Hallucination- and speech-specific hypercoupling in frontotemporal auditory and language networks in schizophrenia using combined task-based fMRI data: An fBIRN study

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.

Functional and structural effects of repetitive transcranial magnetic stimulation (rTMS) for the treatment of auditory verbal hallucinations in schizophrenia: A systematic review

BACKGROUND

Auditory verbal hallucinations (AVH) are a disabling symptom for people with schizophrenia (SCZ), and do not always respond to antipsychotics. Repetitive transcranial magnetic stimulation (rTMS) has shown efficacy for medication-refractory AVH, though the underlying neural mechanisms by which rTMS produces these effects remain unclear. This systematic review evaluated the structural and functional impact of rTMS for AVH in SCZ, and its association with clinical outcomes.

METHODS

A systematic search was conducted in Medline, PsychINFO, and PubMed using terms for four key concepts: AVH, SCZ, rTMS, neuroimaging. Using PRISMA guidelines, 18 studies were identified that collected neuroimaging data of an rTMS intervention for AVH in SCZ. Risk of bias assessments was conducted.

RESULTS

Low frequency (<5 Hz) rTMS targeting left hemispheric language processing regions may normalize brain abnormalities in AVH patients at structural, functional, electrophysiological, and topological levels, with concurrent symptom improvement. Amelioration of aberrant neural activity in frontotemporal networks associated with speech and auditory processing was commonly observed, as well as in cerebellar and emotion regulation regions. Neuroimaging analyses identified neural substrates with direct correlations to post-rTMS AVH severity, propounding their use as therapeutic targets.

DISCUSSION

Combined rTMS-neuroimaging highlights the multidimensional alterations of rTMS on brain activity and structure in treatment-resistant AVH, which may be used to develop more efficacious therapies. Larger randomized, sham-controlled studies are needed. Future studies should explore alternate stimulation targets, investigate the neural effects of high-frequency rTMS and evaluate long-term neuroimaging outcomes.

Low-frequency rTMS induces modifications in cortical structural connectivity - functional connectivity coupling in schizophrenia patients with auditory verbal hallucinations

Auditory verbal hallucinations (AVH) are distinctive clinical manifestations of schizophrenia. While low-frequency repetitive transcranial magnetic stimulation (rTMS) has demonstrated potential in mitigating AVH, the precise mechanisms by which it operates remain obscure. This study aimed to investigate alternations in structural connectivity and functional connectivity (SC-FC) coupling among schizophrenia patients with AVH prior to and following treatment with 1 Hz rTMS that specifically targets the left temporoparietal junction. Initially, patients exhibited significantly reduced macroscopic whole brain level SC-FC coupling compared to healthy controls. Notably, SC-FC coupling increased significantly across multiple networks, including the somatomotor, dorsal attention, ventral attention, frontoparietal control, and default mode networks, following rTMS treatment. Significant alternations in SC-FC coupling were noted in critical nodes comprising the somatomotor network and the default mode network, such as the precentral gyrus and the ventromedial prefrontal cortex, respectively. The alternations in SC-FC coupling exhibited a correlation with the amelioration of clinical symptom. The results of our study illuminate the intricate relationship between white matter structures and neuronal activity in patients who are receiving low-frequency rTMS. This advances our understanding of the foundational mechanisms underlying rTMS treatment for AVH.

Impact of low-frequency repetitive transcranial magnetic stimulation on functional network connectivity in schizophrenia patients with auditory verbal hallucinations

Auditory verbal hallucinations (AVH) are a key symptom of schizophrenia. Low-frequency repetitive transcranial magnetic stimulation (rTMS) has shown potential in the treatment of AVH. However, the underlying neural mechanismof rTMS in the treatment of AVH remains largely unknown. In this study, we used a static and dynamic functional network connectivity approach to investigate the connectivity changes among the brain functional networks in schizophrenia patients with AVH receiving 1 Hz rTMS treatment. The static functional network connectivity (sFNC) analysis revealed that patients at baseline had significantly decreased connectivity between the default mode network (DMN) and language network (LAN), and within the executive control network (ECN) as well as within the auditory network (AUD) compared to controls. However, the abnormal network connectivity patterns were normalized or restored after rTMS treatment in patients, instead of increased connectivity between the ECN and LAN, as well as within the AUD. Moreover, the dynamic functional network connectivity (dFNC) analysis showed that the patients at baseline spent more time in this state that was characterized by strongly negative connectivity between the ENC and AUD, as well as within the AUD relative to controls. While after rTMS treatment, the patients showed a higher occurrence rate in this state that was characterized by strongly positive connectivity among the LAN, DMN, and ENC, as well as within the ECN. In addition, the altered static and dynamic connectivity properties were associated with reduced severity of clinical symptoms. Both sFNC and dFNC analyses provided complementary information and suggested that low-frequency rTMS treatment could induce intrinsic functional network alternations and contribute to improvements in clinical symptoms in patients with AVH.

