User:Emil.mathai/Musical hallucinations

Lead: Musical Hallucinations (also known as auditory hallucinations, auditory Charles Bonnet Syndrome, and Oliver Sacks' syndrome ) describes a neurological disorder in which the patient will hallucinate songs, tunes, instruments and melodies. Moreover, these hallucinations will be subjected only the the individual and they will assume the noise is coming from outside, but eventually they realize the origin of the sound comes from their head. The source of these hallucinations are derived from underlying psychotic illness or hearing impairment. These hallucinations are often rare and are followed by mental decline. Majority of patients who suffer from symptoms of Musical hallucinations are older and have onset conditions predisposing them to the disease. While there is no set form of treatment, research has discovered medications and alternative therapies to be successful in alleviating the hallucinations. (Emil's Contribution)

Description (In this section I talk about more cases)
For the case of an 84 year old widow who complained of hearing sounds, she described her symptoms as pleasant, but also sought for treatment because she felt distracted. The music that played over her head was similar to the hymns and songs sung at her own wedding. Moreover, had been widowed for a while and had no signs of psychiatric disorders. However, she did suffer from hypertension, hyperthyroidism, and osteoporosis. From these diagnosis it was theorized that the distress from the illnesses manifested the hallucinations. Through further analysis, researchers found that due the unexpected origin of the hallucinations, there is no clear diagnosis or treatments to carry out.

Another case, which studies a 74-year-old woman, described her symptoms as music that would play in short verses of patriotic and children's songs. These symptoms would occur when the patient was alone and much more frequently when driving. Researchers suspected her hearing loss as a factor for developing the hallucinations. Moreover, through further analysis the patient had a medical history of hypertension, hyperlipidemia, and atrial fibrillations.

Often times, cases are commonly found in the elderly, but a 29 year-old female reported hearing music for one week. Prior to her hallucinations, the patient had undergone surgery for intraventricular and intracranial hemorrhages, following her recover, she mentioned the onset of hallucinations followed by headaches. Through scans, doctors found no neurological impairments, but prescribed her with medication. For her, the symptoms only lasted a year due to the treatment of quetiapine, which she responded well to.

Causes
Musical hallucinations can occur in people who are physically and mentally healthy, and for them, there is no known cause. Most people find their musical hallucinations obtrusive, and wish to be rid of them, while others welcome them. In addition, investigators have pointed to factors that are associated with musical hallucinations. Evers and Ellgers compiled a significant portion of musical hallucination articles, case studies etc. and were able to categorize five major etiologies:


 * Hypoacusis
 * Psychiatric disorders
 * Focal brain lesion
 * Epilepsy
 * Intoxication

Hypoacusis
Hypoacusis is defined as impairment in hearing or deafness. Hypoacusis is one of five etiologies of musical hallucinations, and is the most common in the case studies reviewed by Evers and Ellgers. According to Sanchez et al. 2011, there have been suggestions that pontine lesions could alter the central auditory system's function causing hypoacusis and musical hallucinations.

Psychiatric disorders
A case study by Janakiraman et al. 2006, revealed a 93‑year‑old woman with major depressive disorder who experienced musical hallucinations while treated with electroconvulsive therapy (ECT). Investigators found that the patient's depression symptoms were inversely related to her hallucinations and primarily stemmed from the ECT treatment. The patient had no known abnormalities in hearing, suggesting that musical hallucinations could arise from a variety of sources including psychiatric illnesses. After a complete course of ECT, her hallucinations dissipated, also suggesting that they can be acute.

According to Evers and Ellgers, some other major psychiatric disorders that contribute to musical hallucinations include schizophrenia and depression. Some patients who have schizophrenia experience musical hallucinations due to their ongoing psychosis, but there are some cases that do so without psychosis. There are also a very small percentage of musical hallucination cases due to obsessive-compulsive disorder (OCD).

