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Brain Advance Access originally published online on July 20, 2009
Brain 2009 132(11):2994-3001; doi:10.1093/brain/awp186
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© The Author(s) 2009. Published by Oxford University Press on behalf of Brain.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reality of auditory verbal hallucinations

Tuukka T. Raij1,2, Minna Valkonen-Korhonen3, Matti Holi4, Sebastian Therman5, Johannes Lehtonen3 and Riitta Hari1,6

1 Brain Research Unit, Low Temperature Laboratory and Advanced Magnetic Imaging Centre, Helsinki University of Technology, Espoo, Finland 2 Department of Psychiatry, University of Helsinki, Helsinki, Finland 3 Department of Psychiatry, University of Kuopio and University Hospital of Kuopio, Kuopio, Finland 4 Kellokoski Hospital, Kellokoski, Finland 5 Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland 6 Department of Clinical Neurophysiology, Helsinki University Central Hospital, Helsinki, Finland

Correspondence to: Tuukka T. Raij, MD, PhD, Advanced Magnetic Imaging Centre, Box 3000, Helsinki University of Technology, Finland E-mail: raijtu{at}neuro.hut.fi

Distortion of the sense of reality, actualized in delusions and hallucinations, is the key feature of psychosis but the underlying neuronal correlates remain largely unknown. We studied 11 highly functioning subjects with schizophrenia or schizoaffective disorder while they rated the reality of auditory verbal hallucinations (AVH) during functional magnetic resonance imaging (fMRI). The subjective reality of AVH correlated strongly and specifically with the hallucination-related activation strength of the inferior frontal gyri (IFG), including the Broca's language region. Furthermore, how real the hallucination that subjects experienced was depended on the hallucination-related coupling between the IFG, the ventral striatum, the auditory cortex, the right posterior temporal lobe, and the cingulate cortex. Our findings suggest that the subjective reality of AVH is related to motor mechanisms of speech comprehension, with contributions from sensory and salience-detection-related brain regions as well as circuitries related to self-monitoring and the experience of agency.

Key Words: brain; functional magnetic resonance imaging; reality distortion; auditory verbal hallucination; inferior frontal gyrus

Abbreviations: AVH, auditory verbal hallucination; IFG, inferior frontal gyrus; HRF, haemodynamic response function; PANSS, Positive and Negative Syndromes Scale; SRH, subjective reality of hallucinations; VAS, visual analogue scale

Received April 2, 2009. Revised May 28, 2009. Accepted June 7, 2009.


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