Auditory hallucinations, top-down processing and language perception: a general population study.

BACKGROUND: Studies investigating the underlying mechanisms of hallucinations in patients with schizophrenia suggest that an imbalance in top-down expectations v. bottom-up processing underlies these errors in perception. This study evaluates this hypothesis by testing if individuals drawn from the general population who have had auditory hallucinations (AH) have more misperceptions in auditory language perception than those who have never hallucinated. METHODS: We used an online survey to determine the presence of hallucinations. Participants filled out the Questionnaire for Psychotic Experiences and participated in an auditory verbal recognition task to assess both correct perceptions (hits) and misperceptions (false alarms). A hearing test was performed to screen for hearing problems. RESULTS: A total of 5115 individuals from the general Dutch population participated in this study. Participants who reported AH in the week preceding the test had a higher false alarm rate in their auditory perception compared with those without such (recent) experiences. The more recent the AH were experienced, the more mistakes participants made. While the presence of verbal AH (AVH) was predictive for false alarm rate in auditory language perception, the presence of non-verbal or visual hallucinations were not. CONCLUSIONS: The presence of AVH predicted false alarm rate in auditory language perception, whereas the presence of non-verbal auditory or visual hallucinations was not, suggesting that enhanced top-down processing does not transfer across modalities. More false alarms were observed in participants who reported more recent AVHs. This is in line with models of enhanced influence of top-down expectations in persons who hallucinate.

Common pathways in mental imagery and pain perception: an fMRI study of a subject with an amputated arm.

The present paper reviews data from two previous studies in our laboratory, as well as some additional new data, on the neuronal representation of movement and pain imagery in a subject with an amputated right arm. The subject imagined painful and non-painful finger movements in the amputated stump while being in a MRI scanner, acquiring EPI-images for fMRI analysis. In Study I (Ersland et al., 1996) the Subject alternated tapping with his intact left hand fingers and imagining "tapping" with the fingers of his amputated right arm. The results showed increased neuronal activation in the right motor cortex (precentral gyrus) when tapping with the fingers of the left hand, and a corresponding activation in the left motor cortex when imagining tapping with the fingers of the amputated right arm. Finger tappings of the intact left hand fingers also resulted in a larger activated precentral area than imagery "finger tapping" of the amputated right arm fingers. In Study II (Rosen et al., 2001 in press) the same subject imagining painful and pleasurable finger movements, and still positions of the fingers of the amputated arm. The results showed larger activations over the motor cortex for movement imagining versus imagining the hand being in a still position, and larger activations over the sensory cortex when imagining painful experiences. It can therefore be concluded that not only does imagery activate the same motor areas as real finger movements, but also that adding instructions of pain together with imaging moving the fingers intensified the activation compared with adding instructions about non-painful experiences. From these studies, it is clear that areas activated during actual motor execution to a large extent also are activated during mental imagery of the same motor commands. In this respect the present studies add to studies of visual imagery that have shown a similar correspondence in activation between actual object perception and imagery of the same object.

Different brain areas activated during imagery of painful and non-painful 'finger movements' in a subject with an amputated arm.

The purpose of the present study was to investigate differences in brain activation with functional magnetic resonance imaging (fMRI) during imagery of painful and non-painful 'finger movements' and 'hand positioning' in a subject with an amputated arm. The subject was a right-handed man in his mid-thirties who lost his right arm just above the elbow in a car-train accident. MRI was performed with a 1.5 T Siemens Vision Plus scanner. The basic design involved four conditions: imagining 'painful finger movements', 'non-painful finger movements', 'painful hand positioning', 'non-painful hand positioning'. Imagery of finger movements uniquely activated the contralateral primary motor cortex which contains the classic 'hand area'. The lateral part of the anterior cerebellar lobe was also activated during imagery of finger movements. Imagery of pain uniquely activated the somatosensory area, and areas in the left insula and bilaterally in the ventral posterior lateral nucleus of the thalamus. It is suggested that the insula and thalamus may involve neuronal pathways that are critical for mental processing of pain-related experiences, which may relate to a better understanding of the neurobiology of phantom limb pain.

