A functional neuroanatomy of hallucinations in schizophrenia

Silbersweig, D. A.; Stern, E.; Frith, C.; Cahill, C.; Holmes, A.; Grootoonk, Sylke; Seaward, J.; McKenna, P.; Chua, S. E.; Schnorr, L.; Jones, T.; Frackowiak, R. S. J.

doi:10.1038/378176a0

Cited by 906Hallucinations in medical conditionsSchizophrenia research and treatmentMental Health and Psychiatry

A functional neuroanatomy of hallucinations in schizophrenia

Silbersweig, D. A., Stern, E., Frith, C., Cahill, C., Holmes, A., Grootoonk, Sylke, Seaward, J., McKenna, P. +4 more·1995·Nature

DOI 10.1038/378176a0

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Abstract

Hallucinations, perceptions in the absence of external stimuli, are prominent among the core symptoms of schizophrenia. The neural correlates of these brief, involuntary experiences are not well understood, and have not been imaged selectively. We have used new positron emission tomography (PET) methods to study the brain state associated with the occurrence of hallucinations in six schizophrenic patients. Here we present a group study of five patients with classic auditory verbal hallucinations despite medication, demonstrating activations in subcortical nuclei (thalamic, striatal), limbic structures (especially hippocampus), and paralimbic regions (parahippocampal and cingulate gyri, as well as orbitofrontal cortex). We also present a case study of a unique, drug-naive patient with visual as well as auditory verbal hallucinations, demonstrating activations in visual and auditory/linguistic association cortices as part of a distributed cortical-subcortical network. Activity in deep brain structures, identified with group analysis, may generate or modulate hallucinations, and the particular neocortical regions entrained in individual patients may affect their specific perceptual content. The interaction of these distributed neural systems provides a biological basis for the bizarre reports of schizophrenic patients.

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AVHs are often accompanied by activation of the speech and language perception areas in the left hemisphere.
“AVHs are often accompanied by activation of the speech and language perception areas in the left hemisphere”
From Auditory verbal hallucinations as atypical inner speech monitoring, and the potential of neurostimulation as a treatment option (2013) · cites this paper as Silbersweig et al., 1995
The putamen and thalamus are involved in initiating and organizing language representations and have been shown to be activated coincident with AVH occurrences.
“The first two were in the putamen and thalamus, which are involved in initiating and organizing language representations ordinarily (56–58), and have been shown to be activated coincident with AVH occurrences in two reports (26,59).”
From Elevated functional connectivity along a corticostriatal loop and the mechanism of auditory/verbal hallucinations in patients with schizophrenia (2011) · cites this paper as [59]

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Background
A Functional Neuroanatomy of Tics in Tourette Syndrome
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Method
Brain Activation during Human Male Ejaculation
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Result
Auditory verbal hallucinations predominantly activate the right inferior frontal area
Sommer, I. E. C., Diederen, K. M. J., Blom, J.-D., Willems, A., Kushan, L., Slotema, K., Boks, M. P. M., Daalman, K., Hoek, H. W., Neggers, S. F. W., et al. (2008) · Brain · doi:10.1093/brain/awn251 · Cited by 297 · see citing works
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Treatment resistant schizophrenia: Clinical, biological, and therapeutic perspectives
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“Finally, the thalamus is metabolically activated during episodic hallucinations (Silbersweig et al 1995), and elevated thalamic, frontal, and cingulate metabolic activity is associated with delusions and thought disorder (Erkwoh et al 1997; Sabri et al 1997).”
Background
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Background
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BackgroundInfluential
Hypnagogic and hypnopompic hallucinations during sleep paralysis: neurological and cultural construction of the night-mare
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“The areas engaged during inner speech and auditory verbal imagery in this study, particularly the inferior frontal}insular, lateral temporal and inferior parietal cortex, are similar to those identified in functional imaging studies of auditory verbal hallucinations (McGuire et al. 1993, 1996; Silbersweig et al. 1995;…”
BackgroundResultInfluential
Musical hallucinosis in acquired deafness: Phenomenology and brain substrate
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Auditory hallucinations in schizophrenia: intrusive thoughts and forgotten memories
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BackgroundResultInfluential
Where the imaginal appears real: a positron emission tomography study of auditory hallucinations
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Transcranial magnetic stimulation of left temporoparietal cortex in three patients reporting hallucinated “voices”
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399. A PET study of brain activation in response to auditory hallucinations and external speech in schizophrenic patients
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Authors: Silbersweig, D. A., Stern, E., Frith, C., Cahill, C., Holmes, A., Grootoonk, S., Seaward, J., McKenna, P., Chua, S. E., Schnorr, L., Jones, T., & Frackowiak, R. S. J.
Affiliations: Hammersmith Hospital (GB)
Fulbourn Hospital (GB)
ORCID: Stern, E.
Frith, C.
Grootoonk, Sylke
McKenna, P.
Jones, T.
Frackowiak, R. S. J.
Venue: Nature
Publisher: Springer Science and Business Media LLC
Published: 1995-11
Volume: 378
Issue: 6553
Pages: 176-179
ISSN: 0028-0836 (ISSN-L)
1476-4687
DOI: 10.1038/378176a0
OpenAlex: W1969273085
Cited by: 906
References: 30
Citations by year: 2026: 4 · 2025: 8 · 2024: 14 · 2023: 15 · 2022: 20 · 2021: 22 · 2020: 13 · 2019: 18 · 2018: 21 · 2017: 24 · 2016: 27 · 2015: 17 · 2014: 27 · 2013: 25 · 2012: 30
FWCI: 19.72
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
Locations: Nature (publishedVersion)
PubMed (publishedVersion)
UCL Discovery (University College London) (submittedVersion)
The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
Topics: Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Keywords: hallucinations, schizophrenia, auditory verbal hallucinations, visual hallucinations, neural correlates, thalamus, striatum, hippocampus, parahippocampal gyrus, cingulate gyrus, orbitofrontal cortex, cortical-subcortical networks
MeSH terms: Adult, Brain, Cerebrovascular Circulation, Hallucinations, Humans, Male, Schizophrenia, Tomography, Emission-Computed

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A functional neuroanatomy of hallucinations in schizophrenia

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