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Cortical Activations During Auditory Verbal Hallucinations in Schizophrenia: A Coordinate-Based Meta-Analysis
Abstract
OBJECTIVE: Auditory verbal hallucinations (AVHs) constitute severe, incapacitating symptoms of schizophrenia. Despite increasing interest in the functional exploration of AVHs, the available findings remain difficult to integrate because of their considerable variability. The authors' aim was to perform a robust quantitative review of existing functional data in order to elucidate consistent patterns observed during the emergence of AVHs and to orient new pathophysiological models of hallucinations. METHOD: Ten positron emission tomography or functional magnetic resonance imaging studies were selected for the meta-analysis after systematic review. A total of 68 patients with schizophrenia spectrum disorders experiencing AVHs during scanning were included. According to a random-effects activation likelihood estimation algorithm, stereotaxic coordinates of 129 foci, reported as significant in the source studies, were extracted and computed to estimate the brain locations most consistently associated with AVHs across studies (cluster-extent threshold: 200 mm³). RESULTS: Patients experiencing AVHs demonstrated significantly increased activation likelihoods in a bilateral neural network, including the Broca's area (activation likelihood estimation=1.84×10⁻³), anterior insula (1.78×10⁻³), precentral gyrus (1.46×10⁻³), frontal operculum (1.29×10⁻³), middle and superior temporal gyri (1.59×10⁻³), inferior parietal lobule (1.33×10⁻³), and hippocampus/parahippocampal region (1.90×10⁻³). CONCLUSIONS: This meta-analysis demonstrated that experiencing AVHs is associated with increased activity in fronto-temporal areas involved in speech generation and speech perception, but also within the medial temporal lobe, a structure notably involved in verbal memory. Such findings support a model for AVHs in which aberrant cortical activations emerge within a distributed network involved at different levels of complexity in the brain architecture. Critical future directions are considered.
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“Our present study extends this by showing commonalities between many of the neural regions activated during AVH (such as left STG, left insula, left IFG) and those strongly activated during dialogic inner speech (Jardri et al., 2011; Kühn and Gallinat, 2012).”
From The brain's conversation with itself: neural substrates of dialogic inner speech (2016) · cites this paper as Jardri et al., 2011
In the citing paper
“Recent meta-analyses of symptom-capture studies have come to only partially overlapping conclusions: while Jardri et al. (2011) found AVHs to be associated with activation in left IFG, anterior insula, superior temporal, and hippocampal areas, Kühn and Gallinat (2012) could only find consistent results for bilateral IFG, postcentral gyrus, and parietal areas.”
From Inner Speech: Development, Cognitive Functions, Phenomenology, and Neurobiology (2015) · cites this paper as Jardri et al. (2011)
In the citing paper
“Increased activation within a bilateral frontotemporal network was confirmed by coordinate-based metaanalysis of the auditory hallucination (AH) state.27”
From Are hallucinations due to an imbalance between excitatory and inhibitory influences on the brain? (2016) · cites this paper as [27]
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“, 2016) built upon the four earlier GingerALE meta-analyses by other researchers that utilised smaller datasets than our own (Jardri et al., 2011; Kompus et al., 2011; Kühn & Gallinat, 2012; Van Lutterveld et al., 2013), and which also used the FDR thresholding settings now known to be unreliable.”
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“In the aberrant memory model, the AVHs are due to a failure of recall inhibition which produces an involuntary activation of the memory, which provokes intrusive memories which emerge “out of context”, and a final perception of “otherness” (Jardri et al., 2011).”
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“For instance, the functional neuroimaging studies have associated AVHs with brain areas involved in speech generation, speech perception and auditory processing [18–20].”
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“The symptom-capture functional MRI/PET studies, along with the task-based functional MRI and structural MRI studies, showed the following brain correlates of symptoms of schizophrenia 33,55–60 .”
Storchak, H., Hudak, J., Dresler, T., Haeussinger, F. B., Fallgatter, A. J., & Ehlis, A. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.644052 · Cited by 3
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Heller, N. H., Barrett, F. S., Buchborn, T., Collerton, D., Dupuis, D., Halberstadt, A. L., Jardri, R., Noorani, T. N., Preller, K. H., Taylor, J., et al. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf068 · Cited by 3
“For example, hyperactivation in speech-related regions corresponds to auditory verbal hallucinations in schizophrenia, 149 while hyperactivation of fusiform gyrus corresponds to face hallucinations in Charles Bonnet syndrome.”
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BackgroundLocalizing and lateralizing value of auditory phenomena in seizures.
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Metadata
- Authors
- Jardri, R., Pouchet, A., Pins, D., & Thomas, P.
- Affiliations
- Centre National de la Recherche Scientifique (FR)
- Venue
- American Journal of Psychiatry
- Published
- 2011-01
- Volume
- 168
- Issue
- 1
- Pages
- 73-81
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2142837020
- Cited by
- 651
- References
- 99
- Citations by year
- 2026: 25 · 2025: 34 · 2024: 31 · 2023: 26 · 2022: 42 · 2021: 43 · 2020: 50 · 2019: 51 · 2018: 50 · 2017: 36 · 2016: 54 · 2015: 30 · 2014: 43 · 2013: 38 · 2012: 72
- FWCI
- 3.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- HAL (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
- auditory verbal hallucinations, schizophrenia, schizophrenia spectrum disorders, cortical activation, activation likelihood estimation, Broca's area, anterior insula, frontal operculum, temporal lobe, hippocampus, parahippocampal region, speech generation, speech perception, verbal memory, fronto-temporal network, medial temporal lobe
- MeSH terms
- Brain Mapping, Cerebral Cortex, Hallucinations, Humans, Magnetic Resonance Imaging, Schizophrenia, Schizophrenic Psychology, Positron-Emission Tomography
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