Neurocognitive correlates of stereotactic thalamotomy and thalamic stimulation in Parkinsonian patients.

In the present paper we have reviewed five different studies that relate to neuropsychological consequences of stereotactic thalamotomy and thalamic stimulation in patients with Parkinson's disease. The neuropsychological results are in a strict sense confined to thalamotomy and thalamic stimulation, although the more general message of the importance of investigating cognitive functions before and after surgery applies to other stereotactic techniques for surgical treatment of movement disorders as well. It is argued in the paper that stereotactic thalamotomy provides a unique model for basic research on the neuropsychology of the thalamus, while in return, neuropsychological tests for cognitive dysfunction after surgery may be the most important clinical follow-up. Three general conclusions seem warranted from the data. (1) Parkinsonian patients are impaired on a range of cognitive functions, including language processing, memory, and executive functions. (2) Stereotactic thalamotomy does not further impair the patient; instead, we observed improvement on some tests, particularly verbal memory. (3) In general, there does not seem to be a laterality effect, depending on which side the thalamotomy lesion is applied. An exception to this are dichotically presented simple speech sounds and autonomic responses. In both instances, left-sided brain stimulation produced enhanced performance, while lesioning the left thalamus impaired dichotic listening performance. Finally, we present a new hypothesis for a mechanism behind the thalamotomy effect, based in part on changes in arousal thresholds.

Lateralization of cognitive processes in the brain.

The lateralization of cognitive processes in the brain is discussed. The traditional view of a language-visuo/spatial dichotomy of function between the hemispheres has been replaced by more subtle distinctions. The use of magnetic resonance imaging (MRI) to study brain morphology has resulted in a renewed focus on the relationship between structural and functional asymmetry. Focus has been on the role played by the planum temporale area in the posterior part of the superior temporal gyrus for language asymmetry, and the possible significance of the larger left planum. The dichotic listening technique is used to illustrate the difference between bottom-up, or stimulus-driven laterality versus top-down, or instruction-driven laterality. It is suggested that the hemispheric dominance observed at any time is the sum result of the dynamic interaction between bottom-up and top-down processing tendencies. Stimulus-driven laterality dominance is always monitored and modulated through top-down cognitive processes, like shifting of attention and changes in arousal. A model of top-down modulation of bottom-up laterality is presented with special reference to the understanding of psychiatric disorders.

Left frontal activation during a semantic categorization task: an fMRI-study.

In the present study we measured brain activation, with functional magnetic resonance imaging (fMRI) during the execution of a covert semantic categorization task. This involves activation of working memory and internal concept generation. Previous brain imaging studies of covert verbal fluency have shown widespread activation in the frontal and temporal lobes, and anterior cingulate. However, most of these studies have employed simple stimulus tasks with repetition of words e.g., beginning with a certain letter of the alphabet. Moreover, the subject is typically cued (either visually or auditory) every 2-5 second. In the present study we used a "single-cue" instruction at the beginning of each activation period where the subject was instructed to internally generate category specific names related to: "States in the USA," "UK Soccer clubs," and "Male names" during 54s periods. The three activation periods were compared to three baseline periods in which the subject was instructed to imagine mentally "lying on a beach and looking at the sky." Functional MRI was performed with a 1.5T Siemens Vision scanner. Initial TIW 3D FLASH scanning of anatomy was done, and thereafter, serial imaging with 60 BOLD sensitive echo planar whole brain measurements were done during the active and passive tasks. Main activation areas were found in the left middle frontal gyrus, partially overlapping with Brodmann area 9. This is in agreement with previous studies of increased activation in the left frontal lobe, and may indicate a left frontal neural network for accessing the mental lexicon.

Effects of hypnotizability on performance of a Stroop task and event-related potentials.

The effect of hypnotizability on verbal reaction times and event-related potentials during performance of a Stroop color-naming task was studied. The Stroop stimuli (colored words) were randomly presented to 5 high and 5 low hypnotizable subjects in the right and left peripheral visual fields during both waking state and hypnotic induction conditions. Unlike studies in which the Stroop stimuli were foveally presented to the subjects, the highly hypnotizable subjects did not show prolonged verbal reaction times in either waking or hypnotic conditions. There was a marked deterioration in performance accuracy, however, for highly hypnotizable subjects during hypnosis. Event-related potentials indicated that the highly hypnotizable subjects showed a reduced P3a amplitude and a decreased N2b latency to the visual stimuli in both waking and hypnotic conditions, suggesting a lack of orienting to or disengagement from peripherally occurring stimuli.

