seen in older patients and are accompanied by known risk factors including brain disease, sensory impairment and age. The relationship of musical hallucinations to auditory hallucinations has been poorly explored. We present two cases of patients who initially presented with musical hallucinations and later went on to develop auditory hallucinations and in one case command hallucinations. The literature with respect to musical hallucinosis will be reviewed and the relationship between auditory and musical hallucinations will be examined.

CASE REPORTS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. CASE REPORTS
  5. DISCUSSION
  6. CONCLUSION
  7. REFERENCES

Case 1

A 73-year-old right-handed Caucasian female presented for psychogeriatric assessment in September 2002 with a 1-year history of musical hallucinations and recent onset of auditory voice hallucinations. The only significant history included mild depressive symptoms, hypertension, right sensorineural hearing loss and the recent suicide of her husband. Mental status examination was significant for a Folstein score of 21/30 likely compromised by a language barrier. Investigations, including neuroimaging and blood work, were negative.

The patient was diagnosed with musical hallucinosis, major depressive disorder and mild cognitive impairment. Olanzapine 10 mg orally qhs was tried with good initial response but 2 months later auditory hallucinations became more intense and further trials of rispiridone and quetiapine were unsuccessful, necessitating an admission to hospital. Venlafaxine extended release 75 mg orally od was added to target depressive symptoms.

Case 2

A 68-year-old right-handed Caucasian female presented for psychogeriatric assessment in February 2002 with a 3-month history of musical hallucinations which had started to evolve into persecutory auditory hallucinations, and eventually command hallucinations. The only significant history included bilateral hearing loss, possibility of mental illness in the patient's mother and a question of delusional disorder relating to residual silicone left in the patient's body following a nasal procedure. Mental status examination was significant for a Folstein score of 24/30, and further neuropsychological assessment showed a pattern consistent with cortical dementia. Neuroimaging and blood work were negative.

The patient was diagnosed with musical hallucinosis, probable Alzheimer's disease, major depression and delusional disorder. Olanzapine 10 mg orally qhs was tried and was intitially successful, but then her hallucinations became more intense and a further trial of quetiapine was unsuccessful, necessitating an admission to hospital in early December. Citalopram 20 mg orally od and galantamine 12 mg orally bid were added to target depressive and cognitive symptoms with little effect.

DISCUSSION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. CASE REPORTS
  5. DISCUSSION
  6. CONCLUSION
  7. REFERENCES

Auditory perceptions in the absence of an auditory stimulus1 are hallucinations, and are classified as either elementary or complex. Elementary auditory hallucinations include tinnitus, whistles and buzzing, while complex involve music, voices or spoken words.2,3

Musical hallucinations are a subset of complex auditory hallucinations and generally refer to the hearing of tunes or melodies that may include harmonics, rhythms, and timbres.4

Hearing loss5–10 advanced age5,6,11–13 and brain disease11–20 seem to play a major role in the etiology of musical hallucinations but the relative importance of each factor remains unclear. Other possible contributing factors include female sex and social isolation.4 Auditory voice hallucinations, in contrast, tend to occur predominantly in illnesses such as schizophrenia, among young adults with no obvious brain disease or hearing loss. Musical hallucinations have been found to exist among patients with schizophrenia21,22 and to respond well to treatment with anitpsychotic agents, while occasional references have been made to patients with musical hallucinations developing voice hallucinations. A possible connection may be the common involvement of the temporal lobe which is connected to auditory brain centers as well as the temporo-limbic system. Further research is required.

In the cases discussed above, both patients were female, elderly, had sensorineural hearing loss, were socially isolated, and were mildly to moderately cognitively impaired. These findings are consistent with the literature thus far. What is interesting is that both patients had musical hallucinations that coexisted with auditory hallucinations and, in one case, with command hallucinations. Furthermore, the degree of insight and treatment response seemed to decline as the hallucinations changed to voices. This suggests a possible link between musical and auditory hallucinations in older patients in which musical hallucinations may evolve into more serious voice hallucinations over time. The mechanism of this, and the relationship of this phenomenon to the auditory voice hallucinations seen in illnesses such as schizophrenia, remains to be seen.

