Schizophrenia Bulletin Advance Access originally published online on November 5, 2008
Schizophrenia Bulletin 2009 35(1):58-66; doi:10.1093/schbul/sbn140
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Tuning in to the Voices: A Multisite fMRI Study of Auditory Hallucinations
2 Yale University, West Haven, CT
3 University of California, San Francisco
4 San Francisco VA Medical Center
5 University of California: Irvine
6 University of California: San Diego
7 Massachusetts General Hospital, Charlestown, MA
8 Brigham and Women's Hospital, Boston, MA
9 University of New Mexico, Albuquerque, NM
10 University of North Carolina, Durham, NC
11 University of Iowa, Iowa City, IA
12 University of Minnesota, Minneapolis, MN
13 Stanford University, Stanford, CA
14 Functional Imaging Biomedical Informatics Research Network
1 To whom correspondence should be addressed; tel: 415-221-4810 x4187, fax: 415-750-6622, e-mail: judith.ford{at}yale.edu.
Introduction: Auditory hallucinations or voices are experienced by 75% of people diagnosed with schizophrenia. We presumed that auditory cortex of schizophrenia patients who experience hallucinations is tonically "tuned" to internal auditory channels, at the cost of processing external sounds, both speech and nonspeech. Accordingly, we predicted that patients who hallucinate would show less auditory cortical activation to external acoustic stimuli than patients who did not. Methods: At 9 Functional Imaging Biomedical Informatics Research Network (FBIRN) sites, whole-brain images from 106 patients and 111 healthy comparison subjects were collected while subjects performed an auditory target detection task. Data were processed with the FBIRN processing stream. A region of interest analysis extracted activation values from primary (BA41) and secondary auditory cortex (BA42), auditory association cortex (BA22), and middle temporal gyrus (BA21). Patients were sorted into hallucinators (n = 66) and nonhallucinators (n = 40) based on symptom ratings done during the previous week. Results: Hallucinators had less activation to probe tones in left primary auditory cortex (BA41) than nonhallucinators. This effect was not seen on the right. Discussion: Although "voices" are the anticipated sensory experience, it appears that even primary auditory cortex is "turned on" and "tuned in" to process internal acoustic information at the cost of processing external sounds. Although this study was not designed to probe cortical competition for auditory resources, we were able to take advantage of the data and find significant effects, perhaps because of the power afforded by such a large sample.
Keywords: schizophrenia / auditory hallucinations / fMRI / auditory cortex