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From: Joe on 30 Sep 2005 08:14 Hi, I always have melodies in my head. This is like a music play again and again and I cannot stop it. I see a couples of psy. doctors but their conclusions are contradicting. 2 of them say is hallucination and 4 say it is neurosis. The problem is now I am taking medications for both of the symptoms, i.e. for OCD and psychosis. I have been taking these medication for 2 years and now I make up my mind that I have to be specific , critical towards my mental health.... so I ask my current doc. and say what I think. I urge him to make a diagnosis for me ( I have not been diagnosed for 2 years). He ask me a couples of questions and tell me that should be OCD. OK, then he take away the antipsychotic med. from me and enhance the OCD medication. But the effect is not so smooth, I experience more melodies than before and insomnia for several night. Medication before making diagnosis: Prozac 20, largetil 100, librium..., Prothiaden 75, lithium 1500. Now: Prozac 30, largetil 0, librium..., Prothiaden 150, lithium 1500 I want to stress that my melodies gone when I am concentrating in doing things like chatting, but it comes back when I have nothing to occupy. Also the melodies are songs that I heard before which mean they are not "alien" to me. So I myself conclude that I am OCD( I am not too sure), and want u guys to ensure me. In short I am feeling not well and I cannot sleep even after taking sleeping pill. I am very serious this time and I dedicated to find out what is happening in my head. Also, I had done MRI of my brain and thoyid test and a couple of test that I don't know the name. Hope you guys can give me a helping hand. I know that my doc. will ask me to take back the combo before if I tell him I have insomnia and more melodies. This is not what I want. I want it clear, OCD= increase Prozac. Hallucination, ok, largetil What I don't want is a mixed combo which I don't think is making sense. I hope I am making myself clear and I look forward for your helping hands. Joe
From: Larry Hoover on 30 Sep 2005 10:53 "Joe" <chl3(a)netvigator.com> wrote in message news:433d2c11$1(a)127.0.0.1... > Hi, > > I always have melodies in my head. This is like a music play again and again > and I cannot stop it. I see a couples of psy. doctors but their conclusions > are contradicting. 2 of them say is hallucination and 4 say it is neurosis. > The problem is now I am taking medications for both of the symptoms, i.e. > for OCD and psychosis. I have been taking these medication for 2 years and > now I make up my mind that I have to be specific , critical towards my > mental health.... > so I ask my current doc. and say what I think. I urge him to make a > diagnosis for me ( I have not been diagnosed for 2 years). He ask me a > couples of questions and tell me that should be OCD. > OK, then he take away the antipsychotic med. from me and enhance the OCD > medication. > But the effect is not so smooth, I experience more melodies than before and > insomnia for several night. > Medication before making diagnosis: Prozac 20, largetil 100, librium..., > Prothiaden 75, lithium 1500. > Now: Prozac 30, largetil 0, librium..., Prothiaden 150, lithium 1500 > I want to stress that my melodies gone when I am concentrating in doing > things like chatting, but it comes back when I have nothing to occupy. Also > the melodies are songs that I heard before which mean they are not "alien" > to me. So I myself conclude that I am OCD( I am not too sure), and want u > guys to ensure me. > In short I am feeling not well and I cannot sleep even after taking sleeping > pill. > I am very serious this time and I dedicated to find out what is happening in > my head. > Also, I had done MRI of my brain and thoyid test and a couple of test that I > don't know the name. > Hope you guys can give me a helping hand. I know that my doc. will ask me to > take back the combo before if I tell him I have insomnia and more melodies. > This is not what I want. I want it clear, OCD= increase Prozac. > Hallucination, ok, largetil > What I don't want is a mixed combo which I don't think is making sense. > I hope I am making myself clear and I look forward for your helping hands. > > Joe Hi Joe. I'm sorry to hear you're struggling so much to understand how best to treat your symptoms. Your major focus, throughout your description, is on the disruptive and unpleasant experience of the melodies. That's one symptom. Yet, you ask for a specific diagnosis. A diagnosis is a pattern of symptoms, and there is a great deal of flexibility on just which symptoms are important enough to shape the