Neuropsychopharmacology of auditory hallucinