The signal detection ability of patients with auditory hallucination: analysis using the continuous performance test

Examining the relationships between cognition and auditory hallucinations: A systematic review

OBJECTIVE

Auditory hallucinations (hearing voices) have been associated with a range of altered cognitive functions, pertaining to signal detection, source-monitoring, memory, inhibition and language processes. Yet, empirical results are inconsistent. Despite this, several theoretical models of auditory hallucinations persist, alongside increasing emphasis on the utility of a multidimensional framework. Thus, clarification of current evidence across the broad scope of proposed mechanisms is warranted.

METHOD

A systematic search of the Web of Science, PubMed and Scopus databases was conducted. Records were screened to confirm the use of an objective behavioural cognitive task, and valid measurement of hallucinations specific to the auditory modality.

RESULTS

Auditory hallucinations were primarily associated with difficulties in perceptual decision-making (i.e. reduced sensitivity/accuracy for signal-noise discrimination; liberal responding to ambiguity), source-monitoring (i.e. self-other and temporal context confusion), working memory and language function (i.e. reduced verbal fluency). Mixed or limited support was observed for perceptual feature discrimination, imagery vividness/illusion susceptibility, source-monitoring for stimulus form and spatial context, recognition and recall memory, executive functions (e.g. attention, inhibition), emotion processing and language comprehension/hemispheric organisation.

CONCLUSIONS

Findings were considered within predictive coding and self-monitoring frameworks. Of concern was the portion of studies which - despite offering auditory-hallucination-specific aims and inferences - employed modality-general measures, and/or diagnostic-based contrasts with psychologically healthy individuals. This review highlights disparities within the literature between theoretical conceptualisations of auditory hallucinations and the body of rigorous empirical evidence supporting such inferences. Future cognitive investigations, beyond the schizophrenia-spectrum, which explicitly define and measure the timeframe and sensory modality of hallucinations, are recommended.

Auditory signal detection in schizophrenia: Correlates with auditory verbal hallucinations & effect of single session transcranial direct current stimulation (tDCS)

INTRODUCTION

Transcranial Direct Current Stimulation (tDCS) has been beneficial for treating auditory verbal hallucinations (AVH) in schizophrenia (SZ). Aberrant auditory signal detection (ASD) is one of the pathogenetic mechanisms for AVH. We investigated the correlates of ASD with AVH and the impact of single-session tDCS on ASD in SZ patients.

METHODS

The ASD performance in SZ patients was compared with matched healthy controls (HC) (N = 24). Subsequently, the effect of single-session tDCS on ASD in SZ patients (N = 24) with AVH was examined in a randomized, double-blind, sham-controlled, cross-over design. The true and sham tDCS were administered (anode at the left dorsolateral prefrontal cortex and cathode at the left temporoparietal junction) on two different days. ASD task was performed before and after each session of tDCS.

RESULTS

Auditory hallucination rating scores correlated significantly with false alarm rate, discriminability index, and response bias. SZ patients had a significantly lesser discriminability index in ASD than HC. Single-session tDCS (true versus sham) did not have any significant effect on ASD in SZ patients.

CONCLUSION

The study findings support the pathogenetic role of ASD in AVH in SZ. Lack of effect on ASD following single-session tDCS suggests the need for multi-session studies in the future.

Auditory false perception in schizophrenia: Development and validation of auditory signal detection task

Auditory hallucinations constitute an important symptom component in 70-80% of schizophrenia patients. These hallucinations are proposed to occur due to an imbalance between perceptual expectation and external input, resulting in attachment of meaning to abstract noises; signal detection theory has been proposed to explain these phenomena. In this study, we describe the development of an auditory signal detection task using a carefully chosen set of English words that could be tested successfully in schizophrenia patients coming from varying linguistic, cultural and social backgrounds. Schizophrenia patients with significant auditory hallucinations (N=15) and healthy controls (N=15) performed the auditory signal detection task wherein they were instructed to differentiate between a 5-s burst of plain white noise and voiced-noise. The analysis showed that false alarms (p=0.02), discriminability index (p=0.001) and decision bias (p=0.004) were significantly different between the two groups. There was a significant negative correlation between false alarm rate and decision bias. These findings extend further support for impaired perceptual expectation system in schizophrenia patients.