diagnosis, and thus, treatment. What you need to find, Joe, is the best treatment for your symptoms. If I understand you correctly, when your dose of largetil (Largectil, chlorpromazine) was stopped, the melodies have become disruptive once more, and you have insomnia. This is pretty strong evidence that the best treatment for your symptom (the melodies) lies in the realm of antipsychotic medication. This response does not depend on proper diagnosis, Joe. I want to also state that you can also have a neurosis, with or without, auditory hallucinations. That would be related to the specific way you respond to the uncertainty about your diagnosis. I can see some of the OCD behaviours right before my eyes. You could very well have both clusters of symptoms, the neurotic/OCD cluster, and the psycotic/hallucinatory/busy brain cluster, at the same time. If so, you would benefit from treating both clusters at the same time. What is important is to find a treatment that makes you feel better, not a diagnosis that makes you feel better. Kind regards, Lar
From: Whistleblower on 30 Sep 2005 11:11 "Joe" <chl3(a)netvigator.com> wrote in message news:433d2c11$1(a)127.0.0.1... > Hi, > > I always have melodies in my head. This is like a music play again and again > and I cannot stop it. I see a couples of psy. doctors but their conclusions > are contradicting. 2 of them say is hallucination and 4 say it is neurosis. > The problem is now I am taking medications for both of the symptoms, i.e. > for OCD and psychosis. I have been taking these medication for 2 years and > now I make up my mind that I have to be specific , critical towards my > mental health.... > so I ask my current doc. and say what I think. I urge him to make a > diagnosis for me ( I have not been diagnosed for 2 years). He ask me a > couples of questions and tell me that should be OCD. > OK, then he take away the antipsychotic med. from me and enhance the OCD > medication. > But the effect is not so smooth, I experience more melodies than before and > insomnia for several night. > Medication before making diagnosis: Prozac 20, largetil 100, librium..., > Prothiaden 75, lithium 1500. > Now: Prozac 30, largetil 0, librium..., Prothiaden 150, lithium 1500 > I want to stress that my melodies gone when I am concentrating in doing > things like chatting, but it comes back when I have nothing to occupy. Also > the melodies are songs that I heard before which mean they are not "alien" > to me. So I myself conclude that I am OCD( I am not too sure), and want u > guys to ensure me. > In short I am feeling not well and I cannot sleep even after taking sleeping > pill. > I am very serious this time and I dedicated to find out what is happening in > my head. > Also, I had done MRI of my brain and thoyid test and a couple of test that I > don't know the name. > Hope you guys can give me a helping hand. I know that my doc. will ask me to > take back the combo before if I tell him I have insomnia and more melodies. > This is not what I want. I want it clear, OCD= increase Prozac. > Hallucination, ok, largetil > What I don't want is a mixed combo which I don't think is making sense. > I hope I am making myself clear and I look forward for your helping hands. > Have you ever had Sleep Studies performed? Sleep deprivation can cause a lot of psych symptoms. Movement disorders such as PLMD---can cause sleep disorders. PLMD occurs owing to having lower than normal levels of dopaimine available. Dopamine agonists are used to treat such. Antipsychotics prescribed to such a person will induce psychosis---and, or auditory hallucinations--even while prescribed to mask it---therefore, can cause a temporarily increase in auditory hallucinations immediate following cessation of the masking agent. Just food for thought. > Joe > >
From: Provigilant on 30 Sep 2005 12:08 Joe wrote: > Hi, > > I always have melodies in my head. This is like a music play again and again > and I cannot stop it. I see a couples of psy. doctors but their conclusions > are contradicting. 