title: Abnormal Effective Connectivity in the Brain is Involved in Auditory Verbal Hallucinations in Schizophrenia.
abstract: Information flow among auditory and language processing-related regions implicated in the pathophysiology of auditory verbal hallucinations (AVHs) in schizophrenia (SZ) remains unclear. In this study, we used stochastic dynamic causal modeling (sDCM) to quantify connections among the left dorsolateral prefrontal cortex (inner speech monitoring), auditory cortex (auditory processing), hippocampus (memory retrieval), thalamus (information filtering), and Broca's area (language production) in 17 first-episode drug-naïve SZ patients with AVHs, 15 without AVHs, and 19 healthy controls using resting-state functional magnetic resonance imaging. Finally, we performed receiver operating characteristic (ROC) analysis and correlation analysis between image measures and symptoms. sDCM revealed an increased sensitivity of auditory cortex to its thalamic afferents and a decrease in hippocampal sensitivity to auditory inputs in SZ patients with AVHs. The area under the ROC curve showed the diagnostic value of these two connections to distinguish SZ patients with AVHs from those without AVHs. Furthermore, we found a positive correlation between the strength of the connectivity from Broca's area to the auditory cortex and the severity of AVHs. These findings demonstrate, for the first time, augmented AVH-specific excitatory afferents from the thalamus to the auditory cortex in SZ patients, resulting in auditory perception without external auditory stimuli. Our results provide insights into the neural mechanisms underlying AVHs in SZ. This thalamic-auditory cortical-hippocampal dysconnectivity may also serve as a diagnostic biomarker of AVHs in SZ and a therapeutic target based on direct in vivo evidence.
authors.affiliation: School of Biomedical Engineering, Fourth Military Medical University, Xi'an, 710032, China.
authors.forename: Baojuan
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
authors.forename: Long-Biao
authors.initials: LB
authors.lastname: Cui
authors.affiliation: Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
authors.forename: Yi-Bin
authors.initials: YB
authors.lastname: Xi
authors.affiliation: Wellcome Trust Center for Neuroimaging, Institute of Neurology, University College London, London, WC1N 3BG, UK.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Friston
authors.affiliation: Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Guo
authors.affiliation: Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
authors.forename: Hua-Ning
authors.initials: HN
authors.lastname: Wang
authors.affiliation: School of Biomedical Engineering, Fourth Military Medical University, Xi'an, 710032, China.
authors.forename: Lin-Chuan
authors.initials: LC
authors.lastname: Zhang
authors.affiliation: Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
authors.forename: Yuan-Han
authors.initials: YH
authors.lastname: Bai
authors.affiliation: Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
authors.forename: Qing-Rong
authors.initials: QR
authors.lastname: Tan
authors.affiliation: Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China. yinhong@fmmu.edu.cn.
authors.forename: Hong
authors.initials: H
authors.lastname: Yin
authors.affiliation: School of Biomedical Engineering, Fourth Military Medical University, Xi'an, 710032, China. luhb@fmmu.edu.cn.
authors.forename: Hongbing
authors.initials: H
authors.lastname: Lu
mesh_terms: D000328:Adult; D001303:Auditory Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology*; D065711:Broca Area / Q000000981:diagnostic imaging / Q000503:physiopathology*; D063132:Connectome / Q000379:methods*; D006212:Hallucinations / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D006624:Hippocampus / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008962:Models, Theoretical; D017397:Prefrontal Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012559:Schizophrenia / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013067:Speech Perception / Q000502:physiology*; D013788:Thalamus / Q000000981:diagnostic imaging / Q000503:physiopathology*
keywords: Auditory verbal hallucinations; Effective connectivity; Schizophrenia; Stochastic dynamic causal modeling