Persistent auditory hallucinations

Grey matter volume reduction in the frontotemporal cortex associated with persistent verbal auditory hallucinations in Chinese patients with chronic schizophrenia: Insights from a 3 T magnetic resonance imaging study

BACKGROUND

Persistent auditory verbal hallucinations (pAVHs) are a fundamental manifestation of schizophrenia (SCZ), yet the exact connection between pAVHs and brain structure remains contentious. This study aims to explore the potential correlation between pAVHs and alterations in grey matter volume (GMV) within specific brain regions among individuals diagnosed with SCZ.

METHODS

76 SCZ patients with pAVHs (pAVH group), 57 SCZ patients without AVHs (non-AVH group), and 83 healthy controls (HC group) were investigated using 3 T magnetic resonance imaging. The P3 hallucination item of the Positive and Negative Syndrome Scale was used to assess the severity of pAVHs. Voxel-based morphometry was used to analyze the GMV profile between the three groups.

RESULTS

Compared to the non-AVH and HC groups, the pAVH group exhibited extensive reduction in GMV within the frontotemporal cortex. Conversely, no significant difference in GMV was observed between the non-AVH and HC groups. The severity of pAVHs showed a negative correlation with GMV in several regions, including the right fusiform, right inferior temporal, right medial orbitofrontal, right superior frontal, and right temporal pole (p = 0.0036, Bonferroni correction). Stepwise linear regression analysis revealed that GMV in the right temporal pole (β = -0.29, p = 0.001) and right fusiform (β = -0.21, p = 0.01) were significantly associated with the severity of pAVHs.

CONCLUSIONS

Widespread reduction in GMV is observed within the frontotemporal cortex, particularly involving the right temporal pole and right fusiform, which potentially contribute to the pathogenesis of pAVHs in individuals with chronic SCZ.

DRD4 VNTR 4/4 homozygosity as a genetic biomarker for treatment selection in patients with schizophrenia

OBJECTIVE

There seems to be an association between the DRD4 48-bp VNTR polymorphisms and antipsychotic treatment response, but there is a rare reference to confirm this finding. Hence, the present study tried to investigate the association between DRD4 48-bp VNTR polymorphisms and the treatment response of antipsychotics in patients with schizophrenia in Taiwan, using a propensity score matching (PSM) method.

METHODS

A total of 882 participants were enrolled in this study and completed informed consent, research questionnaires, including demographic information and the revised Chinese version Beliefs about Voices Questionnaire, and blood sampling. For descreasing of the selection bias and confounding variables, the PSM nearest neighbor matching method was used to select 765 paitents with schizophrenia (ratio of 1:8 between 85 persistent auditory hallucination and 680 controls) with matched and controlled the age and gender.

RESULTS

Schizophrenia patients with DRD4 4 R homozygosity had a lower rate of good antipsychotic treatment response than the other DRD4 genotype carriers (DRD4 non-4/4). Among those 4 R homozygosity carriers, 60 cases of 503 (11.9%) retain persistent auditory hallucinations. Furthermore, this subgroup of patients is accounted for up to 70.6% of cases with poor neuroleptic treatment response.

CONCLUSIONS

A poor treatment outcome for patients with the 4 R homozygosity had presented,that comparing with those DRD non-4/4 genotype carriers. DRD4 VNTR 4 R homozygosity could be a genetic biomarker to predict poor antipsychotic treatment response in schizophrenia. Patients with DRD 4/4 probably receive novel antipsychotic medications preferentially or in combination with alternative therapy, such as psychotherapy or milieu therapy.

Alterations in the volume of thalamic nuclei in patients with schizophrenia and persistent auditory hallucinations

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Analysis of structural MRI images using a probabilistic atlas for segmentation of several nuclei of the thalamus.

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Comparison of chronic patients with schizophrenia, with and without auditory hallucinations and matched healthy controls.

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Volumetric reductions in patients with AH vs controls: Medial geniculate nucleus, anterior pulvinar nucleus and lateral and medial mediodorsal nuclei.

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In patients without AH we found reductions in the volume of the pulvinar and mediodorsal nuclei, but not in the medial geniculate nucleus.

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Found also some significant correlations between the volume of these nuclei and the total score of the PSYRATS scale.

