Hallucinations In Schizophrenia Research Articles

Hypoactivation of the language network during auditory imagery contributes to hallucinations in Schizophrenia

Auditory verbal hallucinations (AVHs) involve perceptions, often voices, in the absence of external stimuli, and rank among the most common symptoms of schizophrenia. Metrical stress evaluation requires determination of the stronger syllable in words, and therefore requires auditory imagery, of interest for investigation of hallucinations in schizophrenia. The current functional magnetic resonance imaging study provides an updated whole-brain network analysis of a previously published study on metrical stress, which showed reduced directed connections between Broca's and Wernicke's regions of interest (ROIs) for hallucinations. Three functional brain networks were extracted, with the language network (LN) showing an earlier and shallower blood-oxygen-level dependent (BOLD) response for hallucinating patients, in the auditory imagery condition only (the reduced activation for hallucinations observed in the original ROI-based results were not specific to the imagery condition). This suggests that hypoactivation of the LN during internal auditory imagery may contribute to the propensity to hallucinate. This accords with cognitive accounts holding that an impaired balance between internal and external linguistic processes (underactivity in networks involved in internal auditory imagery and overactivity in networks involved in speech perception) contributes to our understanding of the biological underpinnings of hallucinations.

The efficacy of low frequency repetitive transcial magnetic stimulation for treating auditory verbal hallucinations in schizophrenia: Insights from functional gradient analyses

BackgroundAuditory Verbal Hallucinations (AVH) constitute a prominent feature of schizophrenia. Although low-frequency repetitive transcranial magnetic stimulation (rTMS) has demonstrated therapeutic benefits in ameliorating AVH, the underlying mechanisms of its efficacy necessitate further elucidation. ObjectiveThis study investigated the cortical gradient characteristics and their associations with clinical responses in schizophrenia patients with AVH, mediated through 1 Hz rTMS targeting the left temporoparietal junction. MethodFunctional gradient metrics were employed to examine the hierarchy patterns of cortical organization, capturing whole-brain functional connectivity profiles in patients and controls. ResultsThe 1 Hz rTMS treatment effectively ameliorated the positive symptoms in patients, specifically targeting AVH. Initial evaluations revealed expanded global gradient distribution patterns and specific principal gradient variations in certain brain regions in patients at baseline compared to a control cohort. Following treatment, these divergent global and local patterns showed signs of normalizing. Furthermore, there was observed a closer alignment in between-network dispersion among various networks after treatment, including the somatomotor, attention, and limbic networks, indicating a potential harmonization of brain functionality. ConclusionLow-frequency rTMS induces alternations in principal functional gradient patterns, may serve as imaging markers to elucidate the mechanisms underpinning the therapeutic efficacy of rTMS on AVH in schizophrenia.

Soundless voices, silenced selves: are auditory verbal hallucinations in schizophrenia truly perceptual?

In much contemporary psychiatric training and practice, there is a strong emphasis on the audible or perceptual quality and externality of auditory verbal hallucinations in clinical assessments. A typical question during clinical assessment is asking whether the voices that a person hears sound identical to the way the clinician's voice is heard. In this Personal View, we argue that the most important factor in auditory verbal hallucinations in schizophrenia spectrum psychoses is a loss of first-person authority, and that a perceptual quality is not required for it to be this kind of hallucination. We draw on evidence from cognitive neuroscience showing that the activation of brain networks retrieved during capture of auditory verbal hallucinations that were experienced when a patient was in a functional MRI scanner does not match activation of networks retrieved during auditory perception. We propose that, despite early writings by Esquirol and Schneider that defined auditory verbal hallucinations as beliefs in perception rather than true perception, cognitive neuroscience, psychiatric training and practice, and patients adopting clinical vocabulary have been strongly influenced by the progression of the diagnostic criteria for schizophrenia, which increasingly place emphasis on language, such as the "full force" of a true perception. We hold that this change has resulted in an unhelpful top-down influence on the field, imposing perceptual qualities on auditory verbal hallucinations, and leading to misunderstandings and inaccuracies in clinical practice and patients' self-reports, and misinterpretations in cognitive neuroscience. We encourage a revision of the definition of auditory verbal hallucinations to move away from the necessity for auditory perception, and towards beliefs in perception due to the loss of first-person authority.

