0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Article |

Mapping Auditory Hallucinations in Schizophrenia Using Functional Magnetic Resonance Imaging FREE

Sukhwinder S. Shergill, BSC, MBBS, MRCPsych; Michael J. Brammer, PhD; Steven C. R. Williams, PhD; Robin M. Murray, MD, DSC, FRCPsych; Philip K. McGuire, MD, PhD, MRCPsych
[+] Author Affiliations

From the Institute of Psychiatry, London, England.


Arch Gen Psychiatry. 2000;57(11):1033-1038. doi:10.1001/archpsyc.57.11.1033.
Text Size: A A A
Published online

Background  Perceptions of speech in the absence of an auditory stimulus (auditory verbal hallucinations) are a cardinal feature of schizophrenia. Functional neuroimaging provides a powerful means of measuring neural activity during auditory hallucinations, but the results from previous studies have been inconsistent. This may reflect the acquisition of small numbers of images in each subject and the confounding effects of patients actively signaling when hallucinations occur.

Methods  We examined 6 patients with schizophrenia who were experiencing frequent auditory hallucinations, using a novel functional magnetic resonance imaging method that permitted the measurement of spontaneous neural activity without requiring subjects to signal when hallucinations occurred. Approximately 50 individual scans were acquired at unpredictable intervals in each subject while they were intermittently hallucinating. Immediately after each scan, subjects reported whether they had been hallucinating at that instant. Neural activity when patients were and were not experiencing hallucinations was compared in each subject and the group as a whole.

Results  Auditory hallucinations were associated with activation in the inferior frontal/insular, anterior cingulate, and temporal cortex bilaterally (with greater responses on the right), the right thalamus and inferior colliculus, and the left hippocampus and parahippocampal cortex (P<.0001).

Conclusions  Auditory hallucinations may be mediated by a distributed network of cortical and subcortical areas. Previous neuroimaging studies of auditory hallucinations may have identified different components of this network.

Figures in this Article

AUDITORY VERBAL hallucinations (hereafter called auditory hallucinations) are perceptions of external speech in the absence of a stimulus and a cardinal feature of schizophrenia. Functional imaging provides a means of studying their pathophysiology in vivo. Previous neuroimaging studies have sought to "capture" the pattern of activity during auditory hallucinations by asking patients to signal when they occur,13 but the results have been inconsistent. This may reflect the confounding effects of signaling the presence of hallucinations, which can engage areas theoretically implicated in auditory hallucinations,4 as well as small numbers of subjects2,3 and the acquisition of a limited number of images per subject.1 Most previous studies, with a few exceptions,3 involved single-photon or positron emission tomography (SPET or PET), which, while silent, constrain the number of scans that can be safely acquired. Studies may have also differed in terms of the characteristics of the patients and hallucinations that have been examined. We have developed a method that measures spontaneous neural activity using functional magnetic resonance imaging (fMRI) and permits the acquisition of a relatively large number of images in each subject, without the subject having to signal when auditory hallucinations occur. Moreover, while the scanner noise generated during conventional fMRI can itself activate auditory cortex,5 our approach allows activity during auditory hallucinations to be examined in silence. This "random sampling" method can be viewed as a variant of event-related fMRI6 that measures the neural correlates of discrete cognitive events, in this case spontaneous hallucinations, rather than the neural response to experimentally presented stimuli.

SUBJECTS

Six male patients with schizophrenia and frequent auditory hallucinations were studied. Diagnosis was based on DSM-IV criteria for schizophrenia,7 a detailed clinical interview, and review of their hospital case notes. Patients were excluded if they had a history of head injury, neurological symptoms, speech or hearing difficulties, fulfilled DSM-IV criteria for abuse or dependence of any illicit drugs or alcohol during their lifetime, or had any contraindications to MRI scanning, including metal implants and claustrophobia. They were recruited from wards and clinics at the Maudsley Hospital, London, England. Their mean age was 35 years (SD, 11 years) with mean IQ 109 (SD, 6), measured using the National Adult Reading Test.8 All experienced intermittent and frequent (typically occupying half of their waking hours) auditory hallucinations of fully formed speech, mostly of a derogatory nature. Two subjects reported exclusively second-person hallucinations while the other 4 subjects described both second- and third-person hallucinations. The mean length of illness in the patients was 11 years (SD, 8 years) and all were being treated with antipsychotic medication at the time of the study; 5 with atypical antipsychotics (patient 1: clozapine, 650 mg and sodium valproate, 1.5 g daily; patient 2 and patient 3: olanzapine, 20 mg daily; patient 4: olanzapine, 30 mg daily; and patient 5: clozapine, 650 mg and sodium valproate, 1 g daily) and 1 with a conventional antipsychotic (patient 6: haloperidol injection, 50 mg monthly). All subjects provided written informed consent to enter the study, which had been approved by the Maudsley Hospital Ethics Committee.