2 of them say is hallucination and 4 say it is neurosis. > The problem is now I am taking medications for both of the symptoms, i.e. > for OCD and psychosis. I have been taking these medication for 2 years and > now I make up my mind that I have to be specific , critical towards my > mental health.... > so I ask my current doc. and say what I think. I urge him to make a > diagnosis for me ( I have not been diagnosed for 2 years). He ask me a > couples of questions and tell me that should be OCD. > OK, then he take away the antipsychotic med. from me and enhance the OCD > medication. > But the effect is not so smooth, I experience more melodies than before and > insomnia for several night. > Medication before making diagnosis: Prozac 20, largetil 100, librium..., > Prothiaden 75, lithium 1500. > Now: Prozac 30, largetil 0, librium..., Prothiaden 150, lithium 1500 > I want to stress that my melodies gone when I am concentrating in doing > things like chatting, but it comes back when I have nothing to occupy. Also > the melodies are songs that I heard before which mean they are not "alien" > to me. So I myself conclude that I am OCD( I am not too sure), and want u > guys to ensure me. > In short I am feeling not well and I cannot sleep even after taking sleeping > pill. > I am very serious this time and I dedicated to find out what is happening in > my head. > Also, I had done MRI of my brain and thoyid test and a couple of test that I > don't know the name. > Hope you guys can give me a helping hand. I know that my doc. will ask me to > take back the combo before if I tell him I have insomnia and more melodies. > This is not what I want. I want it clear, OCD= increase Prozac. > Hallucination, ok, largetil > What I don't want is a mixed combo which I don't think is making sense. > I hope I am making myself clear and I look forward for your helping hands. > > Joe This sounds like OCD-related intrusive music (non-visual obsessional imagery) -- not so uncommon. If you experience the songs as coming from wihin your head, then they're not musical hallucinations. If you experience them as coming from an external source, then they are. High-dose SSRIs (Prozac 80 mg/day; Zoloft 200 mg/day) can knock these songs out and ease your OCD symptoms and anxiety. If you're bipolar, make sure you're also taking a mood stabilizer. Read this: good luck, Fred Intrusive Music and OCD _I've Got the Music in Me: A Look at Intrusive Music and OCD_ by Harold Pupko, M.D. Musical Hallucinations (MH) are defined as the experience of music without any coexisting external stimulus. Not restricted to simple tunes or melodies, they can include the experience of rhythms, harmonics, or timbre depending on the musical appreciation level of the "hallucinator." This being the case, diagnosis may depend on the musical-appreciation talents of the diagnostician. The medical literature describes the phenomenon of MH as rare, more commonly occurring among those with unilateral or bilateral deafness (transient or permanent), and those with brain disease. As the elderly are more prone to both conditions, MH is more commonly reported in this age group. As a clinician whose practice includes many patients with Obsessive-Compulsive Disorder (OCD), I am surprised that a diagnosis of intrusive music, a form of OCD, is rarely entertained by the psychiatrists and neurologists who write about MH in the scientific journals. When I ask my OCD patients about intrusive music, I find that the phenomenon is quite common, with its expression ranging from mildly irritating to sometimes debilitating. More importantly, sufferers are relieved to finally have an opportunity to talk about these "unusual experiences" openly (as is the case with most OCD symptomatology). Because questions regarding intrusive music are not part of standard OCD inventories, such as the Y-BOCS symptom checklist, I hope that this article will stimulate my professional colleagues to start asking these questions so that OCD patients can be assured that they are not "loony tunes." This article is based on a review of the scientific literature, my clinical experience, and letters I received in response to a letter published in this newsleter this past summer. What is the experience like? The experience of intrusive music covers a wide spectrum. A common analogy is that of a radio in one's head; the volume can be high or low, ranging from low-level background music to feeling as if a "boombox" is blasting in one's brain. The music may be clear, with rich detail, or jumbled. Some patients report that they can experience two or more songs playing simultaneously (e.g., ragtime on top of a rock and roll). The music may consist of a bar, a phrase, or even an entire piece, followed by other pieces, in what may seem like an endless musical procession. The intrusive tunes are commonly familiar ones (e.g., religious hymns), although new compositions may erupt spontaneously. Intrusive music is usually triggered by hearing music, from the bells of the local ice cream truck to popular music on the radio. Advertising jingles as well as television and radio signature tunes are notorious triggers. Once heard, the music repeats over and over, lasting anywhere from seconds to hours to days, and in extreme cases, months. A key point to keep in