Musical hallucinations in a musician

The experience of music is difficult to study objectively. Here we describe a detailed analysis of musical hallucinations developing after a probable brainstem stroke in an 83 year old musician who was able to describe and notate the hallucinations. The hallucinations comprised simple, repetitive melodic and rhythmic motifs that were combined apparently randomly without definite tonality, large-scale structure, or timbre. This observation is consistent with the proposal that musical hallucinations represent abnormal spontaneous activity in auditory cortical areas beyond the primary auditory cortex. This activity may generate novel musical motifs.     

Musical hallucinations with a right frontotemporal stroke

ABSTRACT

Musical hallucinations

have been reported in association with psychiatric diseases, brain stem strokes, deafness, degenerative diseases, intoxications, pharmacologic agents, and epilepsy. We present a patient who in the absence of these disorders developed musical hallucinations from an infarction of the right hemisphere that primarily injured his right frontal and anterior temporal lobes. This report discusses some of the possible mechanisms for this patient’s presentation. Although the mechanism of his musical hallucinations remains unclear, recognition of this uncommon syndrome is important when structuring rehabilitation and management for patients with stroke who have this disorder.     

Musical hallucinations in hearing loss in the aged

An 83-year-old woman experienced the abrupt onset of musical hallucinations. She had had long-standing progressive hearing loss due to otosclerosis. The clinical, psychopathological and pathogenetic aspects of this syndrome are discussed by means of a review of the literature.     

Musical hallucinations induced by bromocriptine

A case of bromocriptine‐induced musical hallucinations in a 67‐year‐old patient with probable Lewy body dementia is reported. The patient was given bromocriptine for the treatment of parkinsonism. At a bromocriptine dosage of 7.5 mg, the patient complained, ‘I hear karaoke songs in the inner part of my head.’ The musical hallucinations gradually decreased after administration of the drug was discontinued. Bromocriptine is known to cause hallucinations, but not musical hallucinations. The dopaminergic effect of bromocriptine and the patient's cognitive impairment might have acted together to generate the musical hallucinations.     

Hallucination of soliloquy: speaking component and hearing component of schizophrenic hallucinations

In the present paper, two cases of schizophrenia with hallucinatory soliloquy are presented, and the concept of the symptom, hallucination of soliloquy is proposed. In hallucination of soliloquy, while having the experience of hearing his own voice, the patient has a conviction that he speaks out aloud, without actually vocalizing. It is an abnormal experience of both speaking and hearing; that is, a combination of auditory hallucination and motor hallucination. It is considered that hallucination of soliloquy is an exemplar of schizophrenic hallucinations.     

Musical hallucinations associated with acquired deafness.

Two patients with auditory hallucinations beginning after a long history of progressive bilateral hearing loss were studied. The hallucinations included both unformed (tinnitus and irregular sounds of varying pitch and timbre) and formed (instrumental music, singing and voices) components, and were repetitive. They were affected by ambient noise levels; their content and speed were influenced by attentional and intentional factors. There was no evidence of global dementia, nor of epileptogenic or psychiatric disturbance. A combination of peripheral and associated central "disinhibition" may be responsible for the occurrence of such hallucinations.     

Hymns and arias: musical hallucinations in older people in Wales

This is a phenomenological study of 30 consecutive referrals of older people with musical hallucinations concentrating on the names of the melodies heard. Hymns and Christmas carols were the most common experience with 'Abide with Me' particularly frequent.     

Reduced frontotemporal functional connectivity in schizophrenia associated with auditory hallucinations.

BACKGROUND: We used functional magnetic resonance imaging (fMRI) to investigate the frontotemporal disconnection hypothesis of schizophrenia. METHODS: Eight DSM-IV schizophrenia patients and 10 control subjects were studied with fMRI while they thought of the missing last word in 128 visually presented sentences. The fMRI data were analyzed comparing the effect of sentence completion (vs. rest) using a random effects analysis. RESULTS: There were no significant group differences in regional brain responses. Correlation coefficients between left temporal cortex (x = -54, y = -42, z = 3) and left dorsolateral prefrontal cortex (x = -39, y = 12, z = 24) were significantly lower in the schizophrenic group and were negatively correlated with the severity of auditory hallucinations. CONCLUSIONS: Previous demonstrations of hypofrontality in schizophrenia may reflect particular task requirements. Frontotemporal functional connectivity is reduced in schizophrenia and may be associated with auditory hallucinations.     

A case of vascular depression associated with musical hallucinations successfully treated with paroxetine and a low dose of risperidone

Herein, we report a case of an 83‐year‐old man with vascular depression associated with musical hallucinations. Brain magnetic resonance imaging disclosed diffuse brain atrophy with multiple higher‐density zones in the white matter and basal ganglia. Single photon emission computed tomography images showed areas of hypoperfusion in the bilateral temporal lobe and basal ganglia. Combination treatment with paroxetine and a low dose of risperidone rapidly improved both the depressive symptoms and musical hallucinations.     

Phenomenology of hallucinations: a factor analytic approach

The present study was carried out with the aim of obtaining a factor analytic solution of parameters of hallucinations in schizophrenia. Seventy-five chronic hallucinating schizophrenic patients were assessed on the Phenomenology of Hallucinations Scale and Brief Psychiatric Rating Scale. A factor analytic solution was obtained by principal component analysis using varimax rotation. Two factors, 'reality of hallucinatory perception' and 'immersion in hallucination', were obtained. Findings are discussed in relation to existing literature.     

