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A functional neuroanatomy of hallucinations in schizophrenia
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”
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
In the citing paper
“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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ResultEmerging principles of altered neural circuitry in schizophrenia
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BackgroundA Functional Neuroanatomy of Tics in Tourette Syndrome
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MethodBrain Activation during Human Male Ejaculation
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“Each of these regions showed increased BOLD signals after ketamine infusion, and each has been implicated in the pathogenesis of the positive symptoms of schizophrenia, for example, in fMRI studies in hallucinating patients.(57,58) Participants in the present study did not experience frank hallucinations, but the resu…”
ResultAuditory 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
“All patients were right handed and diagnosed with schizophrenia, schizo-affective disorder or psychotic disorder not otherwise specified.”
BackgroundBrainmap taxonomy of experimental design: Description and evaluation
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BackgroundMethodTreatment resistant schizophrenia: Clinical, biological, and therapeutic perspectives
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“Hippocampal malfunction is thought to contribute to the positive symptoms (Silbersweig et al 1995), whereas changes in the DLPFC may be more related to the negative symptoms.”
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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).”
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BackgroundThe functional anatomy of auditory hallucinations in schizophrenia
Lennox, B. R., Park, S. B. G., Medley, I., Morris, P. G., & Jones, P. B. (2000) · Psychiatry Research Neuroimaging · doi:10.1016/s0925-4927(00)00068-8 · Cited by 277
Sensory and cognitive functions of the basal ganglia
Brown, L. L., Schneider, J. S., & Lidsky, T. I. (1997) · Current Opinion in Neurobiology · doi:10.1016/s0959-4388(97)80003-7 · Cited by 279
Hoffman, R. E., Gueorguieva, R., Hawkins, K. A., Varanko, M., Boutros, N. N., Wu, Y.-T., Carroll, K., & Krystal, J. H. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.03.041 · Cited by 272
Brain correlates of stuttering and syllable production: A PET performance-correlation analysis
Fox, P. T. (2000) · Brain · doi:10.1093/brain/123.10.1985 · Cited by 268
Vercammen, A., Knegtering, H., den Boer, J. A., Liemburg, E. J., & Aleman, A. (2010) · Biological Psychiatry · doi:10.1016/j.biopsych.2009.11.017 · Cited by 261
Phenotype of schizophrenia: a review and formulation
Tamminga, C. A., & Holcomb, H. H. (2004) · Molecular Psychiatry · doi:10.1038/sj.mp.4001563 · Cited by 263
“Cortical activations were present, but their cortical localizations were highly variable between the subjects and not significant in group analysis”
BackgroundThe neural correlates of conscious experience: an experimental framework
Frith, C., Perry, R., & Lumer, E. (1999) · Trends in Cognitive Sciences · doi:10.1016/s1364-6613(99)01281-4 · Cited by 250
Freitas, C., Fregni, F., & Pascual‐Leone, Á. (2009) · Schizophrenia Research · doi:10.1016/j.schres.2008.11.027 · Cited by 250
“…2001), which may underlie improvement of negative symptoms (Heimer et al., 1997), whereas positive correlations between increased temporal cortical activity and the hallucinating state in schizophrenics have been reported (e.g., Silbersweig et al., 1995; Dierks et al., 1999; Shergill et al., 2000).”
BackgroundAleman, A., Sommer, I. E., & Kahn, R. S. (2007) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v68n0310 · Cited by 246
Christian Gaser, B. (2003) · Cerebral Cortex · doi:10.1093/cercor/bhg107 · Cited by 245
“…primarily included language-related areas such as superior temporal cortical regions (Lennox et al., 2000), including the primary auditory cortex in one study (Dierks et al., 1999), Broca’s area (McGuire et al., 1993), as well as the basal ganglia and anterior cingulate (Silbersweig et al., 1995).”
BackgroundInfluentialCheyne, J. A., Rueffer, S. D., & Newby-Clark, I. R. (1999) · Consciousness and Cognition · doi:10.1006/ccog.1999.0404 · Cited by 244
“…on REM dream imagery (Calvo & Fernández-Guardiola, 1984; Hobson, Stickgold, & Pace-Schott, 1998; Marquette et al., 1996), schizophrenia-related hallucinations (Cleghorn et al., 1992; Silbersweig et al., 1995), and hypnotically induced hallucinations (Szechtman, Woody, Bowers, & Nahmias, 1998).”
