Abstract
Schizophrenia is associated with widespread and complex cerebral blood flow (CBF) disturbance. Auditory verbal hallucinations (AVH) and insight are the core symptoms of schizophrenia. However, to the best of our knowledge, very few studies have assessed the CBF characteristics of the AVH suffered by schizophrenic patients with and without insight. Based on our previous findings, Using a 3D pseudo-continuous ASL (pcASL) technique, we investigated the differences in AVH-related CBF alterations in schizophrenia patients with and without insight. We used statistical parametric mapping (SPM8) and statistical non-parametric mapping (SnPM13) to perform the fMRI analysis. We found that AVH-schizophrenia patients without insight showed an increased CBF in the left temporal pole and a decreased CBF in the right middle frontal gyrus when compared to AVH-schizophrenia patients with insight. Our novel findings suggest that AVH-schizophrenia patients without insight possess a more complex CBF disturbance. Simultaneously, our findings also incline to support the idea that the CBF aberrant in some specific brain regions may be the common neural basis of insight and AVH. Our findings support the mostly current hypotheses regarding AVH to some extent. Although our findings come from a small sample, it provide the evidence that indicate us to conduct a larger study to thoroughly explore the mechanisms of schizophrenia, especially the core symptoms of AVHs and insight.
Highlights
Many previous studies, including our own, have confirmed that in schizophrenia patients with widespread and complex cerebral blood flow (CBF) disturbance, anti-psychotics can normalize the aberrant CBF [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15]
We found that AVHschizophrenia patients with and without insight demonstrated decreased CBF in the pivotal brain regions
We found only decreased CBF located in the aforementioned brain regions, which compose the pivotal components of the language and auditory network, self-monitoring related network, visual network, Figure 1: CBF alterations differences among Auditory verbal hallucinations (AVH)-schizophrenic patients without insight, with insight and healthy controls
Summary
Many previous studies, including our own, have confirmed that in schizophrenia patients with widespread and complex cerebral blood flow (CBF) disturbance, anti-psychotics can normalize the aberrant CBF [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15] These studies suggest that in these patients, with decreased CBF always located in the prefrontal and anterior cingulate cortices along with increased CBF in the striatum, the CBF alterations in the thalamus and temporal cortex showed that hyper or hypo CBF can coexist in these regions, CBF alterations showed a complex aberrant pattern, and some CBF alterations are associated with the core clinical symptoms of schizophrenia [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17]. These transmitters may be the pharmacological target for AVH treatment [26]
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