Case reportVisual hallucinations in schizophrenia investigated with functional magnetic resonance imaging
Introduction
Hallucinations are a core symptom of schizophrenia, often causing considerable distress. They can be defined as a perceptual experience in the absence of sensory input and can occur in all sensory modalities. They are most common in the auditory modality (70%; Stephane et al., 2001, Verdoux and van Os, 2002), followed by the olfactory and visual (up to 32%; Bracha et al., 1989) and tactile (4%); Bracha et al., 1989) domains. Previous functional magnetic resonance imaging (fMRI) studies of hallucinations in schizophrenia focused on the auditory modality and yielded activity of auditory cortex, language and limbic areas (e.g., Dierks et al., 1999, Van de Ven et al., 2005). The present case report is the first fMRI study to reveal the direct neural correlates of visual hallucinations in schizophrenia.
Section snippets
Assessment of psychopathology
We examined a 27-year-old, right-handed male out-patient with paranoid schizophrenia (295.30 according to DSM-IV criteria; American Psychiatric Association, 1994), with a 12-year duration of illness, currently treated with clozapine (150 mg/d). Psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS (Kay et al., 1987); total score: 53; positive: 16; negative: 11; general: 26). A measure of predisposition towards hallucinations (Revised Hallucination Scale; Morrison et
Results
Significant activation (P = 0.001, corrected for multiple comparisons; cluster size threshold = 800 voxels) for the hallucination predictor was found in several higher visual areas (Fig. 1, Table 1 [supplementary material] ), posterior cingulate, right hippocampus, superior parietal lobule, precuneus and right middle temporal gyrus.
The results of our localiser scan conform to those of Peelen and Downing (2005) (Table 1, middle and right columns). The higher visual areas activated during
Discussion
The current study provides evidence for the involvement of visual, attention (superior parietal lobule, precuneus) and memory-related (posterior cingulate, hippocampus) areas in the generation or experience of visual hallucinations in schizophrenia. Sensory cortex activity might underlie the vividness and subjective reality of hallucinations (Dierks et al., 1999). However, in contrast to the primary auditory cortex activation found by Dierks et al. (1999) for auditory hallucinations, we did not
Acknowledgements
V.O. was supported by the Scholarship for Graduate Students of the Johann Wolfgang Goethe-University and A.R.-J. by a doctoral studentship of the Josef Buchmann Foundation. We are grateful to Michael Lindner for programming the localiser stimuli. Dr. Paul Downing provided helpful comments on the manuscript.
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