Left hemisphere advantage for classical conditioning to auditory verbal CSs: effects of nonattended extinction.

The effects of brain laterality, or hemispheric asymmetry, on electrodermal classical conditioning during both attended and nonattended stimulus conditions were studied. Participants were conditioned to consonant-vowel (CV) syllables during an acquisition, or learning, phase of the experiment. During a subsequent extinction phase, the conditioned stimuli (CS) were presented in a dichotic mode of presentation. Half of the participants attended to the left ear (right hemisphere) during the extinction phase and the other half of the participants attended to the right ear (left hemisphere). The results showed effects of conditioning for all participants during the acquisition phase. During dichotic extinction, the left hemisphere group showed remaining learning effects in both the attended and nonattended conditions, whereas the right hemisphere group demonstrated conditioning only in the attended condition.

Relateralizing hypnosis: or, have we been barking up the wrong hemisphere?

Research and theory over the past couple decades have suggested that the right cerebral hemisphere might be the focus of brain activity during hypnosis. Recent evidence from electrodermal responding, visual event-related potentials, and Stroop interference, however, can make a case for a role of the left hemisphere in some hypnotic phenomena. Although hemispheric activation on hypnotic challenge may depend in large part on the kind of task the challenge might involve, several general aspects of hypnosis might be more appropriately seen as left-rather than right-hemisphere brain functions. Among these are concentrated attentional focus and the role of language in the establishment of hypnotic reality. A left-hemisphere theory of hypnosis is discussed in light of recent findings and theories about a left-hemisphere basis for synthetic or generational capabilities (Corballis, 1991) and a neuro-evolutionary model of a left-hemisphere dopaminergic activation system for the implementation of predetermined motor programs (Tucker & Williamson, 1984).

Thalamotomy and thalamic stimulation: effects on cognition.

Before, during and after ventrolateral thalamotomy, patients were subjected to neuropsychological tests with emphasis on verbal perception and memory. In the first study, the patients were tested with a dichotic listening task before surgery, during thalamic stimulation, and after the lesion. Left thalamic stimulation increased the number of correct responses from the right ear, whereas a left thalamotomy abolished the expected right ear superiority. Stimulation and lesions of the right thalamus did not have similar effects. In a second study, Parkinsonian patients were tested with an extended neuropsychological test battery before and after thalamotomy. The operation did not reduce the cognitive capacity in this group of patients. In the last study, the effects of thalamic stimulation on verbal memory was tested. High-intensity stimulation of the left thalamus resulted in fewer words being recalled as compared with right thalamic and low-intensity stimulation.

Cognitive function in patients with Parkinson's disease undergoing stereotaxic thalamotomy.

OBJECTIVE: To determine whether thalamotomy leads to cognitive disturbances in patients with Parkinson's disease. METHODS: A total of 53 patients with Parkinson's disease undergoing stereotaxic ventrolateral thalamotomy for tremor and rigidity were tested for cognitive functions before and after surgery. The cognitive functions investigated involved visuospatial perception and memory. verbal memory, attention shift, and executive functions including set maintenance and shift. A neuropsychological test battery was used that contained the Wisconsin card sorting test, Street completion test, Stroop test, a dichotic memory listening test, and a facial recognition test. RESULTS: Clinically, a good or moderately good effect on parkinsonian symptoms was obtained in 50 patients. The neuropsychological investigations showed that the patients were impaired compared with healthy age matched control subjects on most tests, showing slight improvement postoperatively on verbal memory and visuospatial perception. No major differences were found between tests before and after operation, and there were no significant differences between patients undergoing surgery in the right or in the left thalamus. CONCLUSION: The study indicates that ventrolateral thalamotomy does not reduce the cognitive capacity in this group of patients.

