Musical Hallucinations Treated with Atypical Antipsychotics in a Geriatric Population – A Case Series

Musical hallucinations have been likened to the auditory equivalent of Charles Bonnet Syndrome, which involves complex visual hallucinations, most often in the context of visual impairment. Musical hallucination frequently take the form of hymns, carols, and show-tunes and are strongly associated with hearing loss, with some studies suggesting a prevalence of 2.5–3.6% in the hearing impaired. Musical hallucinations are typically treated with anticonvulsant and anticholinesterase medications, with some studies having evaluated the efficacy of sedative hypnotics, antipsychotics and antidepressants in various psychiatric and medical subpopulations suggesting a heterogeneous spectrum of causes for this disorder. We present two cases of musical hallucinations in both a 70-year-old African American female with past psychiatric history of major depressive disorder who developed hymnal auditory hallucinations during an acute medical and psychiatric admission and an 86-year-old Caucasian female, who complained of hearing gospel music with eventual onset of visual hallucinations after a fall at age 80. Our patients were successfully treated in both the inpatient and outpatient settings with atypical antipsychotics. The presented cases add to the paucity of literature regarding utilization of atypical antipsychotics for treatment of musical hallucinations and demonstrate efficacy to this effect. This study lends further validity to the use of psychopharmacologic agents for novel purposes that have yet to be fully explored.