Open Access Highly Accessed Case report

Compulsive carnival song whistling following cardiac arrest: a case study

A Rosaura Polak1*, Jasper W van der Paardt2, Martijn Figee1, Nienke Vulink1, Pelle de Koning1, Miranda Olff13 and Damiaan Denys14

Author Affiliations

1 Department of Anxiety Disorders, Academic Medical Center (AMC), University of Amsterdam (UvA), Meibergdreef 5, Amsterdam, 1105 AZ, the Netherlands

2 Emergency psychiatric hospital, Arkin Mental Health Care, 1e Constantijn Huygensstraat, 38, Amsterdam, 1054 BR, the Netherlands

3 Arq Psychotrauma Expert Group, Nienoord 5, Diemen, 1112 XE, the Netherlands

4 The Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, Amsterdam, 1105 BA, the Netherlands

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BMC Psychiatry 2012, 12:75  doi:10.1186/1471-244X-12-75

Published: 3 July 2012



Compulsivity is the repetitive, irresistible urge to perform a behavior, the experience of loss of voluntary control over this intense urge and the tendency to perform repetitive acts in a habitual or stereotyped manner. Compulsivity is part of obsessive-compulsive disorder (OCD), but may occasionally occur as stand-alone symptom following brain damage induced by cardiac arrest. In this case report, we describe a patient who developed compulsivity following cardiac arrest. We review diagnostic options, underlying mechanisms and possible treatments.

Case presentation

A 65-year-old man presented at our clinic with continuous compulsive whistling following cardiac arrest. Neither obsessive-compulsive symptoms, nor other psychiatric complaints were present prior to the hypoxic incident. An EEG showed diffuse hypofunction, mainly in baso-temporal areas. Treatment with clomipramine resulted in a decrease of whistling.


This case report illustrates de novo manifestation of compulsivity following cardiac arrest and subsequent brain damage and gives additional information on diagnostic options, mechanisms and treatment options. Differential diagnosis between stereotypies, punding, or OCD is difficult. Compulsivity following brain damage may benefit from treatment with serotonin reuptake inhibitors. This finding enhances our knowledge of treatments in similar cases.

OCD; Brain damage; Compulsive; Impulsive; Treatment; SRIs