Time course of regional brain activity accompanying auditory verbal hallucinations in schizophrenia

Background The pathophysiology of auditory verbal hallucinations remains poorly understood. Aims To characterise the time course of regional brain activity leading to auditory verbal hallucinations. Method During functional magnetic resonance imaging, 11 patients with schizophrenia or schizoa fective disorder signalled auditory verbal hallucination events by pressing a button. To control for effects of motor behaviour, regional activity associated with hall cination events was scaled against corresponding activity arising from random button-presses produced by 10 patients who did not experience hallucinations. Results Immediately prior to the hallucinations, motor-adjusted activity in the left inferior frontal gyrus was significantly greater than corresponding activity in the right inferior frontal gyrus. In contrast, motor-adjusted activity in a right posterior temporal region overshadowed corresponding activity in the left homologous temporal region. Robustly elevated motor-adjusted activity in the left temporal region associated with auditory verbal hallucinations was also detected, but only subsequent to hallucination events. At the earliest time shift studied, the correlation between left inferior frontal gyrus and right temporal activity was significantly higher for the hallucination group compared with non-hallucinating patients. Conclusions Findings suggest that heightened functional coupling between the left inferior frontal gyrus and right temporal regions leads to coactivation in these speech processing regions that is hallucinogenic. Delayed left temporal activation may reflect impaired corollary discharge contributing to source misattribution of resulting verbal images.