PROCEDURE

A 1.5-T system was used to measure blood oxygenation level–dependent (BOLD) contrast,9 an index of neural activity, during auditory hallucinations. Two paradigms were used: (1) a novel random "sampling" method and (2) a more conventional "button-pressing" approach. The sampling method required subjects to lie at rest with their eyes closed. At randomly varied intervals of 30 to 60 seconds they heard the noise generated by the acquisition of a single volume of fMRI data (duration, 3 seconds). This served as an auditory cue for them to describe whatever they had been thinking or experiencing in the few seconds preceding the noise. They reported this verbally as soon as the noise stopped. Because there is typically a lag of 3 to 5 seconds between neural activity and the maximum BOLD signal10 (which reflects the local hemodynamic response to that activity), the image depicts the activity that was occurring a few seconds (usually 5 seconds) before the onset of the cue. After providing a description, subjects returned to the resting (but intermittently hallucinating) state and the procedure was repeated until a mean of 50 whole-brain T2-weighted images had been acquired from each subject. The choice of a 30- to 60-second variation between scans was a pragmatic one to keep the total acquisition time between 60 and 90 minutes per subject, the maximum that patients were able to tolerate in 1 session (the individual scan time for 2 subjects was 60 minutes, 75 minutes for 2 subjects, and 90 minutes for the other 2 subjects). Any influence of the scan noise itself is unlikely to have any effect on the BOLD response, because of the hemodynamic delay, and any nonspecific effects, such as the possibility of startle response, would be cancelled out by acquiring the baseline scans in an identical manner. Each image volume was subsequently categorized as corresponding or not corresponding to auditory hallucinations on the basis of each description. In the same session, subjects were also studied using a button-pressing method, signaling the onset and end of discrete auditory hallucinations by pressing a button with the right index finger. The use of this more established method provided a measure of internal validity for the sampling method, as well as an index of activation related to motor response. A continuous series of 100 T2-weighted images were acquired (an image every 3 seconds) during a 5-minute period, and the timing of the button press was used to indicate which portions of this block coincided with auditory hallucinations.

IMAGE ACQUISITION AND STATISTICAL ANALYSIS

Gradient-echo echoplanar MR images were acquired using a 1.5-T scanner fitted with Advanced NMR hardware and software (General Electric, Milwaukee, Wis). In each of 14 noncontiguous planes parallel to the intercommissural (AC-PC) plane, 40 to 100 T2-weighted MR images depicting BOLD contrast were acquired with TE = 40 milliseconds, TR = 3000 milliseconds, in-plane resolution = 3.1 mm, slice thickness = 7 mm, slice = skip 0.7 mm. Following the minimization of movement-related artifacts by realignment and regression,11 voxel-wise activation maps were constructed by computing the Pearson product moment correlation of the time series at each voxel12 with the reported occurrence of auditory hallucinations. Ten further maps were computed at each voxel after randomly permuting the pattern of auditory hallucination reports. Following mapping of observed and randomized correlation data into standard stereotactic space,13 median observed and randomized maps were constructed. Foci of activation with a voxel-wise probability of type I error of <.0001 (at this level of significance one expects <1 random error voxel per slice of data) were identified by determining the critical threshold from the distribution of correlation coefficients computed following random permutation.11,14 To compare the activation with the 2 different methods of acquisition, the data from the 2 experiments were then combined and the correlation coefficients in all subjects, in both experiments, at each voxel in standard space were analyzed using the linear model below. This identified effects that were dependent on, and independent of, the experimental condition (sampling or button-pressing):

