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

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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.·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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“Techniques such as fMRI, PET and EEG have been used to tailor targeting, predict response, optimize dosing, adjust parameters, investigate state dependence and monitor response (Guller et al., 2012; Hoffman et al., 2007; Moseley et al., 2015).”
An ontogenetic role for Broca's and related speech areas in schizophrenic auditory hallucinations? Evidence from sulcal pits analysis
Salgado‐Pineda, P., Barbosa, L., Hostalet, N., García‐León, M. Á., Fuentes‐Claramonte, P., Soler‐Vidal, J., Bucur, L., Alemán‐Gómez, Y., Karuk, A., Ramiro, N., et al. (2025) · Psychiatry Research · doi:10.1016/j.psychres.2025.116502 · Cited by 5
Auditory hallucinations in schizophrenia: Where are we now and where do we go from here? A personal commentary
Sommer, I. E., & Hugdahl, K. (2019) · Schizophrenia Research · doi:10.1016/j.schres.2019.07.017 · Cited by 5
Cognitive models and biology of auditory hallucinations
Shergill, S. S., & David, A. S. (2000) · Contemporary Hypnosis · doi:10.1002/ch.187 · Cited by 5
Curative Effect of Aqueous Leaf Extract of Crinum Giganteum on NMDA-Receptor Antagonist-Induced Schizophrenic Wistar Rat Model
Finbarrs-Bello, E., Obikili, E. N., Esom, E., & Godson, A. E. (2016) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2016.061 · Cited by 5
Musical Hallucinations in Chronic Pain: The Anterior Cingulate Cortex Regulates Internally Generated Percepts
Schmitgen, A., Saal, J., Sankaran, N., Desai, M., Joseph, I., Starr, P. A., Chang, E. F., & Shirvalkar, P. R. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.669172 · Cited by 5
“Prior studies have found that the right anterior cingulate is activated in hallucinators while listening to an auditory stimulus and when these subjects had involuntary hallucinations of that same stimulus (61, 62).”
Background
Long-term potentiation and memory processes in the psychological works of Sigmund Freud and in the formation of neuropsychiatric symptoms
Centonze, D., Siracusano, A., Calabresi, P., & Bernardi, G. (2004) · Neuroscience · doi:10.1016/j.neuroscience.2004.09.032 · Cited by 7
The N2pc as an Electrophysiological Correlate of Attention in Change Blindness
Schankin, A., Hagemann, D., & Wascher, E. (2009) · Journal of Psychophysiology · doi:10.1027/0269-8803.23.2.43 · Cited by 5
Neuroimaging and Psychopathological Domains
Mucci, A., Galderisi, S., Amodio, A., & Dierks, T. (2019) · Springer eBooks · doi:10.1007/978-3-319-97307-4_2 · Cited by 6
Functional Brain Imaging of Hallucinations: Symptom Capture Studies
Jardri, R., & Sommer, I. E. (2012) · Springer eBooks · doi:10.1007/978-1-4614-4121-2_20 · Cited by 5
Distinct neural responses used to gain insight into hallucinatory perception in patients with schizophrenia
Kim, J., Ku, J. H., Lee, H., Choi, S. H., & Kim, I. Y. (2012) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2012.06.012 · Cited by 5
“Several studies have demonstrated the presence of additional top-down functions in the processing of hallucinatory perceptions that include wide-spread brain regions such as the limbic system and perception-related regions (Tiihonen et al., 1992; Silbersweig et al., 1995; Shergill et al., 2000).”
Background
Ressonância magnética funcional e sua contribuição para o estudo da cognição em esquizofrenia
Arcuri, S. M., & McGuire, P. K. (2001) · Brazilian Journal of Psychiatry · doi:10.1590/s1516-44462001000500012 · Cited by 5
Elusive Illusions: Reality Judgment and Reality Assignment in Dreams and Waking Life
Blechner, M. J. (2005) · Neuropsychoanalysis · doi:10.1080/15294145.2005.10773477 · Cited by 5
“Silbersweig et al. (1995), studying hallucinations in schizophrenics, also found activation of the right anterior cingulate, along with other areas (the bilateral thalamus, hippocampus/parahippocampal gyrus, right ventral striatum, and left orbitofrontal cortex).”
Background
New phenomenon of abnormal auditory perception associated with emotional and head trauma: Pathological confirmation by SPECT scan☆
Stephane, M., Hill, T., Matthew, E., & Folstein, M. F. (2004) · Brain and Language · doi:10.1016/j.bandl.2004.01.001 · Cited by 5
“Silbersweig et al. (1995) has shown activation of subcortical, limbic and paralimbic structures in group analysis, and activation in different areas of sensory associative cortex only in individual subject analysis.”
Background
Hearing voices or hearing the self in disguise? Revealing the neural correlates of auditory hallucinations in schizophrenia
Fu, C. H. Y., & McGuire, P. K. (2003) · Cambridge University Press eBooks · doi:10.1017/cbo9780511543708.021 · Cited by 5
Schizophrenie und verwandte Störungen — Neuropsychologie
Jähn, T., & Rockstroh, B. S. (2006) · Springer eBooks · doi:10.1007/3-540-30887-3_8 · Cited by 5
Cortical brain dysfunction in early schizophrenia: secondary pathogenetic hierarchy of neuroplasticity, psychopathology and social impairment
Hemmingsen, R., Madsen, A., Glenthoj, B. Y., & Rubin, P. (1999) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1999.tb05986.x · Cited by 5
Neuropsychological approaches to understanding visual hallucinations
Barnes, J. (2014) · Wiley eBooks · doi:10.1002/9781118892794.ch9 · Cited by 5
The mind as a process
Bruhn, J. G., & Wolf, S. (2002) · Integrative Psychological and Behavioral Science · doi:10.1007/bf02734262 · Cited by 6
“PET techniques have been used to image hallucinations in schizophrenia and tics in Tourette's syndrome, in the absence of external stimuli ( Silbersweig, Stern, Frith, Cahill, Holmes, et al., 1995 ) and to examine the clinical symptoms of schizophrenia and depression (Silbersweig & Stern, 1997).”
Method
Symptome schizophrener Störungen
Jablensky, A. V. (2000) · Springer eBooks · doi:10.1007/978-3-642-59626-1_1 · Cited by 5
Sensory thalamus function, plasticity and neuromodulation in health and disease
Paricio-Montesinos, R., & Gründemann, J. (2025) · Brain Research Bulletin · doi:10.1016/j.brainresbull.2025.111508 · Cited by 7
The antipsychotic agent sulpiride microinjected into the ventral pallidum restores positive symptom-like habituation disturbance in MAM-E17 schizophrenia model rats
Péczely, L., Dusa, D., Lénárd, L., Ollmann, T., Kertes, E., Gálosi, R., Berta, B., Szabó, Á., László, K., Zagorácz, O., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-63059-y · Cited by 4
Neural Correlates of Visual Consciousness
Rees, G. E. (2009) · Elsevier eBooks · doi:10.1016/b978-0-12-800948-2.00004-2 · Cited by 4

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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