Depressive symptoms and presynaptic dopamine function in neuroleptic-naive schizophrenia
Hietala, J. A., Syvälahti, E. K. G., Vilkman, H., Vuorio, K. A., Räkköläinen, V., Bergman, J. R., Haaparanta‐Solin, M., Solin, O. H., Kuoppamäki, M., Eronen, E., et al. (1999) · Schizophrenia Research · doi:10.1016/s0920-9964(98)00113-3 · Cited by 247
Transcranial magnetic brain stimulation: Therapeutic promises and scientific gaps
Wassermann, E. M., & Zimmermann, T. (2012) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2011.09.003 · Cited by 243
The Neurology of Consciousness
VALKENBURG, C. T. V. (2009) · Elsevier eBooks · doi:10.1016/b978-0-12-374168-4.x0001-9 · Cited by 366
McGuire, P. K., Silbersweig, D., Wright, I. C., Murray, R. M., Frackowiak, R. S. J., & Frith, C. (1996) · The British Journal of Psychiatry · doi:10.1192/bjp.169.2.148 · Cited by 241
Musical hallucinosis in acquired deafness: Phenomenology and brain substrate
Griffiths, T. D. (2000) · Brain · doi:10.1093/brain/123.10.2065 · Cited by 239
A functional study of auditory verbal imagery
SHERGILL, S. S., BULLMORE, E. T., BRAMMER, M. J., WILLIAMS, S. C. R., MURRAY, R. M., & McGUIRE, P. K. (2001) · Psychological Medicine · doi:10.1017/s003329170100335x · Cited by 237
“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;…”
BackgroundResultInfluentialReopening the Mental Imagery Debate: Lessons from Functional Anatomy
Mellet, E., Petit, L., Mazoyer, B., Denis, M., & Tzourio, N. (1998) · NeuroImage · doi:10.1006/nimg.1998.0355 · Cited by 237
“However, the hallucinatory activity did not induce an increased activity in the primary visual area while visual associative regions were activated (Silbersweig et al., 1995).”
BackgroundAuditory hallucinations in schizophrenia: intrusive thoughts and forgotten memories
Waters, F., Badcock, J., Michie, P., & Maybery, M. (2006) · Cognitive Neuropsychiatry · doi:10.1080/13546800444000191 · Cited by 233
“, 1995) and hippocampus (e.g. Copolov et al., 2003; Silbersweig et al., 1995; Woodruff & Murray, 1994) during auditory hallucinations is consistent with the notion that selection/retrieval from memory, and context memory deficits, are important in the hallucinatory process.”
BackgroundResultInfluentialWhere the imaginal appears real: a positron emission tomography study of auditory hallucinations
Szechtman, H., Woody, E., Bowers, K. S., & Nahmias, C. (1998) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.95.4.1956 · Cited by 234
Hoffman, R. E., Boutros, N. N., Berman, R., Roessler, E., Belger, A., Krystal, J. H., & Charney, D. S. (1999) · Biological Psychiatry · doi:10.1016/s0006-3223(98)00358-8 · Cited by 234
Bartha, R. (1997) · Archives of General Psychiatry · doi:10.1001/archpsyc.1997.01830220085012 · Cited by 230
The neural mechanisms of hallucinations: A quantitative meta-analysis of neuroimaging studies
Zmigrod, L., Garrison, J. R., Carr, J., & Simons, J. S. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.05.037 · Cited by 226
Grace, A. A. (2011) · Neuropharmacology · doi:10.1016/j.neuropharm.2011.05.011 · Cited by 225
“Thus, imaging studies show hippocampal hyperactivity in schizophrenia patients (Heckers, 2001; Kegeles et al., 2000; Malaspina et al., 1999; Medoff et al., 2001), and moreover this hyperactivity correlates with psychosis (Silbersweig et al., 1995).”
The Role of the Thalamus in Schizophrenia
Andreasen, N. C. (1997) · The Canadian Journal of Psychiatry · doi:10.1177/070674379704200104 · Cited by 216
Positron emission tomography of cortical centers of tinnitus
Mirz, F., Pedersen, C. B., Ishizu, K., Johannsen, P., Ovesen, T., Stødkilde‐Jørgensen, H., & GJEDDE, A. H. (1999) · Hearing Research · doi:10.1016/s0378-5955(99)00075-1 · Cited by 217
Positron Emission Tomography Studies of Abnormal Glucose Metabolism in Schizophrenia
Buchsbaum, M. S., & Hazlett, E. A. (1998) · Schizophrenia Bulletin · doi:10.1093/oxfordjournals.schbul.a033331 · Cited by 210
Metadata
- 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)
- Venue
- Nature
- Published
- 1995-11
- Volume
- 378
- Issue
- 6553
- Pages
- 176-179
- ISSN
- 0028-0836 (ISSN-L)
- 1476-4687
- 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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