where Corri,j is the observed correlation coefficient for subject i in group j; β0 is the overall mean; βj is the mean correlation coefficient in experiment j; E is the classification variable coding experimental design; and ei,j is an error term. This model was fitted to the Talairach transformed correlation coefficients obtained by random permutation of the time series (see above) as well as the correlation coefficients obtained by the analysis of the observed time series. Fitting this model to the randomized correlation data (across the 2 groups on a voxel-wise basis) permitted the construction of distributions of β0 and βj under the null hypothesis that there was no experimentally determined response to the sampling or button-press conditions. The null distributions of β0 and βj were then used to determine the critical values of the 2 parameters for statistical significance at any required level of probability. We were primarily interested in differences due to the method of acquisition (sampling or button press); ie, in estimating and testing experiment-independent effects (β0). However, as β0 is independent of βj, a significant value of β0 could arise principally due to a contribution from one of the experiments. For example, a large response in one experiment and a small one in the other may produce a mean value that is significant but that does not imply any constancy of responses in the 2 experiments. The inclusion of the βj term in the model allows such responses to be identified and removed from the activation maps. Following this conservative correction of the data, significant effects were rendered onto a morphological template.

All 6 subjects experienced frequent auditory hallucinations when studied with the sampling method; subjects were hallucinating during a mean of 44% of scans (range, 33%-60% of scans). Five of these patients reported auditory hallucinations during the button-pressing paradigm (hallucinating during a mean of 25% of scans; range, 5%-52% of scans), with the remaining subject reporting that the scanner noise interfered with the experience. There was no obvious periodicity in the hallucinatory activity of any individual patient.

The sampling method revealed activation associated with auditory hallucinations in the inferior frontal gyrus/insula and middle temporal gyri bilaterally, particularly in the right hemisphere, where there was additional activation in the superior temporal gyrus, middle frontal gyrus, posterior parietal cortex, thalamus, and inferior colliculus. Activation was also evident in the anterior cingulate gyrus, and in the left hippocampus and parahippocampal gyrus (Table 1 and Figure 1). As an index of the consistency of activation across subjects, significant right temporal activation was evident in 4 of the 6 individuals. Using the button-pressing method, there was significantly less activation of the inferior frontal and right lateral temporal gyri than with the sampling approach and there was no activation in the right middle frontal gyrus, thalamus, or inferior colliculus (even at a liberal threshold of P<.01). Conversely, only the button-pressing method was associated with activation in the left primary motor cortex, and the right cerebellum and putamen (Table 1).

Table Graphic Jump LocationRegions Activated During Mapping of Auditory Hallucinations*
Place holder to copy figure label and caption

Group brain activation during random sampling of hallucinations. Five transverse sections through the brain, at different levels relative to the intercommissural plane (in millimeters). The right side of the brain is shown on the left side of each section. The colored areas are regions that were activated during auditory hallucinations, with the foci of maximal significance shown in yellow. The main activations (P<.001) were in the right inferior colliculus (A), the right and left insula (B and C), the left parahippocampal gyrus (E), the right superior temporal gyrus (D), and the right thalamus (F). Activation was also evident in the middle frontal (G) and anterior cingulate gyri (H), and in the right inferior and superior parietal lobule (I).

Graphic Jump Location

A striking feature of this study was the identification of an extensive network of cortical and subcortical areas associated with auditory hallucinations; previous neuroimaging studies of auditory hallucinations have typically reported less extensive activation.13,1517 Thus, our earlier work using SPET linked auditory hallucinations with activation in the left inferior frontal cortex,15 while other studies, mainly using PET, respectively implicated the anterior cingulate gyrus,16 the left3,17 and the right temporal cortex,2,3 the left parahippocampal region18 and the thalamus, striatum, and cerebellum.1 As all of these areas were activated in the present study, these apparently inconsistent findings may have resulted from identification of different elements of the same network. Most previous studies involved SPET or PET, which limits the number of images that can be safely acquired in each subject, and some examined a few selected regions of interest, as opposed to the entire brain.

