Visual hallucinations in schizophrenia investigated with functional magnetic resonance imaging

doi:10.1016/j.pscychresns.2007.09.004

Psychiatry Research: Neuroimaging

Volume 156, Issue 3, 15 December 2007, Pages 269-273

https://doi.org/10.1016/j.pscychresns.2007.09.004 Get rights and content

Abstract

We investigated a 27-year old patient with paranoid schizophrenia. Brain activity related to visual hallucinations was found in higher visual areas corresponding to the content of the hallucinations (faces, bodies, scenes) and the hippocampus. We assume that the hippocampal activity is related to the retrieval of visual images from memory and that sensory cortex activity is related to the vividness of the perceptual experience.

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.

References (20)

DeichmannR. et al.
Optimisation of the 3D MDEFT sequence for anatomical brain imaging: technical implications at 1.5 and 3T
Neuroimage
(2004)
DierksT. et al.
Activation of Heschl's gyrus during auditory hallucinations
Neuron
(1999)
KubickiM. et al.
Cingulate fasciculus integrity disruption in schizophrenia: a magnetic resonance diffusion tensor imaging study
Biological Psychiatry
(2003)
StephaneM. et al.
Auditory verbal hallucinations and dysfunction of the neural substrates of speech
Schizophrenia Research
(2001)
Van de VenV.G. et al.
The spatiotemporal pattern of auditory cortical responses during verbal hallucinations
Neuroimage
(2005)
VerdouxH. et al.
Psychotic symptoms in non-clinical populations and the continuum of psychosis
Schizophrenia Research
(2002)
AggerneaA.
The experienced reality of hallucinations and other psychological phenomena. An empirical analysis
Acta Psychiatrica Scandinavica
(1972)
American Psychiatric Association (APA)
Diagnostic and Statistical Manual of Mental Disorders
(1994)
BrachaH.S. et al.
High prevalence of visual hallucinations in research subjects with chronic schizophrenia
American Journal of Psychiatry
(1989)
ffytcheD.H.
Visual hallucinations and the Charles Bonnet syndrome
Current Psychiatry Reports
(2005)

There are more references available in the full text version of this article.

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Case reportVisual hallucinations in schizophrenia investigated with functional magnetic resonance imaging

Abstract

Introduction

Section snippets

Assessment of psychopathology

Results

Discussion

Acknowledgements

Neuroimage

Neuron

Biological Psychiatry

Schizophrenia Research

Neuroimage

Schizophrenia Research

The experienced reality of hallucinations and other psychological phenomena. An empirical analysis

Acta Psychiatrica Scandinavica

Diagnostic and Statistical Manual of Mental Disorders

High prevalence of visual hallucinations in research subjects with chronic schizophrenia

American Journal of Psychiatry

Visual hallucinations and the Charles Bonnet syndrome

Current Psychiatry Reports

Case report
Visual hallucinations in schizophrenia investigated with functional magnetic resonance imaging