The thalamus is a subcortical structure formed by different nuclei that relay information to the neocortex. Several reports have already described alterations of this structure in patients of schizophrenia that experience auditory hallucinations. However, to date no study has addressed whether the volumes of specific thalamic nuclei are altered in chronic patients experiencing persistent auditory hallucinations. We have processed structural MRI images using Freesurfer, and have segmented them into 25 nuclei using the probabilistic atlas developed by Iglesias and collaborators (Iglesias et al., 2018). To homogenize the sample, we have matched patients of schizophrenia, with and without persistent auditory hallucinations, with control subjects, considering sex, age and their estimated intracranial volume. This rendered a group number of 41 patients experiencing persistent auditory hallucinations, 35 patients without auditory hallucinations, and 55 healthy controls. In addition, we have also correlated the volume of the altered thalamic nuclei with the total score of the PSYRATS, a clinical scale used to evaluate the positive symptoms of this disorder. We have found alterations in the volume of 8 thalamic nuclei in both cohorts of patients with schizophrenia: The medial and lateral geniculate nuclei, the anterior, inferior, and lateral pulvinar nuclei, the lateral complex and the lateral and medial mediodorsal nuclei. We have also found some significant correlations between the volume of these nuclei in patients experiencing auditory hallucinations, and the total score of the PSYRATS scale. Altogether our results indicate that volumetric alterations of thalamic nuclei involved in audition may be related to persistent auditory hallucinations in chronic schizophrenia patients, whereas alterations in nuclei related to association cortices are evident in all patients. Future studies should explore whether the structural alterations are cause or consequence of these positive symptoms and whether they are already present in first episodes of psychosis.

Differences in Cortical Thickness in Schizophrenia Patients With and Without Auditory Verbal Hallucinations

Auditory verbal hallucinations (AVHs) are one of the most common and severe symptoms of schizophrenia (SCZ), but the neuroanatomical mechanisms underlying AVHs remain unclear. This study aimed to investigate whether persistent AVHs (pAVH) are associated with cortical thinning of certain brain regions in patients with SCZ. With the use of the 3T magnetic resonance imaging (MRI) technology, we acquired and analyzed data from 79 SCZ patients with pAVH (pAVH group), 60 SCZ patients without AVHs (non-AVH group), and 83 healthy controls (HC group). The severity of pAVH was assessed by the P3 hallucination items in the Positive and Negative Syndrome Scale (PANSS) and the Auditory Hallucinations Rating Scale (AHRS). Cortical thickness analysis was used to compare the region of interest (ROI) cortical thickness between the groups. The relationship between the severity of pAVH and cortical thickness was also explored. Compared with the non-AVH and HC groups, the pAVH group exhibited significantly reduced cortical thickness in the bilateral lateral orbitofrontal region (p < 0.0007, after Bonferroni correction); no significant difference was found between the non-AVH group and the HC group. The cortical thickness of the left lateral orbitofrontal cortex (P3: r = −0.44, p < 0.001; AHRS: r = −0.45, p < 0.001) and the right lateral orbitofrontal cortex (P3: r = −0.36, p = 0.002; AHRS: r = −0.33, p = 0.004) were negatively correlated with the severity of pAVH (after Bonferroni correction, p < 0.0125). Therefore, abnormal thickness of the bilateral lateral orbitofrontal cortices might be associated with pAVHs in SCZ patients.

Metabolite differences in the medial prefrontal cortex in schizophrenia patients with and without persistent auditory verbal hallucinations: a 1H MRS study

Studies of schizophrenia (SCZ) have associated auditory verbal hallucinations (AVH) with structural and functional abnormalities in frontal cortex, especially medial prefrontal cortex (mPFC). Although abnormal prefrontal network connectivity associated with language production has been studied extensively, the relationship between mPFC dysfunction (highly relevant to the pathophysiology of SCZ) and AVH has been rarely investigated. In this study, proton magnetic resonance spectroscopy was used to measure metabolite levels in the mPFC in 61 SCZ patients with persistent AVH (pAVH), 53 SCZ patients without AVH (non-AVH), and 59 healthy controls (HC). The pAVH group showed significantly lower levels of N-acetyl-aspartate + N-acetyl-aspartyl-glutamate (tNAA) and glutamate + glutamine (Glx), compared with the non-AVH (tNAA: p = 0.022, Glx: p = 0.012) and HC (tNAA: p = 0.001, Glx: p = 0.001) groups. No difference was found in the levels of tNAA and Glx between non-AVH and HC. The levels of tNAA and Glx in the mPFC was negatively correlated with the severity of pAVH (tNAA: r = -0.24, p = 0.014; Glx: r = -0.30, p = 0.002). In conclusion, pAVH in SCZ patients might be related to decreased levels of tNAA and Glx in the mPFC, indicating that tNAA or Glx might play a key role in the pathogenesis of pAVH.

