Clinical features in two cases with musical obsessions who successfully responded to clomipramine

Clinical features in two cases with musical obsessions are presented to discuss phenomenological and psychopharmacological differences from those in patients with musical hallucinations. The present patients commonly experienced music as an internally generated cognitive product accompanied by full insight into the senselessness of the symptoms. They also attempted to suppress the musical symptoms or to neutralize them with other thoughts. Thus, despite no covert or systematic compulsive behaviors, the musical symptoms of the present cases are consistent with the phenomenological nature of obsessive-compulsive disorder defined in DSM-IV. In addition, in contrast to previous case reports of musical hallucinations, the present patients failed to respond to neuroleptics, but showed significant response to an adequate trial of clomipramine. Thus, their symptoms appear to be phenomenologically and biologically distinct from musical hallucinations, especially those characteristic of schizophrenia.