Music Hallucinations and Autonomic Nervous System Disorders

Q: Music Hallucinations and Autonomic Nervous System Disorders

Hello： Since I have not examined the patient, it is difficult to accurately respond to your specific questions regarding the case. <br>I can only provide a brief response regarding general conditions. <br><br>1. <br>If the medication (such as Sertraline) was effective in the past

Autonomic nervous system dysfunction, musical hallucinations?

A female elder in the household, approximately 60 years old, has been experiencing symptoms of depression and insomnia.
Four years ago, she sought treatment at a mental health clinic and was prescribed Cymbalta (duloxetine), Rifampicin, and Seroquel (quetiapine), which led to gradual improvement and a reduction in medication.
However, since April of this year, her symptoms have worsened again, presenting with insomnia, frequent urination, irregular bowel movements, dry mouth, poor appetite, and significant anxiety.
Starting in July, she began experiencing auditory hallucinations of music, feeling as though the music was coming from outside her ears, and it was not always music she enjoyed.
Even when listening to real music, she continued to hear it afterward.
The physician had previously prescribed Risperidone, which she took at a dosage of 0.3 ml daily for three months, but there was no improvement in the auditory hallucinations.
The outpatient physician believes that this symptom differs from typical auditory hallucinations (such as hearing voices) and suggested discontinuing the medication.

I would like to ask Dr.
Dai the following questions:
1.
Four years ago, Cymbalta was effective in improving her condition; why does it seem to have no effect now? (The elder is very resistant to changing medications due to the discomfort caused by side effects.)
2.
What is the difference between musical hallucinations and the auditory hallucinations associated with schizophrenia? Would not taking Risperidone or related medications have any impact?
3.
If Cymbalta and similar medications were effective, could the symptoms of musical hallucinations also be alleviated?

Guo, 60~69 year old female. Ask Date: 2017/10/27

Dr. Dai Wanxiang reply Psychiatry

Hello: Since I have not examined the patient, it is difficult to accurately respond to your specific questions regarding the case.
I can only provide a brief response regarding general conditions.

1.
If the medication (such as Sertraline) was effective in the past but is no longer effective, this is indeed a possibility, but there are many other factors to consider.
These include the potential presence of other physiological or psychiatric disorders, adherence to the medication regimen, whether the dosage is appropriate, and if the duration of use has been sufficient, among others.
2.
Schizophrenia can present with symptoms beyond auditory hallucinations, and one cannot solely rely on the nature of the hallucinations for diagnosis.
Severe depression, delirium, and dementia can also present with auditory hallucinations.
It is essential for the treating physician to clarify the diagnosis, and further tests may be necessary if needed.
When using antipsychotic medications such as Risperidone, it is important to consider the underlying causes of the hallucinations to determine the necessity of treatment.
3.
If it is severe depression, the use of antidepressants can lead to improvement in the condition, and indeed, symptoms such as hallucinations may also alleviate.
It is advisable to have further discussions with the treating physician.
Wishing you well!

Reply Date: 2017/10/27

More Info

Understanding the relationship between music hallucinations and autonomic nervous system disorders requires a multifaceted approach, especially in the context of the symptoms presented by your elderly relative.
1. Why did the medication (Citalopram) that was effective four years ago seem to lose its efficacy now?
Citalopram, a selective serotonin reuptake inhibitor (SSRI), is commonly prescribed for depression and anxiety disorders. Over time, some individuals may experience a phenomenon known as "tolerance," where the body becomes accustomed to the medication, leading to diminished effects. Additionally, the underlying condition may have evolved or worsened, necessitating a reevaluation of the treatment plan. Factors such as changes in metabolism, interactions with other medications, or the emergence of new health issues can also contribute to this change in efficacy. It is crucial to consult with a psychiatrist to explore alternative medications or dosage adjustments that may better address her current symptoms.