Generalization of multisensory perceptual learning

Life in a multisensory world requires the rapid and accurate integration of stimuli across the different senses. In this process, the temporal relationship between stimuli is critical in determining which stimuli share a common origin. Numerous studies have described a multisensory temporal binding window—the time window within which audiovisual stimuli are likely to be perceptually bound. In addition to characterizing this window’s size, recent work has shown it to be malleable, with the capacity for substantial narrowing following perceptual training. However, the generalization of these effects to other measures of perception is not known. This question was examined by characterizing the ability of training on a simultaneity judgment task to influence perception of the temporally-dependent sound-induced flash illusion (SIFI). Results do not demonstrate a change in performance on the SIFI itself following training. However, data do show an improved ability to discriminate rapidly-presented two-flash control conditions following training. Effects were specific to training and scaled with the degree of temporal window narrowing exhibited. Results do not support generalization of multisensory perceptual learning to other multisensory tasks. However, results do show that training results in improvements in visual temporal acuity, suggesting a generalization effect of multisensory training on unisensory abilities.

When Believing is Seeing: The Role of Predictions in Shaping Visual Perception

The study investigated the influence of predictions on perception—in particular, how strong but erroneous prediction coupled with poor sensory data can trigger misperceptions. Using signal detection, we tested whether predictions induced by a semantic cue change the recognition threshold (criterion) or the subjectively perceived differences between stimuli (sensitivity). In a series of 3 experiments, participants observed pictures of (a) real objects distorted to various extents (targets), (b) noise with elements corresponding to meaningful objects (foils), or (c) nonsense images (noise). Stimuli were preceded either by a semantic cue or by a blank screen with equal probability. Presence of the cue resulted in a more liberal criterion, but only for targets and foils. The cue decreased sensitivity between the distorted targets, but increased sensitivity between the targets and noise—that is, the cue increased between-class differences, but decreased within-class differences. When there was no correspondence between prediction and the sensory input, prediction actually increased the chances of correctly rejecting noise. The influence of the cue was strongest for the moderately distorted targets and foils—when uncertainty related to the bottom-up input was the highest.

Dissociation of acute and chronic intermittent phencyclidine-induced performance deficits in the 5-choice serial reaction time task: influence of clozapine

BACKGROUND

Cognitive deficits are a core feature of schizophrenia that respond minimally to existing drugs. PCP is commonly used to model schizophrenia-like deficits preclinically although different dosing protocols may affect different domains. Here we characterise the acute, and chronic intermittent effects of PCP in the 5-choice serial reaction time task (5-CSRTT) in rats, and assess the effects of clozapine. In a novel approach, we also assess the effects of increased inhibitory load and conduct clinically relevant signal detection analysis (SDA).

MATERIALS AND METHODS

The effects of acute and repeated PCP (2.58 mg/kg) treatment on attentional processes and inhibitory control were assessed during and following the chronic treatment regime in the presence or absence of chronic clozapine (20 mg/kg/day).

RESULTS

Thirty minutes post-PCP injection, there was an increase in anticipatory responding which disappeared after 24 h. Although, acute PCP did not change accuracy of responding or processing speed, repeated PCP revealed delayed deficits in cognitive processing speed which were partly ameliorated by clozapine. Extended inter-trial intervals increased premature responding, while SDA revealed that clozapine modified persistent PCP-induced deficits in lnBeta (a composite measure of risk taking versus caution).

CONCLUSION

Acute NMDA receptor antagonism impairs inhibitory control, whereas repeated treatment produces delayed deficits in cognitive processing speed. The ability of clozapine partially to restore persistent PCP-induced deficits in processing speed and in lnBeta is consistent with clinical findings. This suggests that the enduring effects of repeated PCP treatment, combined with SDA, offers a useful, translational, approach to evaluate novel cognitive enhancers in the 5-CSRTT.

