The Propensity to Hear “Voices” in Schizophrenia May Be Established by Infancy, Many Years Before Symptom Onset
Findings reveal how auditory hallucinations may arise in patients with schizophrenia and provide potential new targets for early detection and treatment
Some people suffering from severe mental illness, particularly schizophrenia, hear “voices,” known as auditory hallucinations. This symptom, which afflicts more than 80% of patients, is among the most prevalent and distressing symptoms of schizophrenia. Patients “hear voices” speaking to them or about them without anyone actually being there. Auditory hallucinations, which usually begin in adolescence and young adulthood, “sound” very real to patients and can have a devastating impact on their quality of life because the “voices” are typically distressing and distracting, sometimes compelling the sufferer into suicidal or violent actions. Uncovering the biological origins of auditory hallucinations is essential for reducing their contribution to the disease burden of schizophrenia.
To investigate the biological origins of hearing “voices” in patients with schizophrenia, a team led by researchers at the Icahn School of Medicine at Mount Sinai used ultra-high field imaging to compare the auditory cortex of schizophrenic patients with healthy individuals. They found that schizophrenic patients who experienced auditory hallucinations had abnormal tonotopic organization of the auditory cortex. Tonotopy is the ordered representation of sound frequency in the auditory cortex, which is established in utero and infancy and which does not rely on higher-order cognitive operations. The study findings, which appears this week in the Nature Partner Journal NJP Schizophrenia, suggest that the vulnerability to develop “voices” is probably established many years before symptoms begin.
“Since auditory hallucinations feel like real voices, we wanted to test whether patients with such experiences have abnormalities in the auditory cortex, which is the part of the brain that processes real sounds from the external environment,” says Sophia Frangou, MD, PhD, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai. “
Specifically, the research team used an ultra-high field scanner with a powerful 7 Tesla magnet to obtain high-resolution images of brain activity while study participants listened passively to tones across a range of very low to very high frequencies. In healthy brains, these sounds are processed in a very organized fashion; each frequency activates a specific part of the auditory cortex forming a tonotopic map. The team obtained tonotopic maps from 16 patients with schizophrenia with a history of recurrent auditory hallucination and 22 healthy study participants. They found that patients showed greater activation in response to most sound frequencies. Additionally, the mapping of most sound frequencies to parts of the auditory cortex appeared “scrambled” in patients with schizophrenia, suggesting that the normal processes for the organized representation of sound in the brain are disrupted in schizophrenia.
“Because the tonotopic map is established when people are still infants and remains stable throughout life, our study findings suggest that the vulnerability to develop “voices” is linked a deviance in the organization of the auditory system that occurs during infancy and precedes speech development and the onset of psychotic symptoms by many years. This is particularly exciting because it means that it might be possible to identify potential vulnerable individuals, such as the offspring of schizophrenia patients, very early on.”
According to the authors, in addition to helping doctors spot people who are likely to experience hallucinations before the symptoms appear or become severe, the auditory cortex may be an area of consideration for novel neurmodulation methods to help patients who already have symptoms.
Looking ahead, Dr. Frangou’s research team will replicate and expand the current observations in larger samples to determine their relevance to hallucinations across diagnoses and to quantify the association of tonotopic disruption to auditory cortical activation and connectivity during actual hallucinatory experiences.
The study was supported by the National Institutes of Mental Health, the National Cancer Institute, The Netherlands Organisation for Health Research and Development, the Stanley Foundation and the Brain and Behavior Research Foundation.
About the Mount Sinai Health System
The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology/Neurosurgery, and Orthopedics in the 2019-2020 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 12th nationally for Ophthalmology and Mount Sinai South Nassau is ranked 35th nationally for Urology. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and Mount Sinai South Nassau are ranked regionally.