Comparison of the 2 paradigms (one that required subjects to signal the presence of auditory hallucinations and one that did not) clarified which activations were related to the act of signaling rather than to hallucinations per se. The areas that were exclusively activated with the button-pressing method (the left precentral gyrus, the right cerebellar cortex, and the putamen) are normally engaged during voluntary movements of the right index finger.19 The greater activation of the right middle and superior temporal gyri, thalamus, and inferior colliculus with the sampling method may reflect the fact that with this paradigm neural activity was measured in the absence of background scanner noise, which may have obscured these responses when the button-pressing method was used.5,20,21 This difference in activation is unlikely to have been a simple function of power, as the button-pressing method involved a larger total number of scans. While there were significant differences in activation with the 2 methods, there was also a considerable degree of overlap. Thus, both methods identified activation in the inferior frontal, premotor, inferior parietal, and temporal cortex.22 The engagement of these regions with the sampling method, in the absence of a motor response, is consistent with the notion that auditory hallucinations involve the processing of inner speech, which engages the same areas.23,24 This finding is congruent with one of the most prominent cognitive theories of auditory hallucinations,4 which has suggested that there are 2 types of stimuli; one external that has an effect via the sensory organs, and one that is internally generated from planned or willed action. They believe that the internal monitoring of willed action is defective in psychotic illness, so that, in the case of auditory hallucinations, patients experience internally generated thoughts as externally generated. The left parahippocampal region also revealed activation, common to both methods, as reported in previous studies.18

The pattern of the activation we observed during auditory hallucinations is remarkably similar to that seen when healthy volunteers imagine another person talking to them (auditory verbal imagery); common activation of the bilateral frontal and temporal gyri, along with right-sided precentral and inferior parietal gyri. However, while imagining speech is associated with a marked activation in the supplementary motor area (SMA),24,25 this region was only weakly engaged during auditory hallucinations. Conversely, auditory hallucinations were associated with activation in the left parahippocampal region, but this region is not activated when volunteers imagine alien speech.24,25 The SMA has been implicated in the deliberate generation of inner speech,2426 and lesions in this region are associated with the alien limb syndrome, in which the patient loses awareness that his movements are self-generated and attributes them to someone else.27 The paucity of SMA activation that we observed during auditory hallucinations might thus be related to a lack of awareness that inner speech has been generated,28 thought to be the critical deficit underlying auditory hallucinations.4 The left parahippocampal region is normally activated when subjects encounter unexpected stimuli29 and psychological models of self-monitoring propose that it is engaged when there is a mismatch between the perceived and predicted results of cognitive activity.30 Data from previous neuroimaging studies have suggested that the left parahippocampal gyrus, ventral striatum, and prefrontal cortex could form a network of regions responsible for self-monitoring.18 Parahippocampal activation during auditory hallucinations may thus represent a neural (but not necessarily conscious) response to internal speech that subjects are unaware they have generated.

The prominent involvement of the right hemisphere during auditory hallucinations may seem surprising given that the patients were perceiving speech, but is consistent with data from previous neuroimaging2,3 and electroencephalographic studies31 of auditory hallucinations, and with the greater right frontotemporal activation when subjects imagine another person's speech as opposed to their own.25 Moreover, as auditory hallucinations in schizophrenia are typically derogatory and hostile in tone, the prominent engagement of right hemispheric areas might reflect processing of the prosody32 and inference of what is being said,33 as well as an emotional response to its content.34

A methodological limitation of this study, common to all investigations using the cognitive subtraction method, is the lack of knowledge about the resting brain activity in patients and whether it is different from resting activity in other nonhallucinating schizophrenic patients and in normal individuals. We are planning to investigate this using the sampling technique in future studies. A further limitation of the sampling approach is that it is less precise about the actual timing of the hallucinations, such as the length of the preceding hallucinatory experience, and is reliant on the accuracy of self-report. It is difficult to find large numbers of patients suitable for this type of study and the relatively small sample size could serve to reduce the validity of the findings. However, we attempted to overcome the limitations of small numbers by using fMRI to acquire a larger number of images and using both the sampling and button-pressing technique within the same scanning session, accepting differences in noise and acquisition method, to allow comparison with each other (as an internal control) and the previous button-pressing literature.

In conclusion, this study suggests that auditory hallucinations involve a distributed network of cortical and subcortical areas. This is consistent with the notion that auditory hallucinations arise through the disruption of normal cognitive processes, such as monitoring of self-generated verbal material,4 rather than a result of an epileptiform focus in auditory cortex.35 The engagement of both cortical and subcortical elements of the auditory pathway during hallucinations makes it easier to appreciate why patients often describe these experiences as indistinguishable from "real" auditory perceptions. Defining the brain areas that mediate auditory hallucinations facilitates our understanding of their basis in cognitive, as well as biological, terms and provides a scientific rationale for their treatment using recently developed psychological36 and biological strategies37 that are currently undergoing clinical evaluation.