Resolution of Persistent Auditory Verbal Hallucinations after Long-term Electroconvulsive Therapy Maintenance: A Case Report of a Patient with Clozapine-resistant Schizophrenia

A 32-year-old woman with schizophrenia and persistent auditory verbal hallucinations (AVHs), which caused continuous suicidal thoughts and depression, was treated with electroconvulsive therapy (ECT) of an acute course followed by maintenance ECT (M-ECT) augmented onto clozapine for 7 years. Although the general psychopathology and AVHs initially reduced slightly with ECT and clozapine, her AVHs and suicidal thoughts did not decrease subjectively. When 3 years of M-ECT, her voices declined sharply, and improvement was maintained for 2 years thereafter. A total 91 ECT sessions were performed. The daily clozapine dose was decreased from 325 to 200 mg and plasma levels remained higher than 350 ng/ml; there were no noticeable cognitive side effects. In summary, we report a case showing a sudden sharp reduction in persistent AVHs after 3 years of long-term M-ECT.

Validation of the Hamilton Program for Schizophrenia Voices Questionnaire: Associations with emotional distress and wellbeing, and invariance across diagnosis and sex

BACKGROUND

Voice-hearing is a transdiagnostic experience with evident negative effects on patients. Good quality measurement is needed to further elucidate the nature, impact and treatment of voice-hearing experiences across patient groups. The Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) is a brief self-report measure which requires further psychometric evaluation.

METHODS

Using data from a transdiagnostic sample of 401 adult UK patients, the fit of a conceptual HPSVQ measurement model, proposing a separation between physical and emotional voice-hearing characteristics, was tested. A structural model was examined to test associations between voice-hearing, general emotional distress (depression, anxiety, stress) and wellbeing. The invariance of model parameters was examined across diagnosis and sex.

RESULTS

The final measurement model comprised two factors named 'voice severity' and 'voice-related distress'. The former comprised mainly physical voice characteristics and the latter mainly distress and other negative impacts. Structural model results supported voice-related distress as mediating the associations between voice severity and emotional distress and wellbeing. Model parameters were invariant across psychosis versus non-psychosis diagnosis and partially invariant across sex. Females experienced more severe and distressing voices and a more direct association between voice severity and general anxiety was evident.

CONCLUSIONS

The HPSVQ is a useful self-report measure of voice-hearing with some scope for further exploration and refinement. Voice-related distress appears a key mechanism by which voice severity predicts general distress and wellbeing. Whilst our data broadly support interventions targeting voice-related distress for all patients, females may benefit especially from interventions targeting voice severity and strategies for responding.

Differences between self-reported and clinician-rated evaluations of 1-year changes in auditory verbal hallucinations among schizophrenia patients

Auditory verbal hallucinations (AVHs) constitute a frequent and distressing symptom of schizophrenia, associated with physical, emotional, and cognitive challenges. Despite their clinical importance, changes in the multiple dimensions of AVHs during treatment have rarely been examined, and subjective views thereof have received minimal attention. Here, we evaluated 87 patients with schizophrenia-related AVHs using the Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ; a self-report questionnaire) and the Psychotic Symptom Rating Scales-Auditory Hallucination Subscale (PSYRATS-AH; a clinician-rated scale) at baseline and after 6 months and 1 year of treatment. We explored dimensions that changed from the perspectives of both clinicians and patients and the relationships between these perceptions over the year. The test-retest reliabilities of the HPSVQ and PSYRATS-AH were generally fair. Improvements in AVHs were evident over the first 6 months; the PSYRATS-AH revealed a broader range of symptom improvement than did the HPSVQ. The "interference with life" dimension on the HPSVQ was not reduced, but the "disruption to life" score on the PSYRATS-AH was. At both baseline and 6 months, the physical characteristics of AVHs (frequency, duration, and loudness) were significantly correlated with both distress and life interference/disruption; all correlations except that for frequency were reduced at 1 year. The clinician-rated and self-reported personal perspectives on AVHs exhibited both differences and similarities; physical AVH components and subjective distressful experiences changed in different ways in those with chronic, persistent AVHs. The HPSVQ and PSYRATS-AH data were complementary, improving our understanding of the clinical implications of AVHs and subjective patient distress.