Dopamine, Paranormal Belief, and the Detection of Meaningful Stimuli

Dopamine (DA) is suggested to improve perceptual and cognitive decisions by increasing the signal-to-noise ratio. Somewhat paradoxically, a hyperdopaminergia (arguably more accentuated in the right hemisphere) has also been implied in the genesis of unusual experiences such as hallucinations and paranormal thought. To test these opposing assumptions, we used two lateralized decision tasks, one with lexical (tapping left-hemisphere functions), the other with facial stimuli (tapping right-hemisphere functions). Participants were 40 healthy right-handed men, of whom 20 reported unusual, “paranormal” experiences and beliefs (“believers”), whereas the remaining participants were unexperienced and critical (“skeptics”). In a between-subject design, levodopa (200 mg) or placebo administration was balanced between belief groups (double-blind procedure). For each task and visual field, we calculated sensitivity (d′) and response tendency (criterion) derived from signal detection theory. Results showed the typical right visual field advantage for the lexical decision task and a higher d′ for verbal than facial stimuli. For the skeptics, d′ was lower in the levodopa than in the placebo group. Criterion analyses revealed that believers favored false alarms over misses, whereas skeptics displayed the opposite preference. Unexpectedly, under levodopa, these decision preferences were lower in both groups. We thus infer that levodopa (1) decreases sensitivity in perceptual–cognitive decisions, but only in skeptics, and (2) makes skeptics less and believers slightly more conservative. These results stand at odd to the common view that DA generally improves signal-to-noise ratios. Paranormal ideation seems an important personality dimension and should be assessed in investigations on the detection of signals in noise.

Selective pair recognition memory impairment with no response bias in schizophrenia

Memory is one of the cognitive functions most affected in schizophrenia, but the severity of deficits varies from one task to another. In particular, greater impairments have been reported for pair recognition than item recognition. However, decision biases and how they could affect memory dysfunction in schizophrenia have received scant attention. In this study, 26 people with schizophrenia and 28 healthy controls were administrated an association item recognition task. During encoding, participants studied pairs of visual objects, and they had to memorise objects and their pairing. In a subsequent retrieval task, participants performed an item recognition test (old/new items) and a pair recognition test (intact/rearranged pairs). Results showed that both groups were better at recognizing items than pairs, with lower performance for pair recognition, but not for item recognition, in people with schizophrenia. Analyses of response biases revealed that patients had a conservative response bias for items but not for pairs. The study also provides evidence that associative impairment may not result from decisional bias but rather from impairments in mnesic processes.

Hearing a voice in the noise: auditory hallucinations and speech perception

BACKGROUND

It has recently been suggested that auditory hallucinations are the result of a criterion shift when deciding whether or not a meaningful signal has emerged. The approach proposes that a liberal criterion may result in increased false-positive identifications, without additional perceptual deficit. To test this hypothesis, we devised a speech discrimination task and used signal detection theory (SDT) to investigate the underlying cognitive mechanisms.

METHOD

Schizophrenia patients with and without auditory hallucinations and a healthy control group completed a speech discrimination task. They had to decide whether a particular spoken word was identical to a previously presented speech stimulus, embedded in noise. SDT was used on the accuracy data to calculate a measure of perceptual sensitivity (Az) and a measure of response bias (beta). Thresholds for the perception of simple tones were determined.

RESULTS

Compared to healthy controls, perceptual thresholds were higher and perceptual sensitivity in the speech task was lower in both patient groups. However, hallucinating patients showed increased sensitivity to speech stimuli compared to non-hallucinating patients. In addition, we found some evidence of a positive response bias in hallucinating patients, indicating a tendency to readily accept that a certain stimulus had been presented.