Accepted for publication May 23, 2000.

Dr Shergill is supported by a Wellcome clinical training fellowship.

We thank Chris Andrew, Edson Amaro, MD, Sophia Frangou, MD, Andrew Simmons, PhD, and the neuroimaging staff for technical support.

Corresponding author: Sukhwinder S. Shergill, BSc, MBBS, MRCPsych, Wellcome Clinical Fellow, Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, United Kingdom (e-mail: s.shergill@iop.kcl.ac.uk).

Silbersweig  DAStern  EFrith  CDCahill  CHolmes  AGrootoonk  SSeaward  JMcKenna  PChua  SSchnorr  L A functional neuroanatomy of hallucinations in schizophrenia. Nature. 1995;378176- 179
Link to Article
Woodruff  PBrammer  MMellers  JWright  IBullmore  EWilliams  S Auditory hallucinations and perception of external speech. Lancet. 1995;3461035
Link to Article
Dierks  TLinden  DEJJandl  MFormisano  EGoebel  RLanfermann  HSinger  W Activation of Heschl's gyrus during auditory hallucinations. Neuron. 1999;22615- 621
Link to Article
Frith  CDDone  DJ Towards a neuropsychology of schizophrenia. Br J Psychiatry. 1988;153437- 443
Link to Article
Bandettini  PAJesmanowicz  AVan Kylen  JBirn  RMHyde  JS Functional MRI of brain activation induced by scanner acoustic noise. Magn Reson Med. 1998;39410- 416
Link to Article
Buckner  RL Event-related fMRI and the hemodynamic response. Hum Brain Mapp. 1998;6373- 377
Link to Article
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.  Washington, DC American Psychiatric Association1994;
Nelson  HE National Adult Reading Test.  Windsor, England NFER-Nelson1991;
Ogawa  SLee  TMKay  ARTank  DW Brain magnetic resonance imaging with contrast dependent blood oxygenation. Proc Natl Acad Sci U S A. 1990;879868- 9872
Link to Article
Eden  GFJoseph  JEBrown  HEBrown  CPZeffiro  TA Utilizing hemodynamic delay and dispersion to detect fMRI signal change without auditory interference: the behavior interleaved gradients technique. Magn Reson Med. 1999;4113- 20
Link to Article
Brammer  MJBullmore  ETSimmons  AWilliams  SCRGrasby  PMHoward  RJWoodruff  PWRRabe-Hesketh  S Generic brain activation mapping in fMRI: a nonparametric approach. Magn Reson Imaging. 1997;15763- 770
Link to Article
Bandettini  PAJesmanowicz  AWong  ECHyde  JS Processing strategies for time-course data sets in functional MRI of the brain. Magn Reson Med. 1993;30161- 173
Link to Article
Talairach  JTournoux  P Co-Planar Stereotactic Atlas of the Human Brain.  Stuttgart, Germany Thieme1988;
Edgington  ES Randomisation Tests.  New York, NY Marcel-Dekker1980;
McGuire  PKShah  GMSMurray  RM Increased blood flow in Broca's area during auditory hallucinations in schizophrenia. Lancet. 1993;342703- 706
Link to Article
Cleghorn  JMFranco  SSzechtman  BKaplan  RDSzechtman  HBrown  GMNahmias  CGarnett  ES Toward a brain map of auditory hallucinations. Am J Psychiatry. 1992;1491062- 1069
Suzuki  MYuasa  SMinabe  YMurata  MKurachi  M Left superior temporal blood flow increases in schizophrenic and schizophreniform patients with hallucinations: a longitudinal cast study using 123I-IMP SPECT. Eur Arch Psychiatry Clin Neurosci. 1993;242257- 261
Link to Article
Liddle  PFFriston  KJFrith  CDHirsch  SRJones  TFrackowiak  RSJ Patterns of cerebral blood flow in schizophrenia. Br J Psychiatry. 1992;160179- 186
Link to Article
Rao  SMBandettini  PABinder  JRBobholz  JAHammeke  TAStein  EAHyde  JS Relationship between finger movement rate and functional magnetic resonance signal change in human primary motor cortex. J Cereb Blood Flow Metab. 1996;161250- 1254
Link to Article
Hall  DAHaggard  MPAkeroyd  MAPalmer  ARSummerfield  AQElliott  MRGurney  EMBowtell  RW "Sparse" temporal sampling in auditory fMRI. Hum Brain Mapp. 1999;7213- 223
Link to Article
Guimaraes  ARMelcher  JRTalavage  TMBaker  JRLedden  PRosen  BRKiang  NYFullerton  BCWeisskoff  RM Imaging subcortical auditory activity in humans. Hum Brain Mapp. 1998;633- 41