Network Localization of State and Trait of Auditory Verbal Hallucinations in Schizophrenia.

Neuroimaging studies investigating the neural substrates of auditory verbal hallucinations (AVH) in schizophrenia have yielded mixed results, which may be reconciled by network localization. We sought to examine whether AVH-state and AVH-trait brain alterations in schizophrenia localize to common or distinct networks. We initially identified AVH-state and AVH-trait brain alterations in schizophrenia reported in 48 previous studies. By integrating these affected brain locations with large-scale discovery and validation resting-state functional magnetic resonance imaging datasets, we then leveraged novel functional connectivity network mapping to construct AVH-state and AVH-trait dysfunctional networks. The neuroanatomically heterogeneous AVH-state and AVH-trait brain alterations in schizophrenia localized to distinct and specific networks. The AVH-state dysfunctional network comprised a broadly distributed set of brain regions mainly involving the auditory, salience, basal ganglia, language, and sensorimotor networks. Contrastingly, the AVH-trait dysfunctional network manifested as a pattern of circumscribed brain regions principally implicating the caudate and inferior frontal gyrus. Additionally, the AVH-state dysfunctional network aligned with the neuromodulation targets for effective treatment of AVH, indicating possible clinical relevance. Apart from unifying the seemingly irreproducible neuroimaging results across prior AVH studies, our findings suggest different neural mechanisms underlying AVH state and trait in schizophrenia from a network perspective and more broadly may inform future neuromodulation treatment for AVH.

Functional Connectivity of Language-Related Cerebellar Regions Is Reduced in Schizophrenia Patients.

Schizophrenia (SZ) is a widespread psychiatric disorder that is traditionally characterized by positive and negative symptoms. However, recent focus has shifted to cognitive deficits as a crucial aspect. The cerebellum, conventionally tied to motor coordination, is now recognized as pivotal in the pathophysiology of SZ cognitive impairments. Proposed disruptions in the cortico-cerebellar-thalamic-cortico circuit contribute to these deficits. Despite evidence of cerebellar abnormalities, within-cerebellum functional connectivity is often overlooked. This study explores spontaneous functional interactions within the cerebellum and their link to cognitive deficits in SZ. Using a multi-domain task battery (MDTB) parcellation, fMRI data from SZ patients and healthy controls were analyzed. Significant differences in cerebellar connectivity emerged, particularly in regions related to attention, language, and memory processing. Correlations between connectivity values and SZ symptomatology were identified. A post hoc analysis, considering the patients' hallucination vulnerability, revealed distinct connectivity patterns. Non-hallucinating and low-hallucinating SZ patients exhibited higher cerebellar connectivity than high-hallucinating patients, especially in language and motor control regions. These findings suggest a gradient of cerebellar connectivity alterations corresponding to hallucination vulnerability in SZ patients. This study offers novel insights into cerebellar impairments in SZ, highlighting the role of within-cerebellum connectivity in cognitive deficits. The observed connectivity patterns in language-related regions contribute to understanding language development and auditory verbal hallucinations in SZ.

Uniqueness of auditory hallucinations in patients with schizophrenia and depressive disorder

ABSTRACT Background: While over three-quarters of those suffering from schizophrenia and schizophrenia-like illnesses experience auditory hallucinations, 6% of individuals with depressive disorder report the same. Differentiating between auditory hallucinations in these two illnesses is important both diagnostically and prognostically. Aim: To compare the characteristics of auditory hallucinations in patients with schizophrenia and depressive disorder. Materials and Methods: For both schizophrenia and depressive disorder, 110 patients were selected from inpatients of a tertiary care psychiatric center by purposive sampling. They were assessed with a specially designed proforma containing sociodemographic information, information about clinical features, and characteristics of the Auditory Hallucination Scale. Results: Schizophrenia and depressive disorder patients were matched on age, education, occupation, and socioeconomic status. The patients with schizophrenia rated significantly higher on frequency, clarity, tone, intensity, distractibility, self-control, and distress dimensions of auditory hallucinations as compared to patients with depressive disorder. Conclusion: The characteristics of auditory hallucinations in schizophrenia differ significantly than those in depressive disorder, which bears significant transdiagnostic importance. Clinical evaluation of these differentiating characteristics of auditory hallucinations may aid in diagnostic workup in patients.

