Am J Psychiatry 154:1683-1689, December 1997
© 1997 American Psychiatric Association
Synaptic Elimination, Neurodevelopment, and the Mechanism of Hallucinated "Voices" in Schizophrenia
Ralph E. Hoffman, M.D., and
Thomas H. McGlashan, M.D.
OBJECTIVE: After peaking during childhood, synaptic density in the human frontal cortex declines by 30%–40% during adolescence because of progressive elimination of synaptic connections. The characteristic age at onset of schizophrenia—late adolescence and early adulthood—suggests that the disorder could arise from irregularities involving this neurodevelopmental process. METHOD: A computer simulation of a speech perception neural network was developed. Connections within the working memory component of the network were eliminated on the basis of a "Darwinian rule" in order to model loss of synapses. As a comparison, neuronal cell death, also postulated as being linked to both neurodevelopment and schizophrenia, was simulated. The authors determined whether these alterations at low levels could enhance perceptual capacity and at high levels produce spontaneous speech percepts that simulate hallucinated speech or "voices." RESULTS: Eliminating up to 65% of working memory connections improved perceptual ability; beyond that point, network performance declined and speech hallucinations emerged. Simulating excitotoxic neuronal loss at low levels also improved network performance, but in excess it did not produce hallucinations. CONCLUSIONS: The model demonstrates perceptual advantages of selective synaptic elimination as well as selective neuronal loss, suggesting a functional explanation for these aspects of neurodevelopment. The model predicts that psychosis arises from a pathological extension of one of these neurodevelopmental trends, namely, synaptic elimination. (Am J Psychiatry 1997; 154:1683–1689)
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