2. What is the difference between music hallucinations and auditory hallucinations associated with schizophrenia?
Music hallucinations, often referred to as "musical hallucinations," involve the perception of music that is not present in the environment. This phenomenon can occur in various contexts, including neurological disorders, hearing loss, or as a side effect of certain medications. In contrast, auditory hallucinations associated with schizophrenia typically involve hearing voices or sounds that are not real and are often more complex and distressing. These hallucinations can be indicative of a severe mental health disorder. The distinction is essential, as the treatment approaches may differ. If music hallucinations are not accompanied by other psychotic symptoms, they may not require the same pharmacological interventions as those used for schizophrenia.

3. Will discontinuing medications like Risperidone affect her condition?
Risperidone is an atypical antipsychotic that may be prescribed for various conditions, including mood disorders and hallucinations. If the music hallucinations are not alleviated by this medication, it may be appropriate to discontinue it under medical supervision. However, stopping any psychiatric medication should be done cautiously and under the guidance of a healthcare professional to avoid withdrawal symptoms or exacerbation of underlying conditions.

4. Can Citalopram help alleviate music hallucinations?
While Citalopram primarily targets mood disorders, it may also have a positive effect on anxiety and stress, which can indirectly influence the perception of hallucinations. If the medication is effective in managing her anxiety and depressive symptoms, it might help reduce the distress associated with music hallucinations. However, it is essential to monitor her response closely and adjust the treatment plan as necessary.

In conclusion, the interplay between the autonomic nervous system and psychiatric symptoms is complex. Autonomic nervous system disorders can manifest through various physical symptoms, including sleep disturbances, anxiety, and gastrointestinal issues, which may exacerbate psychiatric conditions. It is crucial to approach treatment holistically, considering both pharmacological and non-pharmacological interventions, such as psychotherapy, lifestyle modifications, and possibly alternative therapies. Regular follow-ups with a psychiatrist or a multidisciplinary team can help ensure that your relative receives comprehensive care tailored to her evolving needs.

Similar Q&A

Understanding Auditory Hallucinations: When to Seek Help

Hello Doctor: Three days ago in the evening, I suddenly thought I heard the sound of a garbage truck, but since it was a time when no garbage trucks would be passing by, I realized I was probably experiencing auditory hallucinations. Since that incident, I have started to have th...

Dr. Lin Mianzhang reply Psychiatry
Hi there! The phenomenon you mentioned is known as "involuntary musical imagery," commonly referred to as an "earworm." This is actually a quite common occurrence, and most people have experienced it at some point. It is different from auditory hallucinations....

Understanding Mental Illness: Do Hallucinations Indicate a Psychiatric Condition?

Hello Doctor: 1. If there have been occurrences of auditory hallucinations in the brain, specifically related to images of past trauma, and I have consulted a neurologist who did not clarify whether medication from the neurology or psychiatry department is necessary, could you ...

Dr. Liang Sunyuan reply Psychiatry
Hello, the psychiatric symptoms are actually caused by an imbalance of neurotransmitters in the brain, so the appearance of these symptoms is fundamentally a phenomenon resulting from neurological dysregulation. Current pharmacological treatments aim to stabilize these dysregulat...

Unseen Voices: Seeking Help for Mysterious Neurological Symptoms

Explanation 1: Several years ago, a community experienced a collective onset of unusual symptoms, including difficulty concentrating, night sweats, tinnitus, dizziness, headaches, a sensation of an explosion in the brain, diarrhea, involuntary movements, rashes on the skin, invol...

Dr. Gao Chunde reply Neurology
It is recommended to seek treatment from a psychosomatic medicine specialist.

Am I Experiencing Auditory Hallucinations or Schizophrenia?

Hello, doctor. I have always been an outgoing person since childhood, considered an invincible source of happiness by my family and friends. I am always the life of the party during celebrations, farewells, and April Fool's Day. I had a passion for role-playing from a young ...

Dr. Zhang Zhehong reply Psychiatry
Hello: Your psychiatric symptoms may include auditory hallucinations, depression, and anxiety. 1. First, there are physiological issues; elevated liver enzymes and weight loss require prompt medical attention. Please consult an internist for evaluation and treatment of internal m...