Musical Hallucinations Successfully Treated with Antipsychotic Medications: Three Case Reports

Abstract

Many people have had the experience of a jingle or ditty that they are unable to get out of their head. For some, these perceptions worsen in intensity to become a hallucination. Musical hallucinations occur in individuals with and without mental illness. Compared with a song stuck in one’s head, they are distracting, less transient, and more life-like. The many case reports of musical hallucinations describe fragments of songs to entire musical scores, often melodies heard in childhood, particularly hymns and carols. The experience is ultimately disagreeable, ranges in severity, and can result in insomnia, paranoia, and social withdrawal. The exact prevalence of this condition is unknown, though estimates as high as 2.5% have been reported in older patients with hearing impairment. Both central and peripheral neurological dysfunction have been implicated as potential causes of musical hallucinations, though in most cases the etiology is likely multifactorial. Case reports about musical hallucinations comment on the relative lack of effectiveness of antipsychotics. We present three cases of musical hallucinations, all in patients with comorbid mental disorders, who experienced psychological distress or loss of reality testing as the hallucinations worsened. In all cases, the hallucinations completely resolved with antipsychotic treatment. Presentation of these cases was approved by the Institutional Review Board of the Portland Veterans Affairs Medical Center.