mind is that OCD sufferers maintain insight into the source of the music, knowing that it emanates from their own minds, and cannot be heard by others (i.e., they are aware that they are not psychotic). A common feature of this condition is that, like nature, musical OCD abhors a vacuum. Patients report that when they are highly focused on some outside task or conversation, the symptoms diminish, only to reappear when their minds are not actively engaged. However, when less focused, the music tends to compete, and often draws the attention away from the preferred target. Intrusive music may also be triggered by feelings, thoughts, or words that can, in turn, trigger associations. This is not to be confused with synethesia, where one sensory modality is experienced as another (e.g., tasting colors), although there may be an overlap between the processes at work in the OCD sufferers and synesthetics. For example, the color blue may trigger the title "Blue Suede Shoes," which, in turn, may automatically trigger the experience of a random song from one's internal Elvis collection. In some cases, intrusive music may "leak" out in the form of humming at inappropriate times. This may lead to embarrassment for the sufferers and/or people close to them, and the individual may not even be aware that this is occurring. This is not to say that humming or hearing music in one's head is abnormal in any way; but rather, that its inappropriateness to the situation makes it pathological. Intrusive music, like other forms of OCD, can truly detract from the quality of one's life, preventing even the enjoyment of the simplest of pleasures, such as a sunset savored in perfect silence. Even when the music stops, the resulting mood can linger on in a person's mind, often to the sufferer's detriment. It is important to note that unilateral musical hallucinations which appear to emanate from one's ear may be a sign of neurological disease. What triggers it? Muscial OCD, like other forms of OCD, thrives under certain conditions. Stress, depression, or any other condition that deprives one of sleep, resulting in fatigue, certainly aggravates it. Intrusive music can also cause insomnia and poor sleep quality, thus perpetuating itself in a vicious cycle. Sufferers often note intrusive music to be their first experience upon wakening in the morning. There is one report in the literature of intrusive music resulting from a single head injury. I also received one letter reporting on such a case. Interestingly, both cases were well controlled by medication (Anafranil in the former, Paxil in the latter). OCD can be seen in some cases as the result of a susceptible brain being further compromised, with resultant symptomatology. For example, a case is described of a patient with "basal ganglia pathology" who developed repetitive musical intrusions secondary to having a low-blood calcium and phosphorus levels. Correction of this metabolic deficiency eliminated the intrusive music. Prescription drugs, especially stimulant drugs, or the withdrawal of sedative drugs (with the resultant stimulation of the cortex) as well as those that lower blood pressure, can precipitate MH, especially in those already at risk (e.g., the deaf, etc.). For example, Anafranil was described in one case to trigger musical hallucinations. It is interesting to note that there is some evidence that representation of musical information shifts with musical training from the non-dominant to the dominant hemisphere of the brain. As OCD is considered by some to be an information-processing problem, it may, for purposes of speculation only, be possible that a flawed transfer of musical information between the hemispheres of the brain contributes to the problem. Treatment So what's a sufferer to do? Avoidance of music in our daily lives is virtually impossible. Behavior therapy (BT), although potentially useful, is not that impressive, based on my clinical experience. Nevertheless, techniques such as visualizing the music as coming from a tape recorder and then hitting the pause button, or manipulating the volume control as a form of thought-stopping, should be considered. "Cranking the volume up" as exposure therapy has been suggested by some behavioral therapists as an effective technique, but I have yet to hear of a successful treatment with this approach, specifically for sufferers of intrusive music. Once underlying conditions, as discussed above, are eliminated, medication should be seriously considered for those with significant impairment. This form of OCD can be responsive to the traditional medications for OCD (i.e., Anafranil, Prozac, Paxil, Zoloft, Luvox). There is