Reduced Functional Connectivity in Brain Networks Underlying Paired Associates Memory Encoding in Schizophrenia

BACKGROUND

Deficits in relational episodic memory encoding are characteristic of schizophrenia (SZ), but whole-brain multivariate analyses of these deficits have been lacking. Open science has provided task-based functional magnetic resonance imaging (fMRI) data investigating paired associate encoding in SZ, but it has not yet been mobilized to address this gap in the literature. Therefore, in this study, we use previously unpublished task fMRI data to conduct the first network-level investigation of impaired relational episodic encoding in SZ.

METHODS

Using fMRI data acquired from 40 healthy control participants and 40 age- and sex-matched persons with SZ, we examined the networks involved in successful versus unsuccessful encoding of verbal paired associates using an associative semantic strategy.

RESULTS

Constrained principal component analysis for fMRI revealed 3 distinct functional networks recruited during encoding: a responding network, a linguistic processing/attention network, and the default mode network. Relative to the healthy control group, the SZ group exhibited aberrant activity in all 3 networks during successful encoding; namely, hypoactivation in the linguistic processing/attention network, lower peak activation in the responding network, and weaker suppression in the default mode network. Independent of group effects, a pattern of stronger anticorrelating linguistic processing/attention-default mode network activity during successful encoding significantly predicted subsequent retrieval of paired associates.

CONCLUSIONS

Together with previous observations of language network hypoactivation during controlled semantic processes, these results suggest that abnormalities in networks representing language and meaning may contribute to difficulties employing deep semantic strategies during relational episodic encoding in SZ.

Altered activity in functional brain networks involved in lexical decision making in bipolar disorder: An fMRI case-control study

BACKGROUND

Brain networks involved in language, attentional and response processes are detectable by fMRI during lexical decision (LD). Here, we investigated possible abnormalities in the functional networks involved in LD in patients with bipolar disorder (BD).

METHODS

fMRI and behavioural data were compared between BD (n = 25) and control (n = 21), with groups matched for age and sex. The functional brain networks involved in LD were extracted by manipulating the "word-likeness" of LD stimuli and using a multidimensional analysis method.

RESULTS

Attentional, response and language processes were captured in separate function-specific brain networks (default mode network, response network, linguistic processing network, respectively) in the BD and control groups, replicating the results of our previous study in an independent group of healthy adults. Behaviourally, the BD group showed higher performance than the control group in the LD task. Activity in the default mode network (DMN) and the linguistic processing network (LPN) did not differ between the groups, but the BD group had higher activation than the control group in the response network (RESP).

LIMITATIONS

Due to the small sample, the study is underpowered, capable of only detecting large effects.

CONCLUSIONS

The results suggest that BD may be associated with sustained activity in the RESP network, which might contribute to psychomotor dysfunction in BD. Future studies should investigate the possible link between altered RESP activation and psychomotor disturbances in BD, as well as the basis for altered RESP activity in BD.