Link to Article
Krams  MRushworth  MFDeiber  MPFrackowiak  RSPassingham  RE The preparation, execution and suppression of copied movements in the human brain. Exp Brain Res. 1998;120386- 398
Link to Article
Price  CJWise  RJSWarburton  EMoore  CJHoward  DPatterson  KFrackowiak  RSFriston  KJ Hearing and saying: the functional neuroanatomy of auditory word processing. Brain. 1996;119919- 931
Link to Article
McGuire  PKSilbersweig  DAMurray  RMDavid  ASFrackowiak  RSJFrith  CD Functional anatomy of inner speech and auditory verbal imagery. Psychol Med. 1996;2629- 38
Link to Article
Shergill  SSBullmore  ESimmons  ABrammer  MJMurray  RMMcGuire  PK A functional MRI study of auditory verbal imagery. Psychol Med. In press.
Curtis  VABullmore  ETBrammer  MJWright  ICWilliams  SCMorris  RGSharma  TSMurray  RMMcGuire  PK Attenuated frontal activation during a verbal fluency task in patients with schizophrenia. Am J Psychiatry. 1998;1551056- 1063
Gasquoine  PG Alien hand sign. J Clin Exp Neuropsychol. 1993;15653- 666
Link to Article
McGuire  PKSilbersweig  DAWright  IMurray  RMDavid  ASFrackowiak  RSFrith  CD Abnormal monitoring of inner speech: a physiological basis for auditory hallucinations. Lancet. 1995;346596- 600
Link to Article
Stern  CECorkin  SGonzalez  RGGuimaraes  ARBaker  JRJennings  PJCarr  CASugiura  RMVedantham  VRosen  BR The hippocampal formation participates in novel picture encoding: evidence from functional magnetic resonance imaging. Proc Natl Acad Sci U S A. 1996;938660- 8665
Link to Article
Gray  JAFeldon  JRawlins  JHemsley  DSmith  A The neuropsychology of schizophrenia. Behav Brain Sci. 1990;141- 84
Link to Article
Line  PSilberstein  RBWright  JJCopolov  DL Steady state visually evoked potential correlates of auditory hallucinations in schizophrenia. Neuroimage. 1998;8370- 376
Link to Article
George  MSParekh  PIRosinsky  NKetter  TAKimbrell  TAHeilman  KMHerscovitch  PPost  RM Understanding emotional prosody activates right hemisphere regions. Arch Neurol. 1996;53665- 670
Link to Article
Bottini  GCorcoran  RSterzi  RPaulesu  ESchenone  PScarpa  PFrackowiak  RSFrith  CD The role of the right hemisphere in the interpretation of figurative aspects of language. Brain. 1994;1171241- 1253
Link to Article
Canli  TDesmond  JEZhao  ZGlover  GGabrieli  JD Hemispheric asymmetry for emotional stimuli detected with fMRI. Neuroreport. 1998;93233- 3239
Link to Article
David  AS The neuropsychology of auditory-verbal hallucinations. David  ASCutting  JCeds.The Neuropsychology of Schizophrenia. Mahwah, NJ Lawrence Erlbaum Associates1994;269- 313
Shergill  SSMurray  RMMcGuire  PK Auditory hallucinations: a review of psychological treatments. Schizophr Res. 1998;32137- 150
Link to Article
Hoffman  REBoutros  NNHu  SBerman  RMKrystal  JHCharney  DS Transcranial magnetic stimulation and auditory hallucinations in schizophrenia. Lancet. 2000;3551073- 1075
Link to Article

Figures

Place holder to copy figure label and caption

Group brain activation during random sampling of hallucinations. Five transverse sections through the brain, at different levels relative to the intercommissural plane (in millimeters). The right side of the brain is shown on the left side of each section. The colored areas are regions that were activated during auditory hallucinations, with the foci of maximal significance shown in yellow. The main activations (P<.001) were in the right inferior colliculus (A), the right and left insula (B and C), the left parahippocampal gyrus (E), the right superior temporal gyrus (D), and the right thalamus (F). Activation was also evident in the middle frontal (G) and anterior cingulate gyri (H), and in the right inferior and superior parietal lobule (I).