no specific drug preferred for this condition, and finding the right one and correct dosage os still a matter of trial and error. The goal should be the elimination of symptoms, but realistically, sometimes all one can achieve is alleviation. If medication fails or severely aggravates the symptoms, one diagnosis that should not be overlooked is temporal lobe epilepsy, as it too can produce hallucinations. Consultation with a neurologist who is competent in this area should be considered. In summary, intrusive music is common, can be debilitating, and is often overlooked in the management of OCD. I hope this brief review will stimulate discussion about this topic for the increased well-being of OCD sufferers everywhere. Comment on this article would be greatly appreciated. Please write to me at (author's address). I would like to thank all of the readers who took the time to share their experiences with me. (From _OCD NEWSLETTER_ Volume 11, Number 2; April, 1997 -- by Harold Pupko, M.D. ====================================================== Obsessional-Compulsive Imagery, Padmal DE Silva Behaviour Research and Therapy Vol. 24, No. 3, pp. 333-350, 1986 Most of the images in obsessional-compulsive experiences are visual. However, there are--infrequently--cases of images that are other than visual. Auditory imagery occurring in the obsession is recognized in the literature. For example, textbooks refer to 'tunes in the head' (e.g. Slater and Roth, 1972, p.128; cf. Shepherd, 1978). The Sandler-Hazari Obsessional Inventory (others since then) includes an item intended to tap into this kind of experience. "I frequently find a thought or a tune keeps recurring in my head for a long time" (Sandler and Hazari, 1980, p. 272). Salman Akhtar et al. (1975) refer to a 23-yr-old student who could not rid his consciousness of a currently popular tune--a case that illustrates this phenomenon. A case described by Broadhurst (1976), as far as one can judge by the description provided, may be construed as one with a recurrent auditory image of a slightly more elaborate nature. Broadhurst (Anne) uses the term 'thought jingles' to describe this patient's symptom (p. 176). Samaan (1975) describes a 42-yr-old woman who had frequent auditory and visual images of her mother, which were of a frightening nature. A further clinical example is as follows: An elderly man had the recurrent intrusive auditory experience of a certain senseless phrase ('these boys when they were young'). He would 'hear' this in his own voice. (Case later documented in _The Boy Who Couldn't Stop Washing: The Experience and Treatment of Obsessive Compulsive Disorder_ by Judith L. Rapaport, M.D.). Some may argue that these phenomena are not images *per se* , but hallucinations, and thus would not need to be taken into account in one's theorizing about imagery. It must be conceded that some obsessional imagery may appear, at first presentation, to be like hallucinations or pseudohallucinations. For example, Hamilton has observed: "At times they may be so vivid that they can be mistaken for pseudohallucinations". And there are, in the literature, instances of authors using these terms to describe particularly clear imagery; an example is the description of an obsessional rumination by Stern et al. as a 'pseudohallucination' of 'Drop dead'. However, closer analysis shows that these are different. There are no grounds for considering the kinds of imagery typically present in obsessional-compulsive patients as hallucinations or pseudohallucinations. Hallucinations have the properties of, among others, external location and realness or 'substance', and are felt to be independent of the person experiencing them. The most important defining feature is that they are experienced as veridical (real; genuine) at the time of their occurrence: the person believes that there is a real stimulus corresponding to his experience. Obsessional-compulsive images, on the other hand, are never experienced as veridical. Further, they are located in subjective space and are not felt to be independent of oneself. These are all properties of non-hallucinatory imagery. The only major feature that hallucinations may appear to share with these images is that of 'unwilledness' or spontaneity, but even here there are important differences. Firstly, the compulsive image is not a spontaneous occurrence. While a hallucination is always beyond the control of the person, the compulsive image is, by definition, brought about by the person. (Not the case, however, in obsessional images -- no cognitive precipitant is necessary -- according to Michael A. Jenike, M.D. in _Obsessive-Compulsive Disorders: Practical Management_.) Secondly, even the other three types of obsessional-compulsive imagery (Obsessional Image, Disaster Image, and Disruptive Image), while spontaneous in their normal course, can be evoked deliberately by the patient, if with some difficulty, as numerous clinical and research reports have shown (e.g. Likieman and Rachman, 1982; Rachman and de Silva, 1978). Thus, one can safely conclude that obsessional-compulsive images cannot be relegated to the realm of hallucinations. Whether they can be regarded as pseudohallucinations is largely a fruitless question as this term has been defined in different ways (multiple citations). Taylor (1983) calls them, along with hallucinations, 'para-percepts' and states that they are not experienced in inner subjective space. All definitions seem to agree that they have the quality of spontaneity; it is stressed that they cannot deliberately be evoked or altered. On both these counts obsessional-compulsive images fall outside the domain of pseudohallucinations. It is worth, too, pointing out in passing that the validity and usefulness of the concept of pseudohallucinations have been seriously called into question (e.g. Gelder, Gath and Mayou, 1983). ============================================================ Excerpts from _The Boy Who Couldn't Stop Washing: The Experience & Treatment of Obsessive-Compulsive Disorder_ -- Judith L. Rapaport, M.D. (1989) Chapter 15; "The Music Goes 'Round and 'Round" "You have to see how it is with these tunes," he pleaded. [16-year-old boy to Dr. Rapaport] "Other people joke when they complain about tunes stuck in the head, but they *enjoy* it. (asterisks denote author's emphasis) Mine are never enjoyable. They continue for hours, days, weeks, months, and years. They cannot be blocked out, these songs are like free spirits who come and go whenever they please." Another case: (Don) "In Don's case, we were also sure that the tunes were obsessive because Don had the other symptoms--washing, counting and checking--that were typical. The tunes in some way felt sort of the same. There was nothing pleasant in these tunes: they were senseless, stuck in the head, a relentless repetitive force that is the essence of any obsession. He had to fight against this music just to get on with the day." "Most of the images in obsessive-compulsive experiences are visual. There are, however, infrequent (far more common than Dr. Rapoport, I believe, realized in 1989, as Dr. Harold Pupko's article, _Intrusive Music and OCD_ delineates) cases of images that are other than visual. Textbooks have referred to tunes in the head." "These specific musical images of OCD are quite rare; visual images are relatively uncommon among our patients. (I think Dr. Rapaport is referring to a patient population she was studying at NIMH around the time of the publication of the book.) But because OCD is so much more common than we ever believed, it is likely that there are several thousand others like Don and George (another case) walking around who think that only *they* have the tunes, who don't know that they might be helped by drugs or therapy. Unless you spend time to talk about such things [something our patients avoid most of their lives], you never will find out about help. Reptitive tunes in the head are hardly an everyday topic; and anyway obsessives are a secretive group. Possibly only musicians would have trouble concealing this affliction, as the repeating tunes could influence their composition (example detailed by Dr. Rapaport about Eric Satie)." "The images in Obsessive-Compulsive Disorder are concrete and detailed. They are not hallucinations; they are seen as definite projected images recurring in the same form, down to the same detail. Obsessive images come from "inside," unlike hallucinations which are seen "out there." All that obsessive images have in common with hallucinations is that neither patient wants them around!"
From: Larry Hoover on 30 Sep 2005 12:24
"Provigilant" <Provigilance(a)yahoo.com> wrote in message news:1128096528.684314.268130(a)g47g2000cwa.googlegroups.com... > > This sounds like OCD-related intrusive music (non-visual obsessional > imagery) -- not so uncommon. If you experience the songs as coming > from wihin your head, then they're not musical hallucinations. If you > experience them as coming from an external source, then they are. > High-dose SSRIs (Prozac 80 mg/day; Zoloft 200 mg/day) can knock these > songs out and ease your OCD symptoms and anxiety. If you're bipolar, > make sure you're also taking a mood stabilizer. Read this: > > good luck, > > Fred Good catch, Fred. I wasn't aware of this form of OCD. Lar |