BACKGROUND AND HYPOTHESES Auditory verbal hallucinations (AVHs) is not only a common symptom in schizophrenia but also observed in individuals in the general population. Despite extensive research, AVHs are poorly understood, especially their underlying neuronal architecture. Neuroimaging methods have been used to identify brain areas and networks that are activated during hallucinations. A characteristic feature of AVHs is, however, that they fluctuate over time, with varying frequencies of starts and stops. An unanswered question is, therefore, what neuronal events co-occur with the initiation and inhibition of an AVH episode. STUDY DESIGN We investigated brain activation with fMRI in 66 individuals who experienced multiple AVH-episodes while in the scanner. We extracted time-series fMRI-data and monitored changes second-by-second from 10 s before to 15 s after participants indicated the start and stop of an episode, respectively, by pressing a hand-held response-button. STUDY RESULTS We found a region in the ventromedial prefrontal cortex (VMPFC) which showed a significant increase in activation initiated a few seconds before participants indicated the start of an episode, and a corresponding decrease in activation initiated a few seconds before the end of an episode. CONCLUSIONS The consistent increase and decrease in activation in this area in advance of the consciously experienced presence or absence of the "voice" imply that this region may act as a switch in turning episodes on and off. The activation is unlikely to be confounded by motor responses. The findings could have clinical implications for brain stimulation treatments, like transcranial magnetic stimulation.

中文翻译：

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腹内侧前额叶皮层的神经激活先于处于或脱离短暂幻觉状态的有意识体验。

背景和假设 听觉言语幻觉 (AVH) 不仅是精神分裂症的常见症状，而且在普通人群中也能观察到。尽管进行了广泛的研究，但人们对 AVH 知之甚少，尤其是其潜在的神经元结构。神经影像学方法已被用于识别在幻觉期间被激活的大脑区域和网络。然而，AVH 的一个特征是它们随时间波动，启动和停止的频率不同。因此，一个悬而未决的问题是，哪些神经元事件与 AVH 发作的启动和抑制同时发生。研究设计 我们使用 fMRI 研究了 66 名在扫描仪中经历过多次 AVH 发作的个体的大脑激活情况。我们提取了时间序列的 fMRI 数据，并监测了参与者通过按下手持响应按钮分别指示事件开始和结束后 10 秒到 15 秒之间的逐秒变化。研究结果 我们在腹内侧前额叶皮层 (VMPFC) 中发现了一个区域，该区域显示在参与者指示事件开始前几秒开始的激活显着增加，而在事件结束前几秒开始的激活相应减少. 结论 在有意识地体验到“声音”存在或不存在之前，该区域激活的持续增加和减少意味着该区域可能充当打开和关闭事件的开关。激活不太可能被运动反应混淆。