Graphic Jump Location

Tables

Table Graphic Jump LocationRegions Activated During Mapping of Auditory Hallucinations*

References

Silbersweig  DAStern  EFrith  CDCahill  CHolmes  AGrootoonk  SSeaward  JMcKenna  PChua  SSchnorr  L A functional neuroanatomy of hallucinations in schizophrenia. Nature. 1995;378176- 179
Link to Article
Woodruff  PBrammer  MMellers  JWright  IBullmore  EWilliams  S Auditory hallucinations and perception of external speech. Lancet. 1995;3461035
Link to Article
Dierks  TLinden  DEJJandl  MFormisano  EGoebel  RLanfermann  HSinger  W Activation of Heschl's gyrus during auditory hallucinations. Neuron. 1999;22615- 621
Link to Article
Frith  CDDone  DJ Towards a neuropsychology of schizophrenia. Br J Psychiatry. 1988;153437- 443
Link to Article
Bandettini  PAJesmanowicz  AVan Kylen  JBirn  RMHyde  JS Functional MRI of brain activation induced by scanner acoustic noise. Magn Reson Med. 1998;39410- 416
Link to Article
Buckner  RL Event-related fMRI and the hemodynamic response. Hum Brain Mapp. 1998;6373- 377
Link to Article
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.  Washington, DC American Psychiatric Association1994;
Nelson  HE National Adult Reading Test.  Windsor, England NFER-Nelson1991;
Ogawa  SLee  TMKay  ARTank  DW Brain magnetic resonance imaging with contrast dependent blood oxygenation. Proc Natl Acad Sci U S A. 1990;879868- 9872
Link to Article
Eden  GFJoseph  JEBrown  HEBrown  CPZeffiro  TA Utilizing hemodynamic delay and dispersion to detect fMRI signal change without auditory interference: the behavior interleaved gradients technique. Magn Reson Med. 1999;4113- 20
Link to Article
Brammer  MJBullmore  ETSimmons  AWilliams  SCRGrasby  PMHoward  RJWoodruff  PWRRabe-Hesketh  S Generic brain activation mapping in fMRI: a nonparametric approach. Magn Reson Imaging. 1997;15763- 770
Link to Article
Bandettini  PAJesmanowicz  AWong  ECHyde  JS Processing strategies for time-course data sets in functional MRI of the brain. Magn Reson Med. 1993;30161- 173
Link to Article
Talairach  JTournoux  P Co-Planar Stereotactic Atlas of the Human Brain.  Stuttgart, Germany Thieme1988;
Edgington  ES Randomisation Tests.  New York, NY Marcel-Dekker1980;
McGuire  PKShah  GMSMurray  RM Increased blood flow in Broca's area during auditory hallucinations in schizophrenia. Lancet. 1993;342703- 706
Link to Article
Cleghorn  JMFranco  SSzechtman  BKaplan  RDSzechtman  HBrown  GMNahmias  CGarnett  ES Toward a brain map of auditory hallucinations. Am J Psychiatry. 1992;1491062- 1069
Suzuki  MYuasa  SMinabe  YMurata  MKurachi  M Left superior temporal blood flow increases in schizophrenic and schizophreniform patients with hallucinations: a longitudinal cast study using 123I-IMP SPECT. Eur Arch Psychiatry Clin Neurosci. 1993;242257- 261
Link to Article
Liddle  PFFriston  KJFrith  CDHirsch  SRJones  TFrackowiak  RSJ Patterns of cerebral blood flow in schizophrenia. Br J Psychiatry. 1992;160179- 186
Link to Article
Rao  SMBandettini  PABinder  JRBobholz  JAHammeke  TAStein  EAHyde  JS Relationship between finger movement rate and functional magnetic resonance signal change in human primary motor cortex. J Cereb Blood Flow Metab. 1996;161250- 1254
Link to Article
Hall  DAHaggard  MPAkeroyd  MAPalmer  ARSummerfield  AQElliott  MRGurney  EMBowtell  RW "Sparse" temporal sampling in auditory fMRI. Hum Brain Mapp. 1999;7213- 223
