INSERM, U797 Research Unit, Neuroimaging and Psychiatry, IFR49, Orsay, France.
Schizophr Bull. 2011 Jan;37(1):212-21. doi: 10.1093/schbul/sbp081. Epub 2009 Aug 7.
Auditory verbal hallucinations are a cardinal symptom of schizophrenia. Bleuler and Kraepelin distinguished 2 main classes of hallucinations: hallucinations heard outside the head (outer space, or external, hallucinations) and hallucinations heard inside the head (inner space, or internal, hallucinations). This distinction has been confirmed by recent phenomenological studies that identified 3 independent dimensions in auditory hallucinations: language complexity, self-other misattribution, and spatial location. Brain imaging studies in schizophrenia patients with auditory hallucinations have already investigated language complexity and self-other misattribution, but the neural substrate of hallucination spatial location remains unknown. Magnetic resonance images of 45 right-handed patients with schizophrenia and persistent auditory hallucinations and 20 healthy right-handed subjects were acquired. Two homogeneous subgroups of patients were defined based on the hallucination spatial location: patients with only outer space hallucinations (N=12) and patients with only inner space hallucinations (N=15). Between-group differences were then assessed using 2 complementary brain morphometry approaches: voxel-based morphometry and sulcus-based morphometry. Convergent anatomical differences were detected between the patient subgroups in the right temporoparietal junction (rTPJ). In comparison to healthy subjects, opposite deviations in white matter volumes and sulcus displacements were found in patients with inner space hallucination and patients with outer space hallucination. The current results indicate that spatial location of auditory hallucinations is associated with the rTPJ anatomy, a key region of the "where" auditory pathway. The detected tilt in the sulcal junction suggests deviations during early brain maturation, when the superior temporal sulcus and its anterior terminal branch appear and merge.
听觉言语幻觉是精神分裂症的主要症状。Bleuler 和 Kraepelin 将幻觉分为 2 大类：头外听见的幻觉（外部空间或外部幻觉）和头内听见的幻觉（内部空间或内部幻觉）。最近的现象学研究证实了这一区别，该研究确定了听觉幻觉的 3 个独立维度：语言复杂性、自我他人归因错误和空间位置。有听觉幻觉的精神分裂症患者的脑成像研究已经研究了语言复杂性和自我他人归因错误，但幻觉空间位置的神经基础仍然未知。对 45 名右利手、持续有听觉幻觉的精神分裂症患者和 20 名健康右利手受试者进行了磁共振成像。根据幻觉的空间位置，将患者分为 2 个同质亚组：只有外部空间幻觉的患者（N=12）和只有内部空间幻觉的患者（N=15）。然后使用 2 种互补的脑形态计量学方法评估组间差异：体素形态计量学和脑沟形态计量学。在右颞顶交界处（rTPJ）检测到患者亚组之间的会聚解剖差异。与健康受试者相比，有内部空间幻觉的患者和有外部空间幻觉的患者的白质体积和脑沟位移均出现相反的偏差。目前的结果表明，听觉幻觉的空间位置与 rTPJ 解剖结构有关，rTPJ 是“何处”听觉通路的关键区域。检测到的脑回交界处倾斜表明，在颞上沟及其前终支出现和融合的早期大脑发育过程中存在偏差。
