title: Functional MRI of verbal self-monitoring in schizophrenia: performance and illness-specific effects.
abstract: 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 Altered striatal and hypothalamic modulation to own and others' voice characterizes emotionally withdrawn and socially avoidant patients.
authors.affiliation: Department of Psychology, Institute of Psychiatry, King's College London, London, UK. v.kumari@iop.kcl.ac.uk
authors.forename: Veena
authors.initials: V
authors.lastname: Kumari
authors.forename: Dominic
authors.initials: D
authors.lastname: Fannon
authors.forename: Dominic H
authors.initials: DH
authors.lastname: Ffytche
authors.forename: Vinodkumar
authors.initials: V
authors.lastname: Raveendran
authors.forename: Elena
authors.initials: E
authors.lastname: Antonova
authors.forename: Preethi
authors.initials: P
authors.lastname: Premkumar
authors.forename: Michael A
authors.initials: MA
authors.lastname: Cooke
authors.forename: Ananatha P P
authors.initials: AP
authors.lastname: Anilkumar
authors.forename: Steven C R
authors.initials: SC
authors.lastname: Williams
authors.forename: Christopher
authors.initials: C
authors.lastname: Andrew
authors.forename: Louise C
authors.initials: LC
authors.lastname: Johns
authors.forename: Cynthia H Y
authors.initials: CH
authors.lastname: Fu
authors.forename: Philip K
authors.initials: PK
authors.lastname: McGuire
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kuipers
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology*; D001364:Awareness / Q000502:physiology*; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D015331:Cohort Studies; D003342:Corpus Striatum / Q000503:physiopathology; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology; D005829:Geniculate Bodies / Q000503:physiopathology; D006212:Hallucinations / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D007031:Hypothalamus / Q000503:physiopathology; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009415:Nerve Net / Q000503:physiopathology; D010101:Oxygen Consumption / Q000502:physiology*; D010469:Perceptual Distortion / Q000502:physiology; D020649:Pulvinar / Q000503:physiopathology; D012559:Schizophrenia / Q000503:physiopathology*; D012564:Schizophrenic Language; D012565:Schizophrenic Psychology; D013061:Speech Acoustics; D013067:Speech Perception / Q000502:physiology*; D013702:Temporal Lobe / Q000503:physiopathology; D014705:Verbal Behavior / Q000502:physiology*; D055815:Young Adult