Abstract
ObjectivesNegative emotional valence of auditory verbal hallucinations (AVHs) in schizophrenia can be a source of distress and is considered a strong predictor of illness severity. Previous studies have found glutamate to mediate AVH severity in frontal and temporal brain regions, however, they do not specifically address emotional valence of AVH. The role of glutamate for the experience of negative‐ versus positive emotional valence of AVH is therefore unknown and was investigated in the current study.MethodsUsing magnetic resonance spectroscopy (MRS), 37 schizophrenia patients had Glx (glutamate+glutamine) measured in the left superior temporal gyrus (STG), and additionally in the anterior cingulate cortex (ACC) and the right STG, or in the left inferior frontal gyrus (IFG). Self‐reported emotional valence in AVH was measured with the Beliefs About Voices Questionnaire (BAVQ‐R).ResultsResults from linear mixed models showed that negative emotional valence was associated with reduced Glx levels across all four measured brain regions in the frontal and temporal lobe. More specifically, voices that were experienced to be omnipotent (p = 0.04) and that the patients attempted to resist (p = 0.04) were related to lower Glx levels. Follow‐up analysis of the latter showed that voices that evoked emotional resistance (i.e., fear, sadness, anger), rather than behavioral resistance, was a significant predictor of reduced glutamate (p = 0.02).ConclusionThe findings could indicate aberrant glutamatergic signaling, or increased NMDA‐receptor hypoactivity in patients who experience their voices to be more emotionally negative. Overall, the study provides support for the glutamate hypothesis of schizophrenia.
Highlights
Auditory verbal hallucinations (AVHs), auditory experiences in the absence of an external acoustic input (Ford et al, 2012; Hugdahl, 2009; Waters et al, 2006), are a key symptom in schizophrenia, and are present in about 70% of the patients (Mueser et al, 1990)
The current study aimed to investigate the relationship between self-experienced and self-reported aspects of auditory verbal hallucinations (AVHs), as measured with the Beliefs About Voices Questionnaire (BAVQ-R) questionnaire, and glutamate levels, as measured with magnetic resonance spectroscopy (MRS)
Multivariate analyses were conducted for each BAVQ-R sub-scale
Summary
Auditory verbal hallucinations (AVHs), auditory experiences in the absence of an external acoustic input (Ford et al, 2012; Hugdahl, 2009; Waters et al, 2006), are a key symptom in schizophrenia, and are present in about 70% of the patients (Mueser et al, 1990) This symptom can be a source of great distress, as hallucinations often take form of voices harassing or commanding the individual to do things against their will. The cognitive theory of AVHs (Chadwick & Birchwood, 1994) suggests that beliefs the patient has regarding the intent of the voice (malevolence or benevolence) and power of the voice (omnipotence) are critical for how the patient will handle and cope with the voice (van der Gaag et al, 2003). Two subscales measure voice intent, the Malevolence and Benevolence subscales Another subscale, the Omnipotence scale, captures how powerful the patient experiences the voice to be. The BAVQ-R includes two additional subscales, Resistance and Engagement, which capture the patient’s relationship to the voice, that is, how the patient responds emotionally and behaviorally to the voice
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