Several different types of psychiatric disorders can be precursors for Musical Hallucinations. according to Blom and Coebergh, Bipolar Disorder and personality disorders can increase the chances of musical hallucinations. Likewise, cocaine dependence can elevate the symptoms.

Focal brain lesions[edit]
Among the handful of cases that Evers and Ellgers studied, major lesion sites included the temporal cortex; however, the specific location and laterality (left vs. right temporal cortex) was variable. Many cases of focal brain lesions had comorbidity with hearing impairment (see hypoacusis), epileptic activity and intoxication. There have also been several findings of acute musical hallucinations in patients with dorsal pons lesions post-stroke and encephalitis potentially due to disruption of connections between the sensory cortex and reticular formation. Also, any kind of traumatic lesion imposed on the brain can be a risk factor for Musical Hallucinations.

Epilepsy
Epileptic brain activity in musical hallucinations originates in the left or right temporal lobe. In a specific case studied by Williams et al. 2008, a patient who received a left temporal lobectomy in order to treat epilepsy was diagnosed with musical hallucinations post-surgery. The patient also had multiple additional risk factors that could have accounted for the hallucinations including mild neuropsychiatric dysfunction and tinnitus. The causation of hallucination through epilepsy is linked to seizure episodes. Through experiments, researchers have found that patients with epilepsy and hallucinations will respond to antiepileptics and surgery.

Intoxication
Intoxication accounts for a small percentage of musical hallucination cases. Intoxication leads to either withdrawal or inflammatory encephalopathy, which are major contributors to musical hallucinations. Some of the drugs that have been found to relate to musical hallucinations include salicylates, benzodiazepines, pentoxifylline, propranolol, clomipramine, amphetamine, quinine, imipramine, a phenothiazine, carbamazepine, marijuana, paracetamol, phenytoin, procaine, and alcohol. General anesthesia has also been associated with musical hallucinations. In a case study by Gondim et al. 2010, a seventy–seven-year-old woman with Parkinson's disease (PD) was administered amantadine after a year of various other antiparkinsonian treatments. Two days into her treatment, she started to experience musical hallucinations, which consisted of four musical pieces. The music persisted until three days after cessation of the drug. Although the patient was taking other medications at the same time, the timing of onset and offset suggested that amantadine either had a synergistic effect with the other drugs or simply caused the hallucinations. Although the case wasn't specific to intoxication, it leads to the idea that persons with PD who are treated with certain drugs can experience musical hallucinations.

Other Risk Factors (Emil's Contribution)
In summary, Musical Hallucinations is separated into five categories: Hyperacusis, Psychiatric disorders, Brain Lesions, Epilepsy, and substance abuse. However, certain factors can trigger hallucinations, these factors include, old age, social isolation and even gender. Many cases highlight female patients who suffer from the disease. Overall, psychiatric disorders and and neurological disease lead to hallucinations, but certain factors, such as age and gender play a role in heightening the causation.

Treatment[edit] (Emil's Contribution)
While there may not be a set form of treatment for patients. Many researchers have found that patients respond well to certain therapies and drugs. The presence of comorbidities in these diseases will cause confusion in the diagnosis of hallucinations. Many disease such as musical obsessions, mood swings, schizophrenia, and PTSD can create a differential diagnosis that prevents the patient from receiving the best treatment. To counteract the possibility of not being able to find treatment., healthcare providers push to educate their patients on psychoeducation and finding support groups to help alleviate the distress these symptoms cause for the patients and families.

Another, potential treatment for hallucinations is donepezil. Researchers found that patients respond well to the drug. The main use of the drug is to treat dementia in patients, but is primarily a cholinesterase inhibitor. The goal of this medication is provide patients with a better quality of life. This includes inhibiting the loss of function or improving the ability to think. For patients of Musial Hallucinations, the medication keeps them more aware and stimulated to control the onset symptoms of hallucinations. Overall, with few adverse effects, research has found that donepezil is an effective and safe choice of treatment.