Abnormal interhemispheric and intrahemispheric functional connectivity dynamics in drug-naïve first-episode schizophrenia patients with auditory verbal hallucinations

Numerous studies indicate altered static local and long‐range functional connectivity of multiple brain regions in schizophrenia patients with auditory verbal hallucinations (AVHs). However, the temporal dynamics of interhemispheric and intrahemispheric functional connectivity patterns remain unknown in schizophrenia patients with AVHs. We analyzed resting‐state functional magnetic resonance imaging data for drug‐naïve first‐episode schizophrenia patients, 50 with AVHs and 50 without AVH (NAVH), and 50 age‐ and sex‐matched healthy controls. Whole‐brain functional connectivity was decomposed into ipsilateral and contralateral parts, and sliding‐window analysis was used to calculate voxel‐wise interhemispheric and intrahemispheric dynamic functional connectivity density (dFCD). Finally, the correlation analysis was performed between abnormal dFCD variance and clinical measures in the AVH and NAVH groups. Compared with the NAVH group and healthy controls, the AVH group showed weaker interhemispheric dFCD variability in the left middle temporal gyrus (p < .01; p < .001), as well as stronger interhemispheric dFCD variability in the right thalamus (p < .001; p < .001) and right inferior temporal gyrus (p < .01; p < .001) and stronger intrahemispheric dFCD variability in the left inferior frontal gyrus (p < .001; p < .01). Moreover, abnormal contralateral dFCD variability of the left middle temporal gyrus correlated with the severity of AVHs in the AVH group (r = −.319, p = .024). The findings demonstrate that abnormal temporal variability of interhemispheric and intrahemispheric dFCD in schizophrenia patients with AVHs mainly focus on the temporal and frontal cortices and thalamus that are pivotal components of auditory and language pathways.

Processing of linguistic deixis in people with schizophrenia, with and without auditory verbal hallucinations

Auditory verbal hallucinations (AVH) are a key symptom of schizophrenia (SZ) defined by anomalous perception of speech. Anomalies of processing external speech stimuli have also been reported in people with AVH, but it is unexplored which specific dimensions of language are processed differently. Using a speech perception task (passive listening), we here targeted the processing of deixis, a key dimension of language governing the contextual anchoring of speech in interpersonal context. We designed naturalistic speech stimuli that were either non-personal and fact-reporting (‘low-deixis’ condition), or else involved rich deictic devices such as the grammatical first and second persons, direct questions, and vocatives (‘high-deixis’). We asked whether neural correlates of deixis obtained with fMRI would distinguish patients with and without frequent hallucinations (AVH + vs AVH−) from controls and each other. Results showed that high-deixis relative to low-deixis was associated with clusters of increased activation in the bilateral middle temporal gyri extending into the temporal poles and the inferior parietal cortex, in all groups. The AVH + and AVH− groups did not differ. When unifying them, the SZ group as a whole showed altered activity in the precuneus, midline regions and inferior parietal cortex. These results fail to confirm deictic processing anomalies specific to patients with AVH, but reveal such anomalies across SZ. Hypoactivation of this network may relate to a cognitive mechanism for attributing and anchoring thought and referential speech content in context.

Cognitive dysfunction and cortical structural abnormalities in first-episode drug-naïve schizophrenia patients with auditory verbal hallucination

OBJECTIVE

The current study aimed to examine the cognitive profiles and cortical structural alterations in first-episode drug-naïve schizophrenia with AVH (auditory verbal hallucination).

METHODS

Cortical structural parameters including cortical thickness and local gyrification index (LGI) estimated using FreeSurfer as well as cognitive performance assessed on the MATRICS Consensus Cognitive Battery (MCCB) were acquired from 78 schizophrenia patients with AVH, 74 schizophrenia patients without AVH (non-AVH), and 76 healthy controls (HC). Hoffman Auditory Hallucination Rating Scale (HAHRS) was applied to assess the severity of AVH.

RESULTS

The results revealed extensive deficits in all cognitive domains among AVH, non-AVH, and HC groups. Compared to non-AVH group, the AVH group showed poorer performance on visual learning and verbal learning domains. There were six brain regions with cortical thinning in the right hemisphere of inferior temporal gyrus, superior temporal gyrus, lateral orbito frontal cortex, rostral anterior cingulate cortex, supramarginal gyrus and insula, and two brain regions with increased LGI in the left hemisphere of superior parietal gyrus and the right hemisphere of caudal anterior cingulate cortex on AVH group relative to non-AVH group. Correlation analysis revealed that the cortical thickness in the right hemisphere of lateral orbito frontal cortex was negatively correlated with the severity of AVH in schizophrenia patients with AVH.

CONCLUSION

Visual learning, verbal learning dysfunction, and specific disruption of cortical structure may characterize schizophrenia patients with AVH during early stages of the disorder. Right lateral orbito frontal cortical deficits may be the pathological mechanisms underlying AVH in first-episode drug-naïve schizophrenia.

