Complex auditory musical hallucinations with ambivalent feelings

Abstract

A 78-year-old woman with hypertension, diabetes mellitus type 2 and bilateral sensorineural hearing loss was referenced to geriatric psychiatry consultation. She presented cognitive dysfunction, erotomanic delusion and complex musical hallucinations (MH), described as hearing her neighbour singing a familiar church song along with bells in the background, making comments and talking to her. A computed tomography (CT) of the brain detected small right nucleocapsular and bilateral external capsules hypodensities of presumed vascular aetiology during hospitalisation. MH are a rare phenomenon with heterogeneous aetiology. Most frequently, the cause is hearing impairment; other causes include social isolation, cognitive dysfunction, vascular risk factors and medication. Studies suggest that some brain areas related to musical memory circuitry might be related and not fully mapped. Auditory verbal hallucinations with a voice that either comments, talks or sings to the patient have never been described in the literature, making this clinical case attractive.

Musical hallucinations, secondary delusions, and lack of insight: results from a cohort study

“…This lack of insight may extend to their musical hallucinations, making it difficult for them to recognize these perceptions as hallucinatory in nature, and encouraging secondary delusions. This was also the case with two of the three patients mentioned in the introduction, who likewise reacted to their musical hallucinations with paranoid delusions ( 18 , 19 ). There are also published cases where neurodegenerative disorders such as Alzheimer’s disease and Lewy body dementia led up to a misattribution of the origin of musical hallucinations [e.g., ( 19 , 34 )].…”

“…For example, Bieler et al ( 16 ) described a 92-year-old cognitively intact woman with hearing impairment and musical hallucinations who called the police because “her neighbors refused to turn off the music.” The hallucinations disappeared after a plug of cerumen and wool had been removed from her right ear, and they were attributed to the auditory Charles Bonnet syndrome, a variant of musical hallucinosis due to hearing loss ( 17 ). Another published case involves a 78-year-old woman with hearing loss, cognitive dysfunction, erotomanic delusions, and complex musical hallucinations, who heard her neighbor singing a familiar church song that was interrupted by provocative and sexually laden comments ( 18 ). The authors diagnosed her with dementia with psychotic symptoms, which reduced slightly with a combined treatment with clozapine, zonisamide, donepezil, and memantine.…”

Music to the Ears: An Unusual Case of Frontal Lobe Stroke With Complex Auditory Hallucinations

“…The largest and most recent review of 393 cases of MH identified five categories of associated comorbid conditions: neurological, psychiatric, structural, drug effect, and not otherwise classifiable [ 4 ]. Some studies report MH in 0.16% of general psychiatric admissions and up to 2.5% of elderly patients with hearing impairment or other neurodegenerative disorders [ 3 , 5 , 7 ]. Over the years researchers have continued to study the prevalence of MH in order to better understand its epidemiology.…”

“…Characteristic features described by patients may shine a light on potential underlying causes of AH. Psychotic spectrum disorders, such as schizophrenia, more commonly present with auditory hallucinations that are verbal in nature [ 3 , 4 ]. Often referred to as “command” hallucinations with voices speaking in the second or third person.…”

“…Musical hallucinations (MH) represent a rare and complex subtype of auditory hallucination characterized by a false perception of melodies, songs, and music [ 5 ]. Musical hallucinations are often familiar to the patient; however, this is not always the case [ 3 ]. An in-depth understanding of etiologies resulting in AH has not quite been achieved.…”