Pons-to-Cerebellum Hypoconnectivity Along the Psychosis Spectrum and Associations With Sensory Prediction and Hallucinations in Schizophrenia

BackgroundSensory prediction allows the brain to anticipate and parse incoming self-generated sensory information from externally generated signals. Sensory prediction breakdowns may contribute to perceptual and agency abnormalities in psychosis (hallucinations, delusions). The pons, a central node in a cortico-ponto-cerebellar-thalamo-cortical circuit, is thought to support sensory prediction. Examination of pons connectivity in schizophrenia and its role in sensory prediction abnormalities is lacking. MethodsWe examined these relationships using resting-state functional magnetic resonance imaging and the electroencephalography-based auditory N1 event-related potential in 143 participants with psychotic spectrum disorders (PSPs) (with schizophrenia, schizoaffective disorder, or bipolar disorder); 63 first-degree relatives of individuals with psychosis; 45 people at clinical high risk for psychosis; and 124 unaffected comparison participants. This unique sample allowed examination across the psychosis spectrum and illness trajectory. Seeding from the pons, we extracted average connectivity values from thalamic and cerebellar clusters showing differences between PSPs and unaffected comparison participants. We predicted N1 amplitude attenuation during a vocalization task from pons connectivity and group membership. We correlated participant-level connectivity in PSPs and people at clinical high risk for psychosis with hallucination and delusion severity. ResultsCompared to unaffected comparison participants, PSPs showed pons hypoconnectivity to 2 cerebellar clusters, and first-degree relatives of individuals with psychosis showed hypoconnectivity to 1 of these clusters. Pons-to-cerebellum connectivity was positively correlated with N1 attenuation; only PSPs with heightened pons-to-postcentral gyrus connectivity showed this pattern, suggesting a possible compensatory mechanism. Pons-to-cerebellum hypoconnectivity was correlated with greater hallucination severity specifically among PSPs with schizophrenia. ConclusionsDeficient pons-to-cerebellum connectivity linked sensory prediction network breakdowns with perceptual abnormalities in schizophrenia. Findings highlight shared features and clinical heterogeneity across the psychosis spectrum.

Sensory Attenuation Deficit and Auditory Hallucinations in Schizophrenia: A Causal Mechanism or a Risk Factor? Evidence From Meta-Analyses on the N1 Event-Related Potential Component

BackgroundSensory attenuation (SA), the dampened perception of self-generated sensory information, is typically associated with reduced event-related potential signals, such as for the N1 component of auditory event-related potentials. SA, together with efficient monitoring of intentions and actions, should facilitate the distinction between self-generated and externally generated sensory events, thereby optimizing interaction with the world. According to many, SA is deficient in schizophrenia. The question arises whether altered SA reflects a sufficient mechanism to explain positive symptoms such as auditory hallucinations. A systematic association of reduced auditory SA in hallucinating patients would support this hypothesis. MethodsWe conducted a series of meta-analyses on 15 studies on auditory SA in which the N1 component of event-related potential–electroencephalogram signals was measured during talking (self-generated sensory signals condition) or when listening to prerecorded vocalizations (externally generated sensory signals condition). ResultsWe found that individuals with schizophrenia did show some auditory SA because their N1 signal was significantly attenuated in talking conditions compared with listening conditions. However, the magnitude of such attenuation was reduced in individuals with schizophrenia compared to healthy control participants. This phenomenon generalizes independently from the stage of the disease, the severity of positive symptoms, and whether patients have auditory hallucinations or not. ConclusionsThese findings suggest that reduced SA cannot be a sufficient mechanism for explaining positive symptoms such as auditory hallucinations in schizophrenia. Because reduced SA was also present in participants at risk of schizophrenia, reduced SA may represent a risk factor for the disorder. We discuss the implications of these results for clinical-cognitive models of schizophrenia.

Sulcal pits of the superior temporal sulcus in schizophrenia patients with auditory verbal hallucinations.