CONCLUSION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. CASE REPORTS
  5. DISCUSSION
  6. CONCLUSION
  7. REFERENCES

Musical hallucinosis is a rare disorder that is poorly understood. Review of the literature does appear to show some association with age, sensorineural hearing loss, female sex, organic brain damage and social isolation, although the relative importance of each factor is unclear. While the cases presented do appear to support findings in the literature, what is less clear is the relationship between auditory hallucinations and musical hallucinosis that coexisted in both patients. The authors suggest that in older patients musical hallucinations exist on a spectrum with auditory hallucinations, and that musical hallucinations over time may evolve into auditory voice hallucinations. Further research is required to clarify this poorly understood phenomenon.

REFERENCES

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. CASE REPORTS
  5. DISCUSSION
  6. CONCLUSION
  7. REFERENCES
  • 1
    Paquier P, Van Vugt P, Bal P et al. Transient musical hallucinosis of central origin: a review and clinical study. J. Neurol. Neurosurgery Psychiatry 1992; 55: 10691073.
  • 2
    Cambier H, Decroix JP, Masson C. Hallucinose auditive dans les lesions du tronc cerebral. Rev. Neurologie 1987; 143: 255262.
  • 3
    Cascino GD, Adams RD. Brainstem auditory hallucinosis. Neurology 1986; 36: 10421047.
  • 4
    Berrios GE. Musical hallucinations – a historical and clinical study. Br. J. Psychiatry 1990; 156: 188194.
  • 5
    Cole MG, Dowson L, Dendukuri N et al. The prevalence and phenomenology of auditory hallucinations among elderly subjects attending an audiology clinic. Int. J. Geriatric Psychiatry 2002; 17: 444452.
  • 6
    Gertz HJ, Gohringer K, Schimmelpfennig C. Successful carbamazepine therapy of 2 cases of music hallucinations. Nervenarzt 1996; 67: 387389 (in German).
  • 7
    Griffiths TD. Musical hallucinosis in acquired deafness. Phenomenology and brain substrate. Brain 2000; 123: 20652076.
  • 8
    Gordon AG. Do musical hallucinations always arise from the inner ear? Med. Hypotheses 1997; 49: 111122.
  • 9
    David RR, Fernandez HH. Quetiapine for hypnogogic musical release hallucinations. J. Geriatric Psychiatry Neurol. 2000; 13: 210211.
  • 10
    Tanriverdi N, Sayilgan MA, Ozcurumez G. Musical hallucinations associated with abruptly developed bilateral loss of hearing. Acta Psychiatrica Scand. 2001; 103: 153155.
  • 11
    Gadecki W, Ramsz-Walecka I, Tomczyszyn E. Case of musical hallucinosis. Psychiatria Polska 2002; 36: 449455 (in Polish).
  • 12
    Kasai K, Asada T, Yumoto M et al. Evidence for functional abnormality in the right auditory cortex during musical hallucinations. Lancet 1999; 354: 17031704.
  • 13
    Couper J. Unilateral musical hallucinations and all that jazz. Aust. NZ. J. Psychiatry 1994; 28: 516519.
  • 14
    Nagaratnam N, Virk S, Brdarevic O. Musical hallucinations associated with recurrence of a right occipital meningioma. Br. J. Clin. Prac. 1996; 50: 5657.
  • 15
    Stephane M, Hsu LK. Musical hallucinations: interplay of degenerative brain disease, psychosis, and culture in a Chinese woman. J. Nervous Mental Dis. 1996; 184: 5961.
  • 16
    Murata S, Naritomi H, Sawada T. Musical auditory hallucinations caused by a brainstem lesion. Neurology 1994; 44: 156158.
  • 17
    Douen AG, Bourque PR. Musical auditory hallucinosis from Listeria rhombencephalitis. Can. J. Neurol. Sci. 1997; 24: 7072.
  • 18
    Terao T, Tani Y. Carbamazepine treatment in a case of musical hallucinations with temporal lobe abnormalities. Aust. NZ. J. Psychiatry 1998; 32: 454456.
  • 19
    Cerrato P, Imperiale D, Giraudo M et al. Complex musical hallucinosis in a professional musician with a left subcortical haemorrhage. J. Neurol. Neurosurgery Psychiatry 2001; 71: 280281.
  • 20
    Schielke E, Reuter U, Hoffmann O et al. Musical hallucinations with dorsal pontine lesions. Neurology 2000; 55: 454455.
  • 21
    Saba PR, Keshavan MS. Musical hallucinations and musical imagery: prevalence and phenomenology in schizophrenic inpatients. Psychopathology 1997; 30: 185190.
  • 22
    Baba A, Hamada H. Musical hallucinations in schizophrenia. Psychopathology 1999; 32: 242251.