Event-related potentials (ERPs) to deviant auditory stimuli during sleep and waking.

Using an oddball paradigm with two tones differing in pitch and probability, event-related potentials (ERPs) were compared during wake and two sleep stages. REM and NREM sleep stages were identified in nine subjects using the Nightcap which continuously records eye and body movements. The N1 occurred later and the P2 was larger during sleep than when awake. The N1 to the infrequent tones was larger during both sleep stages. A late negative wave was significantly larger to infrequent tones during REM sleep. It is concluded that representations of auditory stimuli occur in sleep, and most prominently during the REM phase. The prolonged latency of the ERP components indicates that processing of external sensory stimuli may be delayed.

Brain mechanisms in human classical conditioning: a PET blood flow study.

Five healthy male subjects participated in a classical conditioning experiment, and positron emission tomography (PET) was used to compare regional cerebral blood flow before and after conditioning. The subjects participated in three different experimental phases. In the first (habituation) phase they listened to 24 repetitions of a tone with random intervals. In the second (acquisition) phase, the tone was paired with a brief shock to the wrist. In the third (extinction) phase, the tone was presented alone again. 15OPET scans were taken during the habituation and extinction phases. Because the habituation and extinction phases were similar, any difference in blood flow to the tones presented during extinction probably reflected conditioning that occurred during the acquisition phase. Statistical parametric mapping (SPM) analysis of the PET data showed significantly increased activation in the right hemisphere in the orbito-frontal cortex, dorsolateral prefrontal cortex, inferior and superior frontal cortices, and inferior and middle temporal corticies. The only activated areas in the left hemisphere were area 19 and the superior frontal cortex. The results are interpreted as evidence for the involvement of cortical areas in human classical conditioning.

Attentional effects in dichotic listening.

This study addresses attentional effects in dichotic listening (DL) to consonant-vowel syllables. Previous research has shown that ear advantages in DL are modulated by biased attention to either the left or the right ear. Attentional effects in DL can be the result of two processes: facilitation of reports from the attended ear, or suppression of intrusions from the nonattended ear. Sixty-two students were tested with DL under three different task instructions: nonforced (divided) attention, attention forced to the right ear, and attention forced to the left ear. The main finding was inhibition of intrusions from the nonattended ear, combined with the facilitation of the correct reports from the attended ear during the two forced-attention conditions, compared with the nonforced condition. The results are discussed in relation to right hemisphere processing of dichotic input, and that attention may activate subcortically biased asymmetries which suppress input from the nonattended channel.

Auditory neglect and the ear extinction effect in dichotic listening: a reply to Beaton and McCarthy (1993).

In our reply to Beaton and McCarthy (1993), we argue that the issue of ear extinction in dichotic listening also should take into account lesion site and lesion extension. When the lesion is primarily affecting the auditory pathways, the resulting dichotic dysfunction may be an ear extinction effect. However, when the lesion is outside of the auditory system, the absence of reports from one ear may be part of a larger cognitive deficit, involving more complex processes, like orientation and attention. Thus, by constraining the definition of an "ear extinction effect" to a perceptual deficit, Beaton and McCarthy confounds the issue of ear extinction with auditory neglect. In our reply we also present some new data from a patient with a left-sided thalamic pulvinar lesion, contrasting his dichotic listening performance with the patient reported in our original 1991 study.

Manipulations of subjects' level of arousal in dichotic listening.

The effects of manipulation of the subject's level of arousal on the right ear advantage (REA) in dichotic listening to CV-syllables were investigated. There were three different arousal manipulations under high and low incentive levels. Negative manipulations involved threat of electric shock (high incentive) or noise (low incentive) for incorrect answers. Positive manipulations involved the possibility to earn a substantial (high incentive) or small (low incentive) sum of money for correct answers. A third, neutral, condition involved no specific instructions about consequences for correct or incorrect answers. Thirty-six females participated in the study. Heart rate was recorded as an independent measure of change in level of arousal as a function of the experimental instructions. The results showed that the high negative condition abolished the REA effect, with a non-significant difference between ears. This was caused by both an increase in correct left ear reports and a decrease in correct right ear reports. The other arousal conditions had no effect on the REA. The results are discussed in terms of right hemisphere dominance for aversive emotional processing in dichotic listening.