Long-Term Changes in Self-Report Auditory Verbal Hallucinations in Patients with Schizophrenia Using Clozapine

This study explored long-term changes in self-report auditory verbal hallucinations (AVHs) among patients with schizophrenia taking clozapine. Forty-four patients who were evaluated more than twice and were above the mild severity category on the Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) were enrolled. The mean observation period was 492.5±350.1 days (median, 452 days). The mean total, physical, and emotional factor scores on the HPSVQ were significantly reduced from baseline to the final observations except for one item "interference with life," which was not significantly reduced. Regarding the time-dependent longitudinal changes modeled using linear mixed-effect regression, the total and physical factor scores showed significant changes during the first year, but the emotional factor score did not satisfy a more stringent level of significance. Female gender was negatively associated with the reduction in total and physical factor scores. The duration of treatment with clozapine also had a negative relationship with the reductions in all three scores.

Cortical folding abnormalities in patients with schizophrenia who have persistent auditory verbal hallucinations

In schizophrenia temporal cortical volume loss differs between patients presenting with persistent auditory verbal hallucinations (pAVH) in contrast to those without hallucinatory symptoms (nAVH). However, it is unknown whether this deficit reflects a neural signature of neurodevelopmental origin or if abnormal temporal cortical volume is reflective of factors which may be relevant at later stages of the disorder. Here, we tested the hypothesis that local gyrification index (LGI) in regions of the temporal cortex differs between patients with pAVH (n=10) and healthy controls (n=14), and that abnormal temporal LGI discriminates between pAVH and nAVH (n=10). Structural magnetic resonance imaging at 3T along with surface-based data analysis methods was used. Contrary to our expectations, patients with pAVH showed lower LGI in Broca´s region compared to both healthy persons and nAVH. Compared to nAVH, those individuals presenting with pAVH also showed lower LGI in right Broca's homologue and right superior middle frontal cortex, together with increased LGI in the precuneus and superior parietal cortex. Regions with abnormal LGI common to both patient samples were found in anterior cingulate and superior frontal areas. Inferior cortical regions exhibiting abnormal LGI in pAVH patients were associated with overall symptom load (BPRS), but not with measures of AVH symptom severity. The pattern of abnormal cortical folding in this sample suggests a neurodevelopmental signature in Broca's region, consistent with current AVH models emphasizing the pivotal role of language circuits and inner speech. Temporal cortical deficits may characterize patients with pAVH during later stages of the disorder.

Source-based morphometry of gray matter volume in patients with schizophrenia who have persistent auditory verbal hallucinations

Abnormal structure of frontal and temporal brain regions has been suggested to occur in patients with schizophrenia who have frequent auditory verbal hallucinations (AVH). However, it is unknown whether this is specific to this patient subgroup. This study tested the hypothesis that frontotemporal gray matter volume changes would characterize patients with persistent AVH (pAVH) in contrast to healthy controls and patients without AVH. Using structural magnetic resonance imaging at 3T, we studied 20 patients with schizophrenia and 14 matched healthy controls. Ten patients were classified as having chronic and treatment resistant AVH, whereas the remaining 10 patients either never had AVH in the past or were in full remission with regard to AVH (nAVH). Using a multivariate statistical technique for structural data, i.e. "source-based morphometry" (SBM), we investigated naturally grouping patterns of gray matter volume variation among individuals, the magnitude of their expression between-groups and the relationship between gray matter volume and AVH-specific measures. SBM identified a reduction of medial and inferior frontal, insular and bilateral temporal gray matter volume between pAVH and nAVH. This pattern did not differ between nAVH patients and controls and was associated with "physical" AVH characteristics (such as symptom duration, location, frequency and intensity) in the pAVH patient group. These results suggest that a pattern of lower gray matter volume in medial frontal, insular and bilateral temporal cortical regions differentiates between patients with persistent AVH and non-hallucinating patients. Moreover, the data support a specific role of this neural pattern in AVH symptom expression.

Persistent auditory hallucinations and treatment challenges

Despite improved neurotransmitter identification and emergence of novel antipsychotics, treatment of auditory hallucinatory experiences is frustrating. Interest has developed in non-pharmacological approaches to this problem – these do not eliminate the voices but reduce the distress associated with the experience.

