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Complex auditory musical hallucinations with ambivalent feelings
  1. Hugo Canas-Simião1,
  2. Sandra Teles Nascimento2,
  3. João Reis2 and
  4. Carina Freitas3
  1. 1Department of Psychiatry, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
  2. 2Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
  3. 3SESARAM, Funchal, Portugal
  1. Correspondence to Dr Hugo Canas-Simião; hugo.simiao{at}


A 78-year-old woman with hypertension, diabetes mellitus type 2 and bilateral sensorineural hearing loss was referenced to geriatric psychiatry consultation. She presented cognitive dysfunction, erotomanic delusion and complex musical hallucinations (MH), described as hearing her neighbour singing a familiar church song along with bells in the background, making comments and talking to her. A computed tomography (CT) of the brain detected small right nucleocapsular and bilateral external capsules hypodensities of presumed vascular aetiology during hospitalisation. MH are a rare phenomenon with heterogeneous aetiology. Most frequently, the cause is hearing impairment; other causes include social isolation, cognitive dysfunction, vascular risk factors and medication. Studies suggest that some brain areas related to musical memory circuitry might be related and not fully mapped. Auditory verbal hallucinations with a voice that either comments, talks or sings to the patient have never been described in the literature, making this clinical case attractive.

  • psychiatry
  • medical management
  • neurology

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  • Contributors HC-S monitored data collection, analysed the data and drafted and revised the paper. STN analysed the data and revised the paper. JR provided data collection and revised the paper. CF initiated the project, designed and monitored data collection, analysed the data and validated and revised the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.