Auditory verbal hallucinations (AVHs) are among the most common and disabling symptoms of schizophrenia. They involve the superior temporal sulcus (STS), which is associated with language processing; specific STS patterns may reflect vulnerability to auditory hallucinations in schizophrenia. STS sulcal pits are the deepest points of the folds in this region and were investigated here as an anatomical landmark of AVHs. This study included 53 patients diagnosed with schizophrenia and past or present AVHs, as well as 100 healthy control volunteers. All participants underwent a 3-T magnetic resonance imaging T1 brain scan, and sulcal pit differences were compared between the two groups. Compared with controls, patients with AVHs had a significantly different distributions for the number of sulcal pits in the left STS, indicating a less complex morphological pattern. The association of STS sulcal morphology with AVH suggests an early neurodevelopmental process in the pathophysiology of schizophrenia with AVHs.

Auditory hallucinations in schizophrenia: Psychoeducation among caregivers to help patients develop effective coping strategies

Background: Hallucinations are common symptoms experienced by patients with schizophrenia. These hallucinations pose difficulties in control, becoming a burden for caregivers providing care. Meanwhile, psychoeducation utilizing modules and videos to treat auditory hallucinations has not been previously implemented. Psychoeducation is beneficial in managing caregiver burden, yet the psychoeducation content hasn't been specific to auditory hallucinations.Purpose: To determine the influence of psychoeducation using modules and videos to help patients develop effective coping strategies, and burden among caregiversMethod: A quantitative study with a pre-experimental design using a pre-test and post-test approach. This research was conducted to measure caregiver burden before and after the intervention. The intervention involved providing psychoeducation using modules and videos for caring for auditory hallucinations, while the control group received psychoeducation using only modules. The study was conducted at the outpatient clinic of Jambi Regional Mental Hospital from July to September 2023.Results: There was a significant difference in caregiver burden (p-value 0.000) in the intervention group before and after treatment. There was a significant difference in caregiver burden (p-value 0.000) in the control group before and after treatment. There was no significant difference in caregiver burden (p-value 0.161) between the intervention and control groups one month after the intervention.Conclusion: Psychoeducation with modules and videos can reduce caregiver burden in schizophrenia patients. Psychiatric nurses should educate caregivers using modules and videos for caring for auditory hallucinations as part of reducing the caregiving burden.Suggestion: Healthcare professionals should also provide psychoeducation using auditory hallucination care modules and videos to caregivers on managing the caregiving burden for individuals with schizophrenia experiencing auditory hallucinations. Caregivers are encouraged to understand the module book and video on auditory hallucination care as a form of continued care at home for individuals with schizophrenia experiencing auditory hallucinations.

Reduced neural connectivity in the caudate anterior head predicts hallucination severity in schizophrenia.

Caudate functional abnormalities have been identified as one critical neural substrate underlying sensory gating impairments that lead to auditory phantom hallucinations in both patients with schizophrenia (SZ) and tinnitus, characterized by the perception of internally generated sounds in the absence of external environmental auditory stimuli. In this study, we tested the hypothesis as to whether functional connectivity abnormalities in distinct caudate subdivisions implicated in sensory gating and auditory phantom percepts in tinnitus, which are currently being localized for neuromodulation targeting using deep brain stimulation techniques, would be associated with auditory phantom hallucination severity in SZ. Twenty five SZ and twenty eight demographically-matched healthy control (HC) participants, completed this fMRI resting-state study and clinical assessments. Between-group seed-to-voxel analyses revealed only one region, the caudate anterior head, which showed reduced functional connectivity with the thalamus that survived whole-brain multiple comparison corrections. Importantly, connectivity between the caudate anterior head with thalamus negatively correlated with hallucination severity. In the present study, we deliver the first evidence of caudate subdivision specificity for the neural pathophysiology underlying hallucinations in schizophrenia within a sensory gating framework that has been developed for auditory phantoms in patients with tinnitus. Our findings provide transdiagnostic convergent evidence for the role of the caudate in the gating of auditory phantom hallucinations, observed across patients with SZ and tinnitus by specifying the anterior caudate division is key to mediation of hallucinations, and creating a path towards personalized treatment approaches to arrest auditory phantom hallucinations from reaching perceptual awareness.

A detailed examination of pitch discrimination deficits associated with auditory verbal hallucinations in schizophrenia.

