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      Musical hallucinations: review of treatment effects

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          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.

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          Most cited references 149

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          The clinical spectrum of musical hallucinations.

          Musical hallucinations are a well known although rare phenomenon in neurological and psychiatric patients. Many case reports have been published to date. However, an accepted common theory on the classification and on the pathophysiology of musical hallucinations is still missing. We analysed all cases published to date, including two own cases, with respect to their demographic and clinical features and to the possible pathomechanisms underlying the hallucinations. In total, 132 cases could be analysed statistically and separated into five groups according to their aetiology (hypacusis; psychiatric disorder; focal brain lesion; epilepsy; intoxication). There was a female preponderance of 70% and a mean age of 61.5 years. Patients with focal brain lesions were significantly younger than the other groups, the hemisphere of the lesion did not play a major role. No systematic studies on treatment are available. However, anticonvulsant and antidepressive substances were reported to be effective most consistently. The pathophysiology of musical hallucinations is discussed considering the theories of deafferentiation including the concept of auditory Charles-Bonnet syndrome, of sensory auditory deprivation, of parasitic memory, and of spontaneous activity in a cognitive network module. In conclusion, musical hallucinations are a phenomenon with heterogeneous clinical and pathophysiological backgrounds.
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            Musical hallucinations. A historical and clinical study.

             G Berrios (1990)
            A sample of 46 subjects experiencing musical hallucinations was analysed - 10 new cases in addition to 36 culled from the literature. When compared with controls, it was found that musical hallucinations are far more common in females, and that age, deafness, and brain disease affecting the non-dominant hemisphere play an important role in their development. Psychiatric illness and personality factors were found to be unimportant.
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              Musical hallucinations: prevalence in psychotic and nonpsychotic outpatients.

              Musical hallucinations have been considered a rare manifestation of psychotic states or brain and hearing abnormalities. However, an obsessive-compulsive disorder (OCD) assessment tool refers to musical hallucinations and our preliminary study showed that about one third of OCD patients experienced musical hallucinations. To elucidate the lifetime prevalence of musical hallucinations among psychotic and nonpsychotic psychiatric outpatients. Lifetime experience of musical hallucinations was examined with a specially designed structured interview in 190 consecutive outpatients with diagnoses of anxiety, affective, and schizophrenia disorders. Musical hallucinations occurred in more than one fifth of all diagnoses. The prevalence of musical hallucinations was highest in OCD patients (41%). Musical hallucinations were significantly more frequent with more comorbid disorders, and logistic regression revealed that this finding was mainly due to OCD combined with either social phobia or schizophrenia. Musical hallucinations are more common among psychiatric patients than previously reported and are more suggestive of OCD than of other mental disorders.

                Author and article information

                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                16 June 2015
                : 6
                1Department of Neurology, Haga Hospital The Hague, Netherlands
                2Department of Neurology, Ashford/St. Peter's Hospital Chertsey, UK
                3Department of Neurology, St. George's Hospital London, UK
                4Parnassia Psychiatric Institute The Hague, Netherlands
                5‘S Heeren Loo Noordwijk, Netherlands
                6Department of Psychiatry, University Medical Center Utrecht Utrecht, Netherlands
                7Brain Centre Rudolf Magnus Utrecht, Netherlands
                8Department of Psychiatry, University of Groningen Groningen, Netherlands
                Author notes

                Edited by: Frank Larøi, University of Liege, Belgium

                Reviewed by: Tuomas Eerola, University of Durham, UK; Daniel Collerton, Northumberland, Tyne and Wear NHS Foundation Trust, UK

                *Correspondence: Jan A. F. Coebergh, Department of Neurology, Ashford/St. Peter's Hospital, Guildford Road KT17 0PZ Chertsey, UK jan.coebergh@

                This article was submitted to Psychopathology, a section of the journal Frontiers in Psychology

                Copyright © 2015 Coebergh, Lauw, Bots, Sommer and Blom.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 0, Tables: 4, Equations: 0, References: 158, Pages: 11, Words: 9700


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