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Schizophrenia Bulletin Advance Access published online on November 7, 2008
Schizophrenia Bulletin, doi:10.1093/schbul/sbn148
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© 2008 The Authors
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Functional MRI of Verbal Self-monitoring in Schizophrenia: Performance and Illness-Specific Effects

Veena Kumari1,2,5, Dominic Fannon3, Dominic H. ffytche4, Vinodkumar Raveendran2, Elena Antonova2, Preethi Premkumar2, Michael A. Cooke2, Ananatha P.P. Anilkumar3, Steven C.R. Williams4, Christopher Andrew4, Louise C. Johns2,3, Cynthia H.Y. Fu3,4, Philip K. McGuire3 and Elizabeth Kuipers2,5
2 Department of Psychology
3 Division of Psychological Medicine and Psychiatry
4 Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, London, UK
5 NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Trust, London, UK

1 To whom correspondence should be addressed; Department of Psychology, P078, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK; tel: 00-44-207-848-0233, fax: 00-44-207-848-0860, e-mail: v.kumari{at}iop.kcl.ac.uk.

Previous small-sample studies have shown altered frontotemporal activity in schizophrenia patients with auditory hallucinations and impaired monitoring of self-generated speech. We examined a large cohort of patients with schizophrenia (n = 63) and a representative group of healthy controls (n = 20) to disentangle performance, illness, and symptom-related effects in functional magnetic resonance imaging–detected brain abnormalities during monitoring of self- and externally generated speech in schizophrenia. Our results revealed activation of the thalamus (medial geniculate nucleus, MGN) and frontotemporal regions with accurate monitoring across all participants. Less activation of the thalamus (MGN, pulvinar) and superior-middle temporal and inferior frontal gyri occurred in poorly performing patients (1 standard deviation below controls’ mean; n = 36), relative to the combined group of controls and well-performing patients. In patients, (1) greater deactivation of the ventral striatum and hypothalamus to own voice, combined with nonsignificant activation of the same regions to others’ voice, associated positively with negative symptoms (blunted affect, emotional withdrawal, poor rapport, passive social avoidance) regardless of performance and (2) exaggerated activation of the right superior-middle temporal gyrus during undistorted, relative to distorted, feedback associated with both positive symptoms (hallucinations, persecution) and poor performance. A further thalamic abnormality characterized schizophrenia patients regardless of performance and symptoms. We conclude that hypoactivation of a neural network comprised of the thalamus and frontotemporal regions underlies impaired speech monitoring in schizophrenia. Positive symptoms and poor monitoring share a common activation abnormality in the right superior temporal gyrus during processing of degraded speech. Altered striatal and hypothalamic modulation to own and others’ voice characterizes emotionally withdrawn and socially avoidant patients.

Keywords: psychosis / self / others / social avoidance / fMRI / frontal / temporal / thalamus

Received for publication August 18, 2008. Revision received October 2, 2008. Accepted for publication October 5, 2008.


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