The Etiology of Auditory Hallucinations in Schizophrenia: From Multidimensional Levels

Enormous efforts have been made to unveil the etiology of auditory hallucinations (AHs), and multiple genetic and neural factors have already been shown to have their own roles. Previous studies have shown that AHs in schizophrenia vary from those in other disorders, suggesting that they have unique features and possibly distinguishable mechanisms worthy of further investigation. In this review, we intend to offer a comprehensive summary of current findings related to AHs in schizophrenia from aspects of genetics and transcriptome, neurophysiology (neurometabolic and electroencephalogram studies), and neuroimaging (structural and functional magnetic resonance imaging studies and transcriptome–neuroimaging association study). Main findings include gene polymorphisms, glutamate level change, electroencephalographic alterations, and abnormalities of white matter fasciculi, cortical structure, and cerebral activities, especially in multiple regions, including auditory and language networks. More solid and comparable research is needed to replicate and integrate ongoing findings from multidimensional levels.

External speech processing and auditory verbal hallucinations: A systematic review of functional neuroimaging studies

It has been documented that individuals who hear auditory verbal hallucinations (AVH) exhibit diminished capabilities in processing external speech. While functional neuroimaging studies have attempted to characterise the cortical regions and networks facilitating these deficits in a bid to understand AVH, considerable methodological heterogeneity has prevented a consensus being reached. The current systematic review investigated the neurobiological underpinnings of external speech processing deficits in voice-hearers in 38 studies published between January 1990 to June 2020. AVH-specific deviations in the activity and lateralisation of the temporal auditory regions were apparent when processing speech sounds, words and sentences. During active or affective listening tasks, functional connectivity changes arose within the language, limbic and default mode networks. However, poor study quality and lack of replicable results plague the field. A detailed list of recommendations has been provided to improve the quality of future research on this topic.

Functional Delineation of Prefrontal Networks Underlying Working Memory in Schizophrenia: A Cross-data-set Examination

BACKGROUND

Working memory (WM) impairment in schizophrenia substantially impacts functional outcome. Although the dorsolateral pFC has been implicated in such impairment, a more comprehensive examination of brain networks comprising pFC is warranted. The present research used a whole-brain, multi-experiment analysis to delineate task-related networks comprising pFC. Activity was examined in schizophrenia patients across a variety of cognitive demands.

METHODS

One hundred schizophrenia patients and 102 healthy controls completed one of four fMRI tasks: a Sternberg verbal WM task, a visuospatial WM task, a Stroop set-switching task, and a thought generation task (TGT). Task-related networks were identified using multi-experiment constrained PCA for fMRI. Effects of task conditions and group differences were examined using mixed-model ANOVA on the task-related time series. Correlations between task performance and network engagement were also performed.

RESULTS

Four spatially and temporally distinct networks with pFC activation emerged and were postulated to subserve (1) internal attention, (2) auditory-motor attention, (3) motor responses, and (4) task energizing. The "energizing" network-engaged during WM encoding and diminished in patients-exhibited consistent trend relationships with WM capacity across different data sets. The dorsolateral-prefrontal-cortex-dominated "internal attention" network exhibited some evidence of hypoactivity in patients, but was not correlated with WM performance.

CONCLUSIONS

Multi-experiment analysis allowed delineation of task-related, pFC-anchored networks across different cognitive constructs. Given the results with respect to the early-responding "energizing" network, WM deficits in schizophrenia may arise from disruption in the "energization" process described by Donald Stuss' model of pFC functions.

Exploring concomitant neuroimaging and genetic alterations in patients with and patients without auditory verbal hallucinations: A pilot study and mini review

Objective

To explore concomitant neuroimaging and genetic alterations in patients with schizophrenia with or without auditory verbal hallucinations (AVHs), and to discuss the use of pattern recognition techniques in the development of an objective index that may improve diagnostic accuracy and treatment outcomes for schizophrenia.

Methods

The pilot study included patients with schizophrenia with AVHs (SCH-AVH group) and without AVHs (SCH-no AVH group). High throughput sequencing (HTS) was performed to explore RNA networks. Global functional connectivity density (gFCD) analysis was performed to assess functional connectivity (FC) alterations of the default mode network (DMN). Quantitative long noncoding (lnc) RNA and mRNA expression data were related to peak T values of gFCDs using Pearson’s correlation coefficient analysis.