Link to Article
Guimaraes  ARMelcher  JRTalavage  TMBaker  JRLedden  PRosen  BRKiang  NYFullerton  BCWeisskoff  RM Imaging subcortical auditory activity in humans. Hum Brain Mapp. 1998;633- 41
Link to Article
Krams  MRushworth  MFDeiber  MPFrackowiak  RSPassingham  RE The preparation, execution and suppression of copied movements in the human brain. Exp Brain Res. 1998;120386- 398
Link to Article
Price  CJWise  RJSWarburton  EMoore  CJHoward  DPatterson  KFrackowiak  RSFriston  KJ Hearing and saying: the functional neuroanatomy of auditory word processing. Brain. 1996;119919- 931
Link to Article
McGuire  PKSilbersweig  DAMurray  RMDavid  ASFrackowiak  RSJFrith  CD Functional anatomy of inner speech and auditory verbal imagery. Psychol Med. 1996;2629- 38
Link to Article
Shergill  SSBullmore  ESimmons  ABrammer  MJMurray  RMMcGuire  PK A functional MRI study of auditory verbal imagery. Psychol Med. In press.
Curtis  VABullmore  ETBrammer  MJWright  ICWilliams  SCMorris  RGSharma  TSMurray  RMMcGuire  PK Attenuated frontal activation during a verbal fluency task in patients with schizophrenia. Am J Psychiatry. 1998;1551056- 1063
Gasquoine  PG Alien hand sign. J Clin Exp Neuropsychol. 1993;15653- 666
Link to Article
McGuire  PKSilbersweig  DAWright  IMurray  RMDavid  ASFrackowiak  RSFrith  CD Abnormal monitoring of inner speech: a physiological basis for auditory hallucinations. Lancet. 1995;346596- 600
Link to Article
Stern  CECorkin  SGonzalez  RGGuimaraes  ARBaker  JRJennings  PJCarr  CASugiura  RMVedantham  VRosen  BR The hippocampal formation participates in novel picture encoding: evidence from functional magnetic resonance imaging. Proc Natl Acad Sci U S A. 1996;938660- 8665
Link to Article
Gray  JAFeldon  JRawlins  JHemsley  DSmith  A The neuropsychology of schizophrenia. Behav Brain Sci. 1990;141- 84
Link to Article
Line  PSilberstein  RBWright  JJCopolov  DL Steady state visually evoked potential correlates of auditory hallucinations in schizophrenia. Neuroimage. 1998;8370- 376
Link to Article
George  MSParekh  PIRosinsky  NKetter  TAKimbrell  TAHeilman  KMHerscovitch  PPost  RM Understanding emotional prosody activates right hemisphere regions. Arch Neurol. 1996;53665- 670
Link to Article
Bottini  GCorcoran  RSterzi  RPaulesu  ESchenone  PScarpa  PFrackowiak  RSFrith  CD The role of the right hemisphere in the interpretation of figurative aspects of language. Brain. 1994;1171241- 1253
Link to Article
Canli  TDesmond  JEZhao  ZGlover  GGabrieli  JD Hemispheric asymmetry for emotional stimuli detected with fMRI. Neuroreport. 1998;93233- 3239
Link to Article
David  AS The neuropsychology of auditory-verbal hallucinations. David  ASCutting  JCeds.The Neuropsychology of Schizophrenia. Mahwah, NJ Lawrence Erlbaum Associates1994;269- 313
Shergill  SSMurray  RMMcGuire  PK Auditory hallucinations: a review of psychological treatments. Schizophr Res. 1998;32137- 150
Link to Article
Hoffman  REBoutros  NNHu  SBerman  RMKrystal  JHCharney  DS Transcranial magnetic stimulation and auditory hallucinations in schizophrenia. Lancet. 2000;3551073- 1075
Link to Article

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 341

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
JAMAevidence.com

Users' Guides to the Medical Literature
Clinical Resolution

Users' Guides to the Medical Literature
Clinical Scenario