A Case Study on Auditory Verbal Hallucinations

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Case study on Auditory Verbal Hallucinations

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A Case Study on Auditory Verbal Hallucinations

  1. 1. Mark  GronowskiA  Case  Study  on  Auditory  Verbal  Hallucina5onsMonday, 29 April, 13
  2. 2. Auditory  Verbal  Hallucina5ons  (AVH)• One  of  the  most  characteris4c  symptoms  of  Schizophrenia• But,  why  do  they  occur?• Two  hypotheses  exist:• Misinterpreted  inner  speech• Abnormal  ac4va4on  of  the  auditory  cortexMonday, 29 April, 13
  3. 3. Hypothesis  1:  Misinterpreted  Inner  Speech• AVH  occurrences  with  perioral  movements  • Perioral  ac4vity  is  generally  associated  with  inner  speech  • Inner  Speech  genera4on  ac4vates  Broca’s  area• Misrecogni4on  of  inner  speech  also  associated  with  leK  Middle  Temporal  Gyrus  (MTG)Monday, 29 April, 13
  4. 4. Hypothesis  2:  Abnormal  ac5va5on  of  the  auditory  cortex• AVHs  also  linked  to  abnormal  ac4va4on  of  the  primary  auditory  cortex  (PAC)• May  cause  experience  of  a  perceived  real  sound  leading  to  misinterpreta4on  of  its  source  as  external•Monday, 29 April, 13
  5. 5. Case  Study:  Pa5ent  DT• Female  with  Paranoid  Schizophrenia• Experienced  con4nuos  AVHs• Single  voice  commen4ng  on  her  behaviour• Ordered  her  to  accomplish  some  acts• Some4mes  heard  mul4ple  voices  talking  to  each  other• Trained  to  report  the  onset  and  end  of  her  AVHs• Hallucina4ons  inhibited  by  loud  external  speech  Monday, 29 April, 13
  6. 6. Case  Study:  Control  Subject• Matched  Control  Subject• Both  right-­‐handed  females• Matched  in  age  (36  years)  • Same  level  of  educa4on  (high  school)Monday, 29 April, 13
  7. 7. fMRI  Tes5ng• fMRI  (Func4onal  Magne4c  Resonance  Imaging)  • Measure  of  Blood  Oxygena4on  Level  Dependent  (BOLD)  change• Experimental  Condi4on• Listen  to  noise  generated  by  the  fMRI  scanner• Control  Condi4on• Listen  to  recorded  speech  through  headphonesMonday, 29 April, 13
  8. 8. Results:  Control  Subject• BOLD  signal  response  to  External  Speech  (Control):• LeK/Right  Middle  and  Superior  Temporal  Gyri• LeK  Inferior  Temporal  Gyrus fMRI of audit• fMRI  noise  (Experimental)  response:• No  significant  ac4va4on  seen  in  the  temporal  lobesMonday, 29 April, 13
  9. 9. 9Left Hemisphere Right HemisphereExternal Speech / ControlMonday, 29 April, 13
  10. 10. Results:  Pa5ent  DT• BOLD  signal  response  to  fMRI  noise  (Experimental):• LeK  Superior  Temporal  Gyrus  (Auditory  Cortex)• Right  Middle  Temporal  Gyrus  (Auditory  Associa4on  Cortex)• No  significant  ac4va4on  in  Broca’s  areafMRI of auditorMonday, 29 April, 13
  11. 11. 11Primary Auditory CortexAuditory Association CortexLeft Hemisphere Right HemisphereAVH Response / DTMonday, 29 April, 13
  12. 12. Analysis• Increased  metabolic  ac4vity  in  PAC• Consistent  with  abnormal  ac4va4on  of  PAC• Defec4ve  leK  MTG  could  permit  access  of  internal  speech  to  the  PAC• Consistent  with  misinterpreta4on  of  inner  speech• Lack  of  ac4va4on  of  Broca’s  area  inconsistent  with  hypothesis  predic4on• Type  II  error?Monday, 29 April, 13
  13. 13. Contribu5ons• Areas  ac4vated  by  normal  speech  in  healthy  individuals  are  also  ac4vated  by  the  experience  of  AVHs• Hypotheses  not  mutually  exclusive• Defec4ve  internal  monitoring  in  the  leK  hemisphere  may  be  associated  with  abnormal  ac4va4on  of  the  auditory  cortexMonday, 29 April, 13

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