Prediction of activation patterns preceding hallucinations in patients with schizophrenia using machine learning with structured sparsity

Despite significant progress in the field, the detection of fMRI signal changes during hallucinatory events remains difficult and time‐consuming. This article first proposes a machine‐learning algorithm to automatically identify resting‐state fMRI periods that precede hallucinations versus periods that do not. When applied to whole‐brain fMRI data, state‐of‐the‐art classification methods, such as support vector machines (SVM), yield dense solutions that are difficult to interpret. We proposed to extend the existing sparse classification methods by taking the spatial structure of brain images into account with structured sparsity using the total variation penalty. Based on this approach, we obtained reliable classifying performances associated with interpretable predictive patterns, composed of two clearly identifiable clusters in speech‐related brain regions. The variation in transition‐to‐hallucination functional patterns not only from one patient to another but also from one occurrence to the next (e.g., also depending on the sensory modalities involved) appeared to be the major difficulty when developing effective classifiers. Consequently, second, this article aimed to characterize the variability within the prehallucination patterns using an extension of principal component analysis with spatial constraints. The principal components (PCs) and the associated basis patterns shed light on the intrinsic structures of the variability present in the dataset. Such results are promising in the scope of innovative fMRI‐guided therapy for drug‐resistant hallucinations, such as fMRI‐based neurofeedback.     

Effects of rivastigmine in patients with and without visual hallucinations in dementia associated with Parkinson's disease

We aimed to determine prospectively whether rivastigmine, an inhibitor of acetylcholinesterase and butyrylcholinesterase, provided benefits in patients with and without visual hallucinations in a population with dementia associated with Parkinson's disease (PDD). This was a 24‐week double‐blind placebo‐controlled study. Primary efficacy measures were the Alzheimer's Disease Assessment Scale cognitive subscale (ADAS‐cog) and Alzheimer's Disease Cooperative Study–Clinician's Global Impression of Change (ADCS‐CGIC). Secondary efficacy measures included activities of daily living, behavioral symptoms, and executive and attentional functions. Patients were stratified according to the presence of visual hallucinations at baseline. The study included 188 visual hallucinators (118 on rivastigmine, 70 on placebo) and 348 nonvisual hallucinators (239 on rivastigmine, 109 on placebo). Rivastigmine provided benefits in both visual hallucinators and nonvisual hallucinators. Absolute responses to rivastigmine on the ADAS‐cog were comparable over 6 months, although rivastigmine–placebo differences tended to be larger in visual hallucinators (4.27; P = 0.002) than in nonhallucinators (2.09; P = 0.015). On the ADCS‐CGIC, differences between rivastigmine and placebo were 0.5 in visual hallucinators (P = 0.030) and 0.3 in nonhallucinators (P = 0.111). Rivastigmine provided benefits on all secondary efficacy measures, and placebo declines and treatment differences were more marked in visual hallucinators. Adverse events were reported more frequently by rivastigmine‐treated patients, although this difference was less marked in visual hallucinators. Visual hallucinations appear to predict more rapid decline and possibly greater therapeutic benefit from rivastigmine treatment in PDD. © 2006 Movement Disorder Society     

Chiari Type I malformation presenting with bilateral hearing loss

Chiari Type I malformations can present with several clinical signs and symptoms. We describe a 44-year-old female patient presenting with bilateral hearing loss with hydrocephalus coexisting with Chiari Type I malformation and a unilateral arachnoid cyst. Thus, sensorineural hearing loss may be caused by hydrocephalus with Chiari Type I malformation. The placement of a ventriculoperitoneal shunt without a posterior fossa decompression is an effective treatment.     

Cognitive triggers of auditory hallucinations: An experimental investigation

It has proved difficult to establish the internal process by which mental events are transformed into auditory hallucinations. The earlier stages of the generation of hallucinations may prove more accessible to research. Cognitions have been reported by patients as a trigger of auditory hallucinations, but the role of these preceding thoughts has not been causally determined. Therefore, the role of cognition in triggering auditory hallucinations was tested in an experimental study. Thirty individuals who experienced auditory hallucinations in social situations entered a neutral social situation presented using virtual reality. Participants randomised to the experimental condition were instructed to think their hallucination-preceding thoughts, and those randomised to the control condition were instructed to think neutral thoughts. Twenty-seven participants (93%) were able to spontaneously identify a cognition which preceded a hallucination. There was no difference between the experimental and control groups in the occurrence or severity of auditory hallucinations in virtual reality. Virtual reality did not lead to physical side effects or an increase in anxiety. The relationship between antecedent cognitions and auditory hallucinations is likely to be more complex than the one tested. It is argued that the effect of cognition on auditory hallucinations may be mediated by affect but this needs to be investigated through further experimental research.     

Donepezil in the treatment of musical hallucinations

Musical hallucinations (MH) typically occur among elderly individuals and are associated with hearing impairment. The authors describe a patient with features of typical MH who was successfully treated with donepezil, a cholinesterase inhibitor, as a combination therapy and who has not shown any subsequent cognitive decline for approximately 5 years. The efficacy of donepezil in this patient indicates that age-dependent dysfunction of cholinergic neurons might be related to the development of MH.