Insight among psychotic patients with auditory hallucinations

Poor insight in psychosis has been described as a seeming lack of awareness of the deficits, consequences of the disorder, and of the need for treatment. The aim of this study is to investigate whether patients with auditory hallucinations have less insight than those without hallucinations, and to determine which hallucination characteristics are related to patient insight. Using the PANSS and PSYRATS, the authors have evaluated the lack of insight data corresponding to 168 psychotic patients divided into three groups: patients with a history of nonpersistent hallucinations, patients with persistent hallucinations, and patients without hallucinations. Patients with persistent hallucinations showed significantly less insight than patients without persistent hallucinations and patients without hallucinations, the farther away the hallucination is located, the greater the lack of patient insight. Patients who hear the hallucination inside their head rather than outside show better insight, possibly because such patients can understand the voice as being created by their own mind.

Increased amygdala and parahippocampal gyrus activation in schizophrenic patients with auditory hallucinations: an fMRI study using independent component analysis

OBJECTIVE

Hallucinations in patients with schizophrenia have strong emotional connotations. Functional neuroimaging techniques have been widely used to study brain activity in patients with schizophrenia with hallucinations or emotional impairments. However, few of these studies have investigated the association between hallucinations and emotional dysfunctions using an emotional auditory paradigm. Independent component analysis (ICA) is an analysis method that is especially useful for decomposing activation during complex cognitive tasks in which multiple operations occur simultaneously. Our aim in this study is to analyze brain activation after the presentation of emotional auditory stimuli in patients with schizophrenia with and without chronic auditory hallucinations using ICA methodology. It was hypothesized that functional connectivity differences in limbic regions responsible for emotional processing would be demonstrated.

METHODS

The present functional magnetic resonance imaging (fMRI) study compared neural activity in 41 patients with schizophrenia (27 with auditory hallucinations, 14 without auditory hallucinations) with 31 controls. Neural activity data was generated while participants were presented with an auditory paradigm containing emotional words. The comparison was performed using a multivariate approach, ICA. Differences in temporo-spatial aspects of limbic network were examined in three study groups.

RESULTS

Limbic networks responded differently in patients with auditory hallucinations compared to healthy controls and patients without auditory hallucinations. Unlike control subjects and non-hallucinators, the group of hallucinatory patients showed an increase of activity in the parahippocampal gyrus and the amygdala during the emotional session.

CONCLUSIONS

These findings may reflect an increase in parahippocampal gyrus and amygdala activity during passive listening of emotional words in patients with schizophrenia and auditory hallucinations.

Personality and emotional response in schizophrenics with persistent auditory hallucination

Personality has been proposed as having a possible effect on the reaction that patients have toward auditory hallucination. However, this factor has not been studied previously. Thus, this study investigated the relationship among demographics, personality, cognition and emotional response in schizophrenics with persistent auditory hallucination. One-hundred and fourteen subjects with persistent auditory hallucination completed the Eysenck Personality Questionnaire, the revised Beliefs about Voices Questionnaire and the Chinese-version Hospital Anxiety and Depression Scale. Structural equation model showed that personality had an effect on beliefs about the hallucination (malevolent or benevolent), which then affected the reaction of patients toward these voices (engages or resists). Their reaction will further affect the anxious or depressed state of the patients. When these hallucinations were categorized into the three levels of omnipotence, beliefs and reactions, the model was more significant than that of one-level model. Persistent auditory hallucination only accounted for a portion of the emotional distress when malevolent or benevolent voices were perceived, and personality characteristics accounted for the remaining emotional distress in schizophrenics. This model helped us understand the relationship between personality, cognition and affective symptoms, such that, when therapists decide what "trait" to change, they can determine at which point to intervene.

Spectroscopic metabolomic abnormalities in the thalamus related to auditory hallucinations in patients with schizophrenia

OBJECTIVE

Previous studies have found neurochemical abnormalities in thalamic nuclei in patients with schizophrenia. These abnormalities have been associated with information processing deficiencies and symptom formation. There are no metabolic spectroscopy studies in patients with schizophrenia attending to auditory hallucinations. The aim of the present study is to explore metabolic Magnetic Resonance Spectroscopy (MRS) ratio differences in the thalamus between schizophrenic patients with and without auditory hallucinations and control subjects.