Results

Compared with the SCH-no AVH group (n = 5), patients in the SCH-AVH group (n = 5) exhibited differences in RNA expression in RNA networks that were related to AVH severity, and displayed alterations in FC (reflected by gFCD differences) within the DMN (posterior cingulate and dorsal-medial prefrontal cortex), and in the right parietal lobe, left occipital lobe, and left temporal lobe. Peak lncRNA expression values were significantly related to peak gFCD T values within the DMN.

Conclusion

Among patients with schizophrenia, there are concomitant FC and genetic expression alterations associated with AVHs. Data from pattern recognition studies may inform the development of an objective index aimed at improving early diagnostic accuracy and treatment planning for patients with schizophrenia with and without AVHs.

Hallucination-Specific structure-function associations in schizophrenia

Combining structural (sMRI) and functional magnetic resonance imaging (fMRI) data in schizophrenia patients with and without auditory hallucinations (9 SZ_AVH, 12 SZ_nAVH), 18 patients with bipolar disorder, and 22 healthy controls, we examined whether cortical thinning was associated with abnormal activity in functional brain networks associated with auditory hallucinations. Language-task fMRI data were combined with mean cortical thickness values from 148 brain regions in a constrained principal component analysis (CPCA) to identify brain structure-function associations predictable from group differences. Two components emerged from the multimodal analysis. The "AVH component" highlighted an association of frontotemporal and cingulate thinning with altered brain activity characteristic of hallucinations among patients with AVH. In contrast, the "Bipolar component" distinguished bipolar patients from healthy controls and linked increased activity in the language network with cortical thinning in the left occipital-temporal lobe. Our findings add to a body of evidence of the biological underpinnings of hallucinations and illustrate a method for multimodal data analysis of structure-function associations in psychiatric illness.

Hemodynamic responses are abnormal in isolated cervical dystonia

Neuroimaging studies using functional magnetic resonance imaging (fMRI), which measures brain activity by detecting the changes in blood oxygenation levels, are advancing our understanding of the pathophysiology of dystonia. Neurobiological disturbances in dystonia, however, may affect neurovascular coupling and impact the interpretability of fMRI studies. We evaluated here whether the hemodynamic response patterns during a behaviorally matched motor task are altered in isolated cervical dystonia (CD). Twenty-five CD patients and 25 healthy controls (HCs) underwent fMRI scanning during a paced finger tapping task (nondystonic task in patients). Imaging data were analyzed using a constrained principal component analysis-a statistical method that combines regression analysis and principal component analysis and enables the extraction of task-related functional networks and determination of the spatial and temporal hemodynamic response patterns associated with the task performance. Data from three patients and two controls were removed due to excessive movement. No significant differences in demographics or motor performance were observed. Three task-associated functional brain networks were identified. During task performance, reduced hemodynamic responses were seen in a sensorimotor network and in a network that included key nodes of the default mode, executive control and visual networks. During rest, reductions in hemodynamic responses were seen in the cognitive/visual network. Lower hemodynamic responses within the primary sensorimotor network in patients were correlated with the increased dystonia severity. Pathophysiological disturbances in isolated CD, such as alterations in inhibitory signaling and dopaminergic neurotransmission, may impact neurovascular coupling. Not accounting for hemodynamic response differences in fMRI studies of dystonia could lead to inaccurate results and interpretations.

Functional brain networks underlying evidence integration and delusional ideation

Cognitive biases affecting evidence integration contribute to delusions and delusional ideation in the psychosis continuum. In previously published work we observed hyperactivity in a visual attention network (VsAN) during confirmatory evidence integration, and hypoactivity in a cognitive evaluation network (CEN) during disconfirmatory evidence integration in schizophrenia patients with delusions, suggesting that a task-specific imbalance of these networks may contribute to delusion maintenance. In the current study, we investigated whether patterns of aberrant functional connectivity observed in past work were associated with delusional ideation in 41 healthy individuals by examining associations between cognitive biases, subclinical schizotypal traits, and functional brain activity during evidence integration. Behaviourally, we replicated positive associations between schizotypal traits and cognitive biases and further showed that this association was driven by delusional ideation specifically. Constrained principal component analysis for fMRI (fMRI-CPCA) revealed recruitment of the brain networks observed in our previous clinical and non-clinical evidence integration studies: default-mode network (DMN); cognitive evaluation network (CEN); and visual attention (VsAN) network. Moreover, as with clinically-significant delusions, delusional ideation was associated with decreased CEN activity during the processing of disconfirmatory evidence and increased VsAN activity during the processing of confirmatory evidence. These findings suggest that this altered pattern of activation across networks during evidence integration may underlie delusional ideation and delusions in the psychosis continuum.

