Musical obsessions: a case report and review of literature.

The phenomenon of musical obsessions is scantly researched and poorly established. Here we present a case with musical obsessions in addition to body dysmorphophia and severe depression and review the available literature for musical obsessions.

INTRODUCTION

Musical obsessions are miscellaneous obsessions, explained by patients as repeated, intrusion of musical sounds/tunes or songs in the mind which are anxiety provoking, difficult to suppress or get rid.[12] However, this phenomenon has been very infrequently described in the literature.[123456789] Here, we report the case of a young male who presented with severe distressing musical obsessions and review the existing literature about musical obsessions.

CASE REPORT

Mr. X, 20-year-old male patient, with pre-morbid anxious personality traits presented with an insidious onset illness of 1 year duration characterized by hearing music in his head. On exploration patients explained that, whenever he would attempt to concentrate in studies or try to do any activity requiring focused attention and concentration, he would have repeated intrusion of the melodies of recently heard songs. The songs/melodies would be of a particular singer with some sensual content in their lyrics or videos. The songs/lyrics/melodies ran in his mind against his wish, attempts to resist would evoke anxiety. This would occur repeatedly in the day for about 5-10 min at each occasion or shorter if he succeeded to distract; would end-up wasting about 1-2 h daily battling with this symptom. Over the period these symptoms kept on increasing and would occur anytime of the day and led to marked dysfunction and influenced his performance in the examinations. After 2-3 months of onset of these symptoms, he started remaining sad; his interaction with the family members reduced and preferred to sit alone in his room. His sleep was also disturbed with difficulty in initiation of sleep; appetite reduced and developed ideas of worthlessness. Over the period of next 2-3 months, with the onset of depressive symptoms, the intensity, frequency and duration of the hearing music increased. He once tried to end his life by strangulating himself but could not complete the act. He was seen by a psychiatrist after 1 year of onset of symptoms, was prescribed tablet desvenlafaxine 50 mg OD with which patient perceived 20-25% improvement in symptoms over the period of 8 weeks. Due to lack of further improvement, patient came to our hospital.

On the basis of available information a diagnosis of obsessive compulsive disorder and severe depression without psychotic symptoms was considered. He was managed with tablet escitalopram 10-15 mg/day. Additionally behavior therapy in the form thought stopping was done. Over the period of 6 weeks, patient achieved remission of his depressive symptoms. His musical obsessions also reduced significantly. However, 4 months later, due to pressure of examination his symptoms of musical obsessions worsened and resultantly dose of tablet escitalopram was increased to 30 mg/day and thought stopping was supervised. With the above over the period of 12 weeks he achieved remission.

DISCUSSION

At times it becomes very difficult to interpret the phenomenon of hearing music from the patients descriptions and thus to label them as obsession, hallucination or illusions. In hallucinations, patients usually report hearing the voices or sounds in the ear and often attribute it some external agency. Palinacousis, described as persistent/recurring paroxysmal auditory illusions is understood as a phenomenon in which environmentally produced auditory perceptions persist or recur in form of exact replicas or fragmented sounds after the initial stimulus has ended.[1011]

A review of literature suggests that there are eight case reports/case series describing 12 cases with musical obsessions, details of which are shown in Table 1. The review of case reports of musical obsessions suggest it to be more frequently described in males who has some inclination toward music or young students undergoing through the stress of examinations. It was the only obsessive phenomenon present in 7 of 12 described cases in the literature.[12479] Co-morbidity with depressive disorders is common in patients with musical obsessions.[126] Literature also suggests many patients with musical obsessions are bothered by a single song/tune/jingle.[345] One of the patient developed musical obsessions after suffering from sore throat and another after head trauma.[24] With regards to treatment, literature suggests that patients with musical obsessions respond well to clomipramine.

Table 1

Review of case reports of musical obsessions

Our case adds to the limited existing literature on musical obsessions which was the presenting symptom in the index patient. The phenomenon of musical obsessions has been shown to be distressing to the patient but it had not received much attention from the clinicians and researchers. Further studies are required to establish this phenomenon and delineate it from other closely related entities.