METHODS

MRS studies (MRI 1.5 T unit) were performed in 49 patients with schizophrenia (30 with auditory hallucinations and 19 without auditory hallucinations) and 37 controls. (1)H MRS imaging was used to acquire 2 transverse slices (TR/TE 2700/272 ms, region of interest 110 x 100 x 23 mm). In the quantitative analysis four elements of volume (9.2 x 9.2 x 23 x 4 mm), added into one spectrum representative of each thalamus, were chosen in the slice passing through the main body of the thalamus. The areas of metabolites were integrated with the jMRUI program.

RESULTS

The patients with schizophrenia had significantly lower bilateral NAA/Cho ratios when compared with healthy subjects. There was also a lower NAA/Cho ratio in the right thalamus in patients with auditory hallucinations compared to patients without auditory hallucinations and control subjects. Significant correlations were found between metabolic ratios and BPRS, PANSS and PSYRATS scores, age of onset of auditory hallucinations, and age of subjects.

CONCLUSIONS

Choline and NAA ratio abnormalities determined by thalamic spectroscopy may be related to the pathogenesis of auditory hallucinations in patients with schizophrenia.

Hallucinatory disorder, an original clinical picture? Clinical and imaging data

OBJECTIVE

The aim of this study was to verify the existence of areas of clinical and neurofunctional homogeneity in a group of patients with auditory verbal hallucinations (AVHs) as an isolated symptom, attributable to what we have called "Hallucinatory Disorder" (HD) in an attempt to propose a clinical picture that is distinct from Schizophrenia.

METHOD

Nine patients clinically characterised by chronic AVHs were compared with nine schizophrenic patients using the Structured Clinical Interview for DSM-III-R, BPRS, PANSS, SAPS, SANS, HRS-A, HRS-D, CDSS, MMSE, CGI and PSYRATS. Both groups of patients and nine healthy subjects underwent EEG and SPECT examinations.

RESULTS

Considering the psychopathological dimensions of Schizophrenia, in the HD patients clinical evaluations revealed a mono-dimensional clinical profile, whereas all these dimensions contributed to the clinical picture of the schizophrenic patients. The SPECT data showed that the schizophrenic patients had a reduced rCBF in some areas of the right frontal lobe, while the HD patients did not show any area of hypoperfusion. The SPECT hyperperfusion data showed an activation pattern in the HD patients that was characterised by the involvement of various cortical and subcortical cerebral areas, similar to those found in studies of inner speech and auditory verbal imagery.

CONCLUSIONS

The two groups of patients present significant differences that seem capable of supporting the proposed hypothesis that HD may be an independent nosographical entity.

Chronic auditory hallucinations in schizophrenic patients: MR analysis of the coincidence between functional and morphologic abnormalities

PURPOSE

To prospectively evaluate if functional magnetic resonance (MR) imaging abnormalities associated with auditory emotional stimuli coexist with focal brain reductions in schizophrenic patients with chronic auditory hallucinations.

MATERIALS AND METHODS

Institutional review board approval was obtained and all participants gave written informed consent. Twenty-one right-handed male patients with schizophrenia and persistent hallucinations (started to hear hallucinations at a mean age of 23 years +/- 10, with 15 years +/- 8 of mean illness duration) and 10 healthy paired participants (same ethnic group [white], age, and education level [secondary school]) were studied. Functional echo-planar T2*-weighted (after both emotional and neutral auditory stimulation) and morphometric three-dimensional gradient-recalled echo T1-weighted MR images were analyzed using Statistical Parametric Mapping (SPM2) software. Brain activation images were extracted by subtracting those with emotional from nonemotional words. Anatomic differences were explored by optimized voxel-based morphometry. The functional and morphometric MR images were overlaid to depict voxels statistically reported by both techniques. A coincidence map was generated by multiplying the emotional subtracted functional MR and volume decrement morphometric maps. Statistical analysis used the general linear model, Student t tests, random effects analyses, and analysis of covariance with a correction for multiple comparisons following the false discovery rate method.

RESULTS

Large coinciding brain clusters (P < .005) were found in the left and right middle temporal and superior temporal gyri. Smaller coinciding clusters were found in the left posterior and right anterior cingular gyri, left inferior frontal gyrus, and middle occipital gyrus.

CONCLUSION

The middle and superior temporal and the cingular gyri are closely related to the abnormal neural network involved in the auditory emotional dysfunction seen in schizophrenic patients.