Abnormalities of intrinsic regional brain activity in first-episode and chronic schizophrenia: a meta-analysis of resting-state functional MRI

BACKGROUND

Resting-state functional MRI (fMRI) studies have provided much evidence for abnormal intrinsic brain activity in schizophrenia, but results have been inconsistent.

METHODS

We conducted a meta-analysis of whole-brain, resting-state fMRI studies that explored differences in amplitude of low-frequency fluctuation (ALFF) between people with schizophrenia (including first episode and chronic) and healthy controls.

RESULTS

A systematic literature search identified 24 studies comparing a total of 1249 people with schizophrenia and 1179 healthy controls. Overall, patients with schizophrenia displayed decreased ALFF in the bilateral postcentral gyrus, bilateral precuneus, left inferior parietal gyri and right occipital lobe, and increased ALFF in the right putamen, right inferior frontal gyrus, left inferior temporal gyrus and right anterior cingulate cortex. In the subgroup analysis, patients with first-episode schizophrenia demonstrated decreased ALFF in the bilateral inferior parietal gyri, right precuneus and left medial prefrontal cortex, and increased ALFF in the bilateral putamen and bilateral occipital gyrus. Patients with chronic schizophrenia showed decreased ALFF in the bilateral postcentral gyrus, left precuneus and right occipital gyrus, and increased ALFF in the bilateral inferior frontal gyri, bilateral superior frontal gyrus, left amygdala, left inferior temporal gyrus, right anterior cingulate cortex and left insula.

LIMITATIONS

The small sample size of our subgroup analysis, predominantly Asian samples, processing steps and publication bias could have limited the accuracy of the results.

CONCLUSION

Our comprehensive meta-analysis suggests that findings of aberrant regional intrinsic brain activity during the initial stages of schizophrenia, and much more widespread damage with the progression of disease, may contribute to our understanding of the progressive pathophysiology of schizophrenia.

Functional Brain Networks Underlying Evidence Integration and Delusions in Schizophrenia

Integrating evidence that contradicts a belief is a fundamental aspect of belief revision and is closely linked to delusions in schizophrenia. In a previous functional magnetic resonance imaging (fMRI) study on healthy individuals, we identified functional brain networks underlying evidence integration as visual attention network (VsAN; dorsal anterior cingulate cortex, insula, occipital regions), default-mode network (DMN), and cognitive evaluation network (CEN; orbitofrontal cortex, inferior frontal gyrus, parietal cortex). In the current clinical fMRI study, we compared network-based activity during evidence integration between healthy controls (n = 41), nondelusional (n = 37), and delusional (n = 33) patients with schizophrenia, and related this activity to cognitive processing involved in evidence integration measured outside the scanner. Task-induced coordinated activation was measured using group-constrained principal component analysis for fMRI. Increased VsAN activation, reduced DMN deactivation, and reduced CEN activation were observed for schizophrenia, with this pattern being most pronounced for the delusional group. Importantly, poor evidence integration comprehensively measured outside the scanner was significantly associated with increased VsAN activation and reduced DMN deactivation when processing confirmatory evidence, and with reduced CEN activation when processing disconfirmatory evidence. This is the first comprehensive study of the functional brain networks associated with evidence integration in schizophrenia and highlights how an imbalance of functional brain networks responding to confirmatory and disconfirmatory evidence may underlie delusions in schizophrenia.

