Table 2.
Summary of publications included in the systematic review which met the eligibility criteria.
| No. | Author | Sample and Group Size (n) | Total N | Study Design | Questionnaires and Research Methods | Types of Treatment | Main Outcomes | Statistical Significance of Main Results |
|---|---|---|---|---|---|---|---|---|
| (1) Case reports on the musical symptoms in patients with OCD and their treatment | ||||||||
| (1a) Pharmacological treatments | ||||||||
| 1 | Bergman et al. (2014) [29] | Elderly patients diagnosed with OCD and music hallucinations; female (n = 4) and male (n = 2) | 6 | Case series | Mini-mental status examination Y-BOCS adapted to music hallucinations |
Escitalopram (10 to 20 mg/d), perphenazine (4 to 8 mg/d), risperidone (1 to 2 mg/d) | Decrease in the severity and the duration of musical hallucinations, decrease in Y-BOCS total score under 10 to 20 mg/d escitalopram. |
∆Y-BOCS total score before and after escitalopram p < 0.01 (mean Y-BOCS before: 13.2 ± 0.9; after: 7.8 ± 2.8) |
| 2 | Focseneanu (2015) [46] | Elderly female patient, 71 years old, diagnosed with OCD and music hallucinations (n = 1) | 1 | Case report | HAMD, HAM-A, MMSE, Y-BOCS | Escitalopram (10 mg/d), lorazepam (10 mg/d), risperidone—starting 1 mg/day for 2 weeks, then 2 mg/d for another 2 weeks, and finally 3 mg/d | Slight improvement in symptoms at 2 mg/d risperidone; a daily dose of 3 mg/d risperidone induced extrapyramidal symptoms and cognitive impairment. | N/A |
| 3 | Gomibuchi (2000) [47] | Male patients diagnosed with hearing music as an obsession (n = 2) | 2 | Case series | N/A | C1: Diazepam (6 mg/d) C2: Bromazepam (6 mg/d) |
Diazepam did not lead to symptom improvement; symptoms diminished after 1 week 6 mg/d bromazepam. | N/A |
| 4 | Güçlü (2013) [48] | 44-year-old female patient diagnosed with OCD and music hallucinations (n = 1) | 1 | Case report | N/A | Fluvoxamine (up to 200 mg/d within 2 months) quetiapine (200 mg/d) | Reduction in OCD or musical hallucinations during treatment with fluvoxamine and quetiapine. | N/A |
| 5 | Islam et al. (2014) [49] | 51-year-old female patient diagnosed with OCD, otosclerosis with musical obsessions (n = 1) | 1 | Case report | N/A | Paroxetine (20 mg/d to 40 mg/d) | YBOCS scores decreased from 26 to 15; HAM-D scored from 40 to 6 and HAM-A scores from 14 to 4 after 8 weeks of treatment at 3 months follow-up visit. | N/A |
| 6 | Mahendran (2007) [50] | Case 1: 61-year-old widow diagnosed with depression with music hallucination symptoms (n = 1) Case 2: 78-year-old man who experienced music hallucinations (n = 1) Case 3: 56-year-old woman diagnosed with OCD with major depression and music hallucination symptoms (n = 1) |
3 | Case series | N/A | C1: Fluvoxamine (up to 150 mg/d) C2: Citalopram (no dose was given) C3: Citalopram (20 to 40 mg/d) |
C1: Musical hallucinations continued but the patient masked the symptoms with singing and/or playing other music. C2: Symptoms disappeared 10 months after a major surgery for colon cancer. C3: OCD and depressive symptoms disappeared under 40 mg/d citalopram. |
N/A |
| 7 | Matsui et al. (2003) [16] | Case 1: 20-year-old male diagnosed with OCD and dysthymic disorder with musical symptoms (n = 1) Case 2: 28-year-old male diagnosed with OCD with musical symptoms (n = 1) |
2 | Case series | Y-BOCS SDS |
C1: Haloperidol (1 to 12 mg/d) Risperidone (6 mg/d) Clomipramine (25 to 150 mg/d) C2: Haloperidol (6 mg/d) Clomipramine (25 to 150 mg/d) |
Both ratings of Y-BOCS and depressive symptoms decreased within 12 weeks (case 1) and 8 weeks (case 2), both at 150 mg clomipramine per day | N/A |
| 8 | Mendhekar and Andrade (2009) [51] | 22-year-old male patient diagnosed with OCD (n = 1) | 1 | Case report | Y-BCOS | Fluvoxamine (200 mg/d), clomipramine (75 mg/d) | Subjective improvement. | N/A |