Individuals with schizophrenia spectrum disorders (SSD) and a history of experiencing auditory verbal hallucinations (AVH) exhibit poor pitch discrimination relative to those with an SSD but no AVH history. The present study extended this research, asking if a lifetime history, and the current presence, of AVH exacerbated the pitch discrimination challenges that are seen in SSD. Participants completed a pitch discrimination task, where the tones presented differed in pitch by either 2%, 5%, 10%, 25% or 50%. Pitch discrimination accuracy, sensitivity, reaction time (RT) and intra-individual RT variability (IIV) were examined in individuals with SSD and AVHs (AVH+; n=46), or without AVHs (AVH-; n=31), and healthy controls (HC; n=131). Secondary analyses split the AVH+ group into state (i.e., actively experiencing AVH; n=32) and trait hallucinators (i.e., a history of, but not actively experiencing, AVH; n=16). Relative to HC, significantly poorer accuracy and sensitivity was detected in individuals with SSD at 2% and 5% pitch deviants, and in hallucinators at 10%; however, no significant differences in accuracy, sensitivity, RT nor IIV were found between AVH+ and AVH- groups. No differences between state and trait hallucinators were observed. A general SSD deficit drove the current findings. The findings may inform future research into the auditory processing capabilities of AVH+ individuals.

CASES OF CRIMES COMMITTED BY PEOPLE SUFFERING FROM SCHIZOPHRENIA AN ATTEMPT TO BRING THE PROBLEM CLOSER

The article presents in detail the issue of punishable criminal acts in the course of severe, especially untreated schizophrenia. Psychiatric and legal awareness is high among experts, while stereotypes and myths that harm calm people with schizophrenia, who outnumber aggressive ones, still exist in wide circles of society. Just like among the healthy, i.e. mentally normalized, there are crimes, so also in the population of schizophrenics, who constitute only 1% of the population, there are statistically cases of aggression. Most often, patients commit prohibited acts after discontinuing pharmacological treatment, which, according to the unanimous opinion of psychiatrists, should be the basis of therapy for this disease. Also very often the families and friends of schizophrenic people deny the biological nature of schizophrenia and persuade them to discontinue or reduce the dose of medication, which in most cases ends in exacerbation or even full-blown relapse. A patient who, under the influence of the most frequently heard whispers and voices in the head (auditory hallucinations, the most common hallucination in schizophrenia), which tell him to kill himself and/or someone else, is often not sane at all, commanded by commanding voices and cannot go to prison where his mental state would deteriorate further. Compulsory treatment is the only way to protect the life and health of both the patient and people around them. The only way to prevent crimes in schizophrenia, especially the most serious ones (murder, rape, robbery), is psychoeducation of the society in the basic knowledge of psychopathology and the acquisition of a healthy habit of not being indifferent, but reacting to any disturbing signals.

Mindfulness trait mediates between schizotypy and hallucinatory experiences

Schizotypy is a personality trait in healthy people that is related to schizophrenic symptoms. People with high schizotypy tend to have hallucinatory experiences. The relationship between high schizotypy and hallucinatory experiences could be explained by mindfulness traits and stress. To test our hypothesized model, we conducted a preregistered online survey in a Japanese non-clinical sample. In the preregistered analysis, structural equation modeling revealed that our model insufficiently fit our data and stress did not mediate between schizotypy and hallucinatory experiences. However, consistent with our hypothesis, mindfulness traits mediated between them. Exploratory analysis revealed that the model including three facets of mindfulness traits (i.e., observing, acting with awareness, and non-judging) as mediators fit our data best. These findings suggest that attention to current experiences could be a key factor in understanding the cognitive mechanisms underlying hallucinatory experiences in schizotypy and hallucinations in schizophrenia.