CONCLUSIONS

Within the context of schizophrenia, patients with auditory hallucinations show enhanced sensitivity to speech stimuli, combined with a liberal criterion for deciding that a perceived event is an actual stimulus.

Effects of transdermal nicotine on episodic memory in non-smokers with and without schizophrenia

RATIONALE

Nicotinic agonists may improve attention and memory in humans and may ameliorate some cognitive deficits associated with neuropsychiatric disorders such as schizophrenia.

MATERIALS AND METHODS

We investigated the effects of a single dose of nicotine on episodic memory performance in 10 adults with schizophrenia and 12 healthy controls. Participants were nonsmokers in order to avoid confounding effects of nicotine withdrawal and reinstatement on memory. At each of two study visits, participants performed a test of episodic memory before and 4 h after application of a 14-mg transdermal nicotine (or identical placebo) patch in counterbalanced order.

RESULTS

Compared with placebo, nicotine treatment was associated with more rapid and accurate recognition of novel items. There was a trend for a treatment by diagnosis interaction, such that the effect of nicotine to reduce false alarms was stronger in the schizophrenia than the control group. There was no effect of nicotine on accuracy or reaction time for identification of previously viewed items.

CONCLUSIONS

These data suggest that nicotine improves novelty detection in non-smokers, an effect that may be more pronounced in non-smokers with schizophrenia. Because memory deficits are associated with functional impairment in schizophrenia and because impaired novelty detection has been linked to the positive symptoms of schizophrenia, study of the effects of chronic nicotinic agonist treatment on novelty detection may be warranted.

Auditory discrimination in female adolescents varying in schizotypal features: preliminary findings

Earlier experiments have suggested impaired auditory perception in patients with schizophrenia. The purpose of the present study was to investigate auditory discrimination in young adults varying in schizotypal features. Three hundred and forty-nine female adolescent subjects were rated with the Schizotypal Personality Questionnaire (SPQ) and the Perceptual Aberration Scale (PAS) and with questions from the Chinese Health Questionnaire (CHQ) that address non-psychotic, psychological status of the subjects. Sixty-one subjects were selected to participate in an auditory detection and discrimination task, with 20 subjects each with low and high, and 21 subjects with intermediate, SPQ scores. The sensitivity in auditory discrimination and the response bias were computed, using signal detection theory. The results show that the ratings of the subjects in the three questionnaires correlate with one another and that subjects with higher SPQ scores appear to perform worse in auditory discrimination. The impaired performance occurs for most of the signal-to-noise ratios. Taken together, these preliminary findings are consistent with earlier studies demonstrating impaired auditory processing in schizophrenia patients. In contrast, the significant correlation between both the SPQ and PAS scores and the CHQ score suggests that further studies are required to rule out the effect of non-psychotic factors such as anxiety on the current results. Second, the three groups of subjects did not differ in the response bias. This latter finding provides evidence at odds with the 'self-monitoring' model of auditory hallucination.

Altered performance of schizophrenia patients in an auditory detection and discrimination task: exploring the 'self-monitoring' model of hallucination

It has been suggested that perceptual hallucination results from a bias in attributing a self-generated event to an external source. The 'self-monitoring' model proposes that the impairment arises from a defective corollary discharge in perceptual decisions. However, psychophysical studies in schizophrenia patients have not found consistent support for the model. We re-explored this issue by including subjects with mood disorders as patient controls and employed signals of variable intensities in an auditory detection and discrimination task. Using signal detection theory, we found decreased sensitivity in auditory detection and discrimination in schizophrenia patients, as compared to control subjects. Moreover, the psychometric functions of schizophrenics had a shallower slope than those of the controls. According to the uncertainty theory of signal detection, this suggested that schizophrenia patients monitored a smaller number of perceptual channels. On the other hand, hallucinating and non-hallucinating schizophrenia patients did not differ from each other, nor did they as a group differ from control subjects in terms of response bias. Overall, our results do not support the idea that hallucination results from an altered bias in the online processing of perceptual signals.