| 9 | Orjuela-Rojas and Rodriguez (2018) [52] | 32-year-old female patient diagnosed with OCD, musical obsessions (n = 1) | 1 | Case report | Y-BOCS The Beck Depression Inventory HAM-A |
Fluvoxamine (200 mg/d), paroxetine (50 mg/d), fluoxetine (60 to 80 mg/d) | Fluoxetine (60 mg/d) reduced obsessive symptoms by 60% and improved quality of life (Y-BOCS scores). Headache at 80 mg of fluoxetine per day. |
N/A |
| 10 | Pfizer and Andrade (1999) [53] | 25-year-old female patient diagnosed with OCD and musical obsession (n = 1) | 1 | Case report | N/A | Clomipramine (25 mg three times daily), alprazolam (0.25 mg three times daily), antipyretic drugs | Musical obsessions remained unchanged. | N/A |
| 11 | Zungu-Dirway et al. (1999) [54] | Case 1: 59-year-old woman presented with musical obsessions (n = 1) Case 2: 29-year-old woman presented with musical obsessions (n = 1) |
2 | Case series | N/A | C1: Fluoxetine, paroxetine, citalopram, clomipramine, risperidone (no dose reported) C2: Refuse any types of intervention (offered pharmacological) |
C1: Treatment resistance. C2: No improvement in symptoms. |
N/A |
| (1b) Combinations of pharmacological and non-pharmacological interventions | ||||||||
| 1 | Aneja et al. (2015) [55] | 20-year-old male patient diagnosed with OCD and musical obsession (n = 1) | 1 | Case report | N/A | Desvenlafaxine (50 mg/d) Escitalopram (10 to 30 mg/d), behaviour therapy: Thought-stopping |
A slight improvement over a period of 8 weeks under desvenlafaxine (50 mg/d). With the increase in escitalopram to 30 mg/d and supervised thought-stopping, the patient achieved remission after 12 weeks. |
N/A |
| 2 | Chauhan et al. (2010) [17] | 35-year-old female patient diagnosed with OCD and obsessive auditory imagery | 1 | Case report | Y-BOCS | Sertraline (up to 200 mg/d) fluoxetine (80 mg/d) fluvoxamine (300 mg/d) clomipramine (300 mg/d); behaviour therapy: exposure, response prevention, vivo exposure | Y-BOCS score improved under 300 mg clomipramine per day by 75%; SSRIs had no significant effect. | N/A |
| 3 | Liikkanen and Raaska (2013) [22] | 36-year-old female patient diagnosed with schizophrenia with obsessive musical hallucinations (n = 1) | 1 | Case report | N/A | CBT-inspired instrumental music adjunct to pharmacological treatment:olanzapine (5 to 10mg/d), risperidone (up to 4mg/d), fluoxetine (20mg/d), fluvoxamine (50 to 100mg/d, escitalopram (10mg/d), clozapine (5 to 75 mg/d) | Frequency of and disturbance due to symptoms decreased under clozapine only at 75 mg/d. | N/A |
| 4 | Matta et al. (2012) [56] | Case 1: 57-year-old woman diagnosed with OCD and experiences of musical obsessions (n = 1) Case 2: 25-year-old man with history of OCD and current experiences of musical obsessions (n = 1) Case 3: 47-year-old man diagnosed with OCD and experiences of musical obsessions (n = 1) |
3 | Case series | N/A | C1 and 2: Sertraline (100 to 150 mg/d) + CBT C3: Citalopram (20 to 40 mg/d), Alprazolam (0.5 mg per 12 h) |
3 cases: Symptoms improved moderately. | N/A |
| 5 | Nath et al. (2013) [57] | 22-year-old male patient diagnosed with OCD, comorbid tic disorder, and musical obsessions (n = 1) | 1 | Case report | N/A | Olanzapine (10 mg/d) clomipramine (50 to 150 mg/d), flupentixol (1 mg/d) + thought-stopping, response-prevention, Morita therapy | Improvement in musical obsessions and reduction in other obsessive and compulsive features at 150 mg/d clomipramine + 1 mg/d flupentixol and thought-stopping, response-prevention, Morita therapy. | N/A |
| 6 | Naskar et al. (2017) [58] | 25-year-old male patient diagnosed with OCD and musical obsession (n = 1) | 1 | Case report | HAM-A and HAM-D Y-BOCS |
Escitalopram (20 to 40 mg/d). No doses were reported for desvenlafaxine, clomipramine, fluvoxamine, risperidone Thought-stopping |
Reduction in intensity and frequency of symptoms with 40 mg escitalopram per day and behaviour therapy. | N/A |
| 7 | Praharaj et al. 2009 [30] | 21-year-old male patient diagnosed with OCD with persistent musical obsessions (n = 1) | 1 | Case report | N/A | Fluvoxamine (up to 300 mg/d), risperidone (2 mg/d) Thought-stopping technique |
Reduction in both the duration and frequency of musical obsessions. | N/A |
| 8 | Saha (2012) [59] | 30-year-old male patient diagnosed with OCD and musical obsession. | 1 | Case report | Y-BOCS | Fluvoxamine (200 mg/d), fluoxetine (60 mg/d), lithium (900 mg/d) Individual psychotherapy, exposure prevention therapy, and systematic desensitisation |
Subjective improvement after 4 weeks and scored lower on Y-BOCS after 8 weeks. | N/A |
| (2) Studies on the perception of music in people with obsessive compulsive personality traits or an OCD diagnosis | ||||||||
| (2a) Studies in people with obsessive compulsive personality traits | ||||||||
| 1 | Buse et al. (2015) [60] | Healthy young adults; Females (n = 46); Males (n = 19) | 64 | RCT, Harmonic expectancy violation paradigm: harmonic condition vs. disharmonic condition | OCI-R, OCTCDQ-R, OCTCDQ-GR, Harm avoidance and general experiences of incompleteness | N/A | The response time (RT) to disharmonic chord sequences was significantly shorter than the RT to harmonic chord sequences. | ∆RT to harmonic and RT to disharmonic was significantly correlated to incompleteness score (p = 0.05) |
| 2 | Negishi and Sekiguchi (2020) [21] | University students aged 18 to 24: Females (n = 58), Males (n = 43) | 101 | Experience sampling study | Obsessive compulsive tendencies (Japanese adaptation of Maudsley Obsessional Compulsive Inventory, the Padua Inventory, the indecisiveness scale) A short form of Big Five (Japanese version/adaptation) Gold-MSI PACO |
N/A | Obsessive compulsive tendencies were positively correlated with the involuntary musical imagery, negatively correlated with pleasantness of involuntary musical imagery experience and the extent to likability of the music heard internally. Obsessive compulsive personality traits and music expertise were significantly associated with involuntary musical imagery occurrence. |
Effect of compulsive washing and pleasantness (p < 0.01), liking the music (p < 0.05). Effect of openness and liking the music (p < 0.01). Effect of intrusive thoughts and involuntary musical imagery occurrences (p < 0.01). Effect of singing abilities and involuntary musical imagery occurrences (p < 0.01). |
| (2b) Studies in people with an OCD diagnosis | ||||||||
| 1 | Buse and Roessner (2016) [61] | Boys with OCD (n = 21) versus healthy controls (n = 29) | 50 | Harmonic expectancy violation paradigm: harmonic condition vs. disharmonic condition | fMRI, CY-BOCS, OCI-R, OCTCDQ-R, ZWIK | N/A | Boys with OCD exhibited increased activation compared to healthy controls in the harmonic condition and decreased condition in the disharmonic condition. | Response time (RT) to disharmonic chord sequences was significantly faster than the RT to harmonic chord sequences (p < 0.001). Error rates in disharmonic condition were significantly smaller than in the harmonic condition (p < 0.001) |
| 2 | Nielzén and Cesarec (1982a) [62] | Inpatients with schizophrenic psychosis (n = 22); depressive psychosis (n = 12); manic psychosis (n = 10); obsessive neurosis (n = 12); depressive neurosis (n = 20); anxiety neurosis (n = 12); hysterical neurosis (n = 19) versus normal subject (n = 100) |
207 | As stimuli, 7 short pieces of orchestral music were exposed to psychiatric patients and normal subjects. | Assessment of emotional experience: tension-relaxation, gaiety-gloom, attraction-repulsion | N/A | Obsessive compulsive group rated all music as more tense, more sensitive to tense music than normal group. | N/A |
| 3 | Nielzen and Cesarec (1982b) [63] | Inpatients with schizophrenic psychosis (n = 22); depressive psychosis (n = 12); manic psychosis (n = 10); obsessive neurosis (n = 12); depressive neurosis (n = 20); anxiety neurosis (n = 12); hysterical neurosis (n = 19) | 107 | As stimuli, 7 short pieces of orchestral music were exposed to psychiatric patients and normal subjects. | Assessment of emotional experience: tension-relaxation, gaiety-gloom, attraction-repulsion | N/A | Obsessive compulsive group rated all music as more sensitive to tense music compared to schizophrenia, depressive, and anxiety groups. | N/A |
| (3) Studies on the effect of music and music therapy for patients with OCD | ||||||||
| 1 | Abdulah et al. (2019) [43] | Females with OCD (n = 19); Males with OCD (n = 17) | 36 | RCT; Music tracks (relaxing, sleep and meditation music) composed by Peder B. Helland vs. regular treatment; parallel group. | YBOCS | Music therapy; frequency: 7 50 min tracks/per day; duration: 3 months | Obsessive compulsive symptoms and obsessions and compulsions were lower in group treated with music therapy compared to regular treatment alone. | N/A |
| 2 | Ciambella, et at. (2019) [64] | Patients of a psychiatric day hospital. Group 1 received add-on therapy on 14 improvisational music therapy (n = 11). Group 2 received 7 improvisational music therapy sessions alternated with 7 listening music therapy therapy session (n = 13). In each group was one patient with OCD. |
24 | Add-on therapy improvisational music therapy session vs. improvisational music therapy session alternated with listening music therapy session. | Assess the efficacy of music therapy through nine variables: method of approaching the instruments, method of handling the instruments, vocal production method, interaction frequency, sharing instruments, gaze interaction, facial expression, tension, and movement. | Music therapy: Frequency: Group 1: 14 improvisational music therapy sessions/per week Group 2: 7 improvisational + 7 listening music session/per week Duration: 6 months |
In both groups, good response from OCD patients. | N/A |
| 3 | Shiranibidabadi and Mehryar (2015) [42] | Outpatients with OCD who live in Iran (n = 30) | 30 | RCT; standard treatment + music therapy vs. standard treatment only; music therapy: receptive or individual or group | BAI, BDI-SF, MOCI | Music therapy Frequency and Duration: 12 sessions over 1 month |
Music therapy results in greater decrease in obsessive score, anxiety, and depressive symptoms. | ∆ anxiety, distress: p < 0.001 ∆ obsessive score: p < 0.001 |
Abbreviations: BAI: Beck Anxiety Inventory; BDI-SF: Beck Depression Inventory—Short Form; CY-BOCS: Children’s Yale–Brown Obsessive-Compulsive Scale; fMRI: Functional Magnetic Resonance Imagine; Gold-MSI: Goldsmith Musical Sophistication Index; HAM-A: Hamilton Anxiety Scale; HMA-D: Hamilton Depression Raring Scale; mg/d: milligram per day; MMSE: mini-mental state examination; MOCI: Maudsley Obsessive-Compulsive Inventory; OCI-R: Obsessive-Compulsive Inventory; OCTCDQ-GR: Obsessive-Compulsive Trait Core Dimensions Questionnaire—Revision in German; OCTCDQ-R: Obsessive-Compulsive Trait Core Dimensions Questionnaire—Revision; PACO: Personal Analytics Companion; RCT: randomised control trial; SDS: Zung’s Self-Rating Depression Scale; Y-BOCS: Yale–Brown Obsessive-Compulsive Scale; ZWIK: Zwangsinventar für Kinder und Jugendliche/ a German questionnaire to dimensionally assess paediatric OC symptoms was completed by all participants and their parents. ∆: Difference.