Abstract
Schizophrenic patients often experience auditory hallucinations (AHs) and visual hallucinations (VHs). However, brain and retinal alterations associated with combined AHs and VHs in schizophrenic patients are unknown. This study aimed o investigate brain and retinal alterations in first episode un-treated schizophrenic patients with combined AHs and VHs (FUSCHAV). FUSCHAV patients (n = 120), divided into four groups according to severity of AH and VH symptoms, were compared to healthy controls (n = 30). Gray matter volume (GMV) and global functional connectivity density (gFCD) were recorded to reflect brain structure and functional alterations. Total retinal thickness was acquired by optical coherence tomography to assess retinal impairment. The majority of FUSCHAV patients (85.8%) demonstrated both GMV reduction and gFCD increases along with retinal thinning compared to healthy controls. The severity of GMV reduction and gFCD increase differed between patient groups, ranked from highest to lowest severity as follows: severe AHs combined with severe VHs (FUSCHSASV, 20 patients), moderate AHs combined with severe VHs (FUSCHMASV, 23 patients), severe AHs combined with moderate VHs (FUSCHSAMV, 28 patients), and moderate AHs combined with moderate VHs (FUSCHMAMV, 26). Retinal impairment was similar among the four FUSCHAV groups. GMV reduction and gFCD increases in the frontal-parietal lobule show an inverted U-shaped pattern among FUSCHAV patients according to AH and VH severity, while retinal impairment remains stable among FUSCHAV groups. These findings indicate a reciprocal deterioration in auditory and visual disturbances among FUSCHAV patients.
Highlights
Auditory perceptual disturbances in patients with schizophrenia are generally experienced as auditory hallucinations (AHs) (Pinheiro et al 2019)
According to the above classification rule, we established four groups: severe AHs combined with severe visual hallucinations (VHs) (FUSCHSASV, 20 patients); middle to moderate AHs combined with severe VHs (FUSCHMASV, 23 patients); severe AHs combined with middle to moderate VHs (FUSCHSAMV, 28 patients); and middle to moderate AHs combined with middle to moderate VHs (FUSCHMAMV, 26 patients)
magnetic resonance imaging (MRI) data from five patients and optical coherence tomography (OCT) data from two patients were excluded from analysis due to poor acquisition quality
Summary
Auditory perceptual disturbances in patients with schizophrenia are generally experienced as auditory hallucinations (AHs) (Pinheiro et al 2019). Studies have focused on the brain pathology associated with AHs and several hypotheses have been established (Baumeister et al 2017; Blom 2015; Hugdahl and Sommer 2018; Northoff 2014). While these hypotheses have not been met with full acceptance, these prior studies have provided many important findings on the brain mechanisms associated with AHs (Huang et al 2019; Stephane 2019; Zmigrod et al 2016). According to some reports, visual disturbances can be used as an index for symptoms, endophenotypes, biomarkers, and predictors for the study of the clinical, pathological and physiological features of schizophrenia (Garcia-Portilla et al 2019; Guidotti and Grayson 2011)
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