Altered Effective Connectivity in Schizophrenic Patients With Auditory Verbal Hallucinations: A Resting-State fMRI Study With Granger Causality Analysis

PURPOSE

Auditory verbal hallucinations (AVH) are among the most common and prominent symptoms of schizophrenia. Although abnormal functional connectivity associated with AVH has been reported in multiple regions, the changes in information flow remain unclear. In this study, we aimed to elucidate causal influences related to AVH in key regions of auditory, language, and memory networks, by using Granger causality analysis (GCA).

PATIENTS AND METHODS

Eighteen patients with schizophrenia with AVH and eighteen matched patients without AVH who received resting-state fMRI scans were enrolled in the study. The bilateral superior temporal gyrus (STG), Broca's area, Wernicke's area, putamen, and hippocampus were selected as regions of interest.

RESULTS

Granger causality (GC) increased from Broca's area to the left STG, and decreased from the right homolog of Wernicke's area to the right homolog of Broca's area, and from the right STG to the right hippocampus in the AVH group compared with the non-AVH group. Correlation analysis showed that the normalized GC ratios from the left STG to Broca's area, from the left STG to the right homolog of Broca's area, and from the right STG to the right homolog of Broca's area were negatively correlated with severity of AVH, and the normalized GC ratios from Broca's area to the left hippocampus and from Broca's area to the right STG were positively correlated with severity of AVH.

CONCLUSION

Our findings indicate a causal influence of pivotal regions involving the auditory, language, and memory networks in schizophrenia with AVH, which provide a deeper understanding of the neural mechanisms underlying AVH.

Reduced integrity of superior longitudinal fasciculus and arcuate fasciculus as a marker for auditory hallucinations in schizophrenia: A DTI tractography study

AIMS AND OBJECTIVES

The study aimed to assess and compare fractional anisotropy (FA) in bilateral superior longitudinal fasciculi (SLF) and arcuate fasciculi (AF) across schizophrenia with auditory hallucinations(AH), without AH, and healthy controls using diffusion tensor imaging (DTI) tractography.

METHODOLOGY

Right-handed adult (18-50 years) individuals with DSM-5 diagnosis of schizophrenia with AH (group-I; n=30) were compared to those without lifetime AH (group-II; n=32) and healthy controls (group-III; n=30). Severity of psychosis in groups-I and II was assessed using SAPS, SANS, and CGI-SCH, and psychopathology was assessed using PSYRATS. The FA was calculated for all images on DTI studio-version 3.0 using tractography technique.

RESULTS

All three groups were comparable for age, gender, education and illness-severity. Schizophrenia subjects with AH had significantly lower FA values in bilateral SLF and AF compared to those without AH and healthy controls. No difference was observed in corresponding FA values between schizophrenia without AH and healthy controls.

CONCLUSION

White matter disruptions in bilateral SLF and AF appear to be specific to schizophrenia with AH and must be explored further as potential marker of AH, pending replication in other studies.

Hallucination- and speech-specific hypercoupling in frontotemporal auditory and language networks in schizophrenia using combined task-based fMRI data: An fBIRN study

Hypercoupling of activity in speech-perception-specific brain networks has been proposed to play a role in the generation of auditory-verbal hallucinations (AVHs) in schizophrenia; however, it is unclear whether this hypercoupling extends to nonverbal auditory perception. We investigated this by comparing schizophrenia patients with and without AVHs, and healthy controls, on task-based functional magnetic resonance imaging (fMRI) data combining verbal speech perception (SP), inner verbal thought generation (VTG), and nonverbal auditory oddball detection (AO). Data from two previously published fMRI studies were simultaneously analyzed using group constrained principal component analysis for fMRI (group fMRI-CPCA), which allowed for comparison of task-related functional brain networks across groups and tasks while holding the brain networks under study constant, leading to determination of the degree to which networks are common to verbal and nonverbal perception conditions, and which show coordinated hyperactivity in hallucinations. Three functional brain networks emerged: (a) auditory-motor, (b) language processing, and (c) default-mode (DMN) networks. Combining the AO and sentence tasks allowed the auditory-motor and language networks to separately emerge, whereas they were aggregated when individual tasks were analyzed. AVH patients showed greater coordinated activity (deactivity for DMN regions) than non-AVH patients during SP in all networks, but this did not extend to VTG or AO. This suggests that the hypercoupling in AVH patients in speech-perception-related brain networks is specific to perceived speech, and does not extend to perceived nonspeech or inner verbal thought generation.