Effects of habituation and classical conditioning on reflex modification.

Reflex modification is the inhibition or facilitation of a reflex by a stimulus (S1) occurring prior to a reflex-eliciting stimulus (S2). Two experiments were conducted that investigated the effects of habituation of the orienting response (OR) and classical conditioning on reflex modification of skin conductance responses (SCRs). During the first phase of Expt. 1 two groups (Group S1 and the Control group) received pre-presentations of S1 (200 Hz). Another group (Group S3) received pre-presentations of a different tone (S3, 3000 Hz). During the second phase, Groups S1 and S3 received pairings of S1 with S2 (white noise), whereas the Control group received pairings of S2 with S1. The predictions were: if the OR to S1 produces reflex modification of the response to S2, then Group S1 and the Control group will display larger SCRs on the first trial of the second phase of the experiment compared to Group S3, in which the OR to S1 will produce reflex modification. However, if conditioned diminution of the unconditioned response (UR) elicited by S1 produces reflex modification of the response to S2, then there should be no initial differences between the groups in the second phase of the experiment. The results showed that SCRs in Group S1 were significantly larger in the second phase compared to Group S3. This result favors an OR explanation of reflex modification. In Expt. 2, the effect of conditioned diminution of the UR on reflex modification was further investigated.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of the left and right thalamus in language asymmetry: dichotic listening in Parkinson patients undergoing stereotactic thalamotomy.

Fourteen patients with Parkinson's disease (rigidity and unilateral tremor as main symptoms) were treated with stereotactic thalamotomy. The operation was performed in either the left or right ventrolateral thalamus, depending on which hand (or foot) was most affected with tremor. Nine patients were operated on the left side and four on the right side. All patients were tested for asymmetry of language functioning with dichotic presentations of consonant-vowel (CV) syllables. The patients had to indicate which of the two syllables he/she heard on each trial. Dichotic listening was performed before and after the operation, as well as during electrical stimulation of the VL nucleus just before the lesion was carried out. The results revealed essentially three things: an overall reduced right ear advantage (REA) in the patient group compared to what is known from studies of healthy individuals; an increase in REA during left-sided stimulations; and a marked reduction in REA after left-sided lesions. It is concluded that the present data support the notion put forward by Ojemann (e.g., 1975) of a lateralized activating gating mechanism in the left VL nucleus that gates access for language information to the appropriate cortical areas. The gating mechanism seems to be activated by stimulation, and deactivated after lesions. Dichotic listening may thus be a heuristic instrument in assessment of language functions in Parkinson patients.

An IBM-PC and Commodore 64 microcomputer-based system for elicitation and recording of eyeblink reflexes.

The eyeblink reflex is well suited for the study of habituation, sensitization, reflex modification and classical conditioning in humans. A microcomputer-based system for elicitation and recording of the eyeblink reflex is described. The system consists of three functional units: (1) an air-pressure bottle and pressure-reducing valves for delivery of air puffs to the eye in order to elicit the eyeblink reflex, and a CBM 64 computer for presentations of auditory stimuli in conjunction with air puffs; (2) a pair of light-emitting diodes and photocells placed in a pair of goggles placed on the subject for detection of eyeblinks; (3) an IBM-compatible personal computer, equipped with the ASYSTANT + software for eyeblink data acquisition and overall control of experiment and parameters. The system is presently in use in our laboratory, and technical details about the system can be obtained by writing to the first author.

Psychophysiological aspects of phobic fears: an evaluative review.

The present paper is a review of the use of psychophysiology in diagnosis and treatment of simple phobias. The paper begins with a definition and characterization of phobic fears, together with a description of prevalence rates, age onset, and gender differences. Acquisition is then discussed within a Three-Systems model. Psychophysiological measures are described, and the typical response patterns obtained in phobic reactions are outlined. Special attention is devoted to the paradoxical response seen in blood injury phobias, and the use of beta-blockers and other pharmacological drugs. The paper is ended with a discussion of Lang's emotional imagery as a psychophysiological model for fear reactions and fear therapy.