Cortical Interactions During the Experience of Auditory Verbal Hallucinations

Auditory verbal hallucinations (AVHs), the perception of voices in the absence of auditory stimuli, are common and distressing symptoms reported by 50%–80% of patients with schizophrenia. However, the results in a number of imaging and electrophysiological studies on the origins of AVH are not consistent, and the underlying pathophysiology remains unclear. The authors enrolled a group of schizophrenia patients and normal-control subjects, age 18–45 years. Two patient groups participated in the study; 1) a group of 8 patients with drug-resistant spontaneous AVHs; and 2) a group of 7 patients whose AVHs were successfully controlled with neuroleptic medication; along with 16 normal-control subjects. The entire sample had EEG recording done, with the AVH group told to press a button when they experienced a hallucination, and the other two groups randomly told when to press the button. In the AVH group, hallucinations were longer in the “eyes-closed” than “eyes-open” condition. There was spreading phase-coupling in the AVH group, intra- and inter-hemispherically, at left and right frontal and temporal areas, under both eyes-closed and eyes-open condition, during the experience of AVH. There was a statistically significant increase of α-band frequency-specific synchrony maximum values in the AVH group. AVHs are considered to be complex features, and, as such, they reflect abnormal functional connectivity in multiple related regions in both intra- and inter-hemispherical brain sites, primarily defined by phase-integration.