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Am J Psychiatry 1992; 149:1062-1069
Copyright © 1992 by American Psychiatric Association
Toward a brain map of auditory hallucinations
JM Cleghorn, S Franco, B Szechtman, RD Kaplan, H Szechtman, GM Brown, C Nahmias and ES Garnett
Department of Psychiatry, McMaster University, Hamilton, Ont., Canada.
OBJECTIVE: This study asks whether auditory hallucinations are reflected in
a distinctive metabolic map of the brain. METHOD: Regional brain metabolism
was measured by positron emission tomography with [18F]-fluorodeoxyglucose
in 12 DSM-III schizophrenic patients who experienced auditory
hallucinations during glucose uptake and 10 who did not. All patients were
free of neuroleptics and 19 had never been treated with neuroleptics. Nine
patients were reexamined after 1 year to assess effects of neuroleptic
treatment. RESULTS: Compared with the patients who did not experience
hallucinations, the patients who did experience hallucinations had
significantly lower relative metabolism in auditory and Wernicke's regions
and a trend toward higher metabolism in the right hemisphere homologue of
Broca's region. Hallucination scores correlated positively and
significantly with relative metabolism in the striatum and anterior
cingulate regions. Neuroleptic treatment resulted in a significant increase
in striatal metabolism and a reduced frontal-parietal ratio, which was
significantly correlated with a decrease in hallucination scores.
CONCLUSIONS: Auditory hallucinations involve language regions of the cortex
in a pattern similar to that seen in normal subjects listening to their own
voices but different in that left prefrontal regions are not activated. The
striatum plays a critical role in auditory hallucinations.
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