The moderating effect of cognitive impairment on the relationship between inner speech and auditory verbal hallucinations among chronic patients with schizophrenia

BackgroundEven though there is an increasing amount of evidence from behavioral and neuroimaging studies to suggest that pathological inner speech plays a role in the emergence of auditory verbal hallucinations (AVH), studies investigating the mechanisms underlying this relationship are rather scarce. Examining moderators might inform the development of new treatment options for AVH. We sought to extend the existing knowledge by testing the moderating role of cognitive impairment in the association between inner speech and hallucinations in a sample of Lebanese patients with schizophrenia.MethodsA cross-sectional study was conducted from May till August 2022, enrolling 189 chronic patients.ResultsModeration analysis revealed that, after controlling for delusions, the interaction of experiencing voices of other people in inner speech by cognitive performance was significantly associated with AVH. In people having low (Beta = 0.69; t = 5.048; p < .001) and moderate (Beta = 0.45; t = 4.096; p < .001) cognitive performance, the presence of voices of other people in inner speech was significantly associated with more hallucinations. This association was not significant in patients with high cognitive function (Beta = 0.21; t = 1.417; p = .158).ConclusionThis preliminarily study suggests that interventions aiming at improving cognitive performance may also have a beneficial effect in reducing hallucinations in schizophrenia.

The effectiveness of application of drawing activity occupational therapy against auditory hallucination symptoms

Auditory hallucinations are the most common hallucinations in schizophrenia, experienced by more than 60% of people with schizophrenia. Patients who have hallucinations often become irrational and lose control of their actions, which can lead to homicide, suicide, and environmental destruction. This study aims to examine the effects of occupational therapy drawing exercises on auditory hallucination symptoms. This study used a quasi-experimental control group technique with a sample size of 40 respondents. The results showed an impact of occupational therapy on drawing activity on auditory hallucinations symptoms, with a p-value of 0.000, and a significant difference in the reduction of auditory hallucinations symptoms between the intervention and control group after occupational therapy with a drawing activity. Patients with auditory hallucinations are advised to engage in occupational therapy drawing activities to alleviate their symptoms.

12. Sensory Attenuation Elicited by Inner Speech and its Role for Auditory Hallucinations in Schizophrenia

12. Sensory Attenuation Elicited by Inner Speech and its Role for Auditory Hallucinations in Schizophrenia

73. Accelerated Low Frequency RTMS for Treatment-Resistant Auditory Hallucinations in Schizophrenia

73. Accelerated Low Frequency RTMS for Treatment-Resistant Auditory Hallucinations in Schizophrenia

Phenomenology of auditory verbal hallucination in schizophrenia: An erroneous perception or something else?

This study presents phenomenological features of auditory verbal hallucinations (AVH) in schizophrenia and associated anomalies of experience. The purpose is to compare the lived experience of AVH to the official definition of hallucinations as a perception without object. Furthermore, we wish to explore the clinical and research implication of the phenomenological approach to AVH. Our exposition is based on classic texts on AVH, recent phenomenological studies and our clinical experience. AVH differ on several dimensions from ordinary perception. Only a minority of schizophrenia patients experiences AVH localized externally. Thus, the official definition of hallucinations does not fit the AVH in schizophrenia. AVH are associated with several anomalies of subjective experiences (self-disorders) and the AVH must be considered as a product of self-fragmentation. We discuss the implications with respect to the definition of hallucination, clinical interview, conceptualization of a psychotic state and potential target of pathogenetic research.

Discrimination of auditory verbal hallucination in schizophrenia based on EEG brain networks

Auditory verbal hallucinations (AVH) are a core positive symptom of schizophrenia and are regarded as a consequence of the functional breakdown in the related sensory process. Yet, the potential mechanism of AVH is still lacking. In the present study, we explored the difference between AVHs (n = 23) and non-AVHs (n = 19) in schizophrenia and healthy controls (n = 29) by using multidimensional electroencephalograms data during an auditory oddball task. Compared to healthy controls, both AVH and non-AVH groups showed reduced P300 amplitudes. Additionally, the results from brain networks analysis revealed that AVH patients showed reduced left frontal to posterior parietal/temporal connectivity compared to non-AVH patients. Moreover, using the fused network properties of both delta and theta bands as features for in-depth learning made it possible to identify the AVH from non-AVH patients at an accuracy of 80.95%. The left frontal-parietal/temporal networks seen in the auditory oddball paradigm might be underlying biomarkers of AVH in schizophrenia. This study demonstrated for the first time the functional breakdown of the auditory processing pathway in the AVH patients, leading to a better understanding of the atypical brain network of the AVH patients.