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CORRESPONDENCE Letters of 600 words or less, with minimal allowance for tables, figures, and references, will be considered for publication. Rules regarding prior publication, conflict of interest, etc., are the same as for full manuscripts. All letters are subject to editing and condensation. Proofs will not be distributed.

Humming, Auditory Hallucinations, and Dystonia To the Editor: Green and Kinsboume (1989) have recently reported in your journal that humming significantly reduces auditory hallucinations. Bick and Kinsbourne (1987) found that mouth opening also attenuated hallucinations, although Green and Kinsboume did not replicate this. These phenomena suggest another intriguing possible explanation beside those discussed by the authors. Over the past decade, a wealth of new data has been elaborated to suggest that the basal ganglia may mediate circuitry important to psychiatric conditions. Limbic connections to the basal ganglia (Nauta !989; Alexander et al. 1986) and the increased prevalence of psychiatric disorders in basal ganglia diseases (Cummings 1985) have added new strength to the hypothesis that the basal ganglia are important in schizophrenia (Schneider 1984). Early et al. (1987) have presented positron emission tomography (PET) scan evidence suggesting that the globus pallidus or striatum may be involved in schizophrenia. The data of Green and Kinsboume and Bick and Kinsbourne are strikingly similar to primary idiopathic dystonia, which appears to be a disorder of the pallidum or striatum (Chase et al. 1988; Gilman et al. 1988; Perlmutter and Raichle 1988). Alleviation by "sensory tricks" has been considered pathognomonic for dystonia (Fahn 1986), and is thought to be due to tactile or proprioceptive sensory input which may alter the abnormal firing pattern of the basal ganglia (Falm 1985), though this remains to be proven. Influence by sensory tricks has been considered evidence that a disorder is dystonic in nature (Fahn 1985; Weiner and Nora 1984), thus, probably a basal ganglia disorder (Sheehy and Marsden !982; Rothwell et al. 1983). A particular form of dystonia, Meige's Syndrome, is known to improve with sensory tricks such as humming, chewing, vocalizing, talking, and singing (Jankovic 1985; Fahn 1985, 1986). Humming is specifically considered to be a sensory trick and

© 1990Societyof BiologicalPsychiatry

not merely a distracting manuever. Indeed, relief of Meige's Syndrome by such sensory tricks is cited as evidence that the syndrome is an organic dystonia rather than of psychological etiology (Weiner and Nora 1984). In fact, relief of dystonia by distraction is evidence against dystonia and argues for a psychogenic conversion disorder instead (Fahn and Williams 1988; KoUer et al. 1989). Could sensory trick phenomena account for the relief from hallucinosis afforded by humming? Alexander et al. (1986) have provided evidence of at least five parallel circuits coursing through the basal ganglia. Motor and anterior cingulate circuits may be important in dystonia and schizophrenia, respectively. The similarities of PET scan data and "trick" phenomena in both schizophrenia and dystonia are interesting and, among other considerations, may be suggestive of similar basal ganglia pathology, albeit in different parallel circuits. Edward C. Lauterbach

Department of Psychiatry Mercer University School of Medicine 1550 College St. Macon, GA 31.207

References Alexander GE, DeLong MR, Strick PL (1986): Parallel organization of functionallysegregated circuits linking basal ganglia and cortex. Annu Rev Neurosci 9:357381.

Bick PA, Kinsboume M (1987): Auditory hallucinations and subvocal speech in schizophrenic patients. Am J Psychiatry 144:222-225. Chase TN, Tamminga CA, Burrows H (1988): Positron emission tomographic studies of regional cerebral glucose metabolism in idiopathic dystonia. In Fahn S, Marsden CD, Calne DB (ed), Dystonia 2. New York: Raven Press, pp 237-241. (Adv Neurol, Vol 50). CummingsJL (1985): Psychosomaticaspects of movement disorders. In Trimble MR (ed), Interface Between Neurology and Psychiatry. Basel: Karger, pp 111-132. (Adv Psychosom Med, Vol 13). 0006-3223/90/$03.50

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Early TS, Reiman EM, Raichle ME, Spitznagel EL (1987): Left globus pallidus abnormality in never-medicated patients with schizophrenia. Scien,'e 84:561-563. Fahn S (1985): Blepharospasm: a focal dystonia. In Smith BC, Bosniak SL (ed), Blepharospasm. New York: Pergamon Press, pp 87-92. (Adv Ophthalmic Plast Reconstr Surg, Vol 4). Fahn S (1986): Generalized dystonia: concept and treatment. Clin Neuropharmacol 9 Suppl 2:$37-48. Fahn S, Williams DT (1988): Psychogenic dystonia. In Fahn S, Marsden CD, Calne DB (ed), Dystonia 2. New York: Raven Press, pp 431-455. (Adv Neurol, Vol 50). Gilman S, Junck L, Young AB, Hichwa RD, Markel DS, Koeppe RA, Ehrenkaufer RLE (1988): Cerebral metabolic activity in idiopathic dystonia studied with positron emission tomography. In Fahn S, Marsden CD, Calne DB (ed), Dystonia 2. New York: Raven Press, pp 231236. (Adv Neurol, Vol 50). Green MF, Kinsbourne M (i989): Auditory hallucinations in schizophrenia: Does humming help,?Biol Psychiatry 25:630-633. Jankovic J (1985): Clinical featur,es, differential diagnosis, and pathogenesis of blepharo~pasm and cranial-cervical dystonia. In Smith BC, Bosniak SL (ed), Blepharos-

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pasm. New York: Pergamon Press, pp 67-82. (Adv Ophthalmic Plast Reconstr Surg, Vol 4). Koller W, Lang A, Vetere-Overlield B, et al. (1989): Psychogenic tremors. Neurology 39:1094-1099. Nauta WSH (1989): Reciprocal links of the corpus striatum with the cerebral cortex and limbic system: A common substrate for movement and thoughr? In Mueller J (ed), Neurology and Psychiatry: A Meeting of the Minds. Basel: Karger, pp 43-63. Perlmutter JS, Raichle ME (1988): Regional cerebral blood flow in dystonia: an exploratory study. In Fahn S, Marsdel, CD, Calne DB (ed), Dystonia 2. New York: Raven i'~ess, pp 255-264. (Adv Neurol, Voi 50). Rothwell JC, Obeso JA, Day BL. Pathophysiology of dystonias. In Desmedt JE (ed), Motor Control Mechanisms in Health and Disease. New York: Raven Press, pp 851863. Schneider JS (1984): Basal ganglia role in behavior: Importance of sensory gating and its relevance to psychiatry. Biol Psychiatry 19:1693-1710. Sheehy MP, Marsden CD (1982): Writers' cramp---a focal dystonia. Brain 105:461-480. Weiner WJ, Nora LM (1984): "Trick" movements in facial dystonia. J Clin Psychiatry 45:519-521.

Humming, auditory hallucinations, and dystonia.

934 BIOLPSYCHIATRY 1990:27:93,~935 CORRESPONDENCE Letters of 600 words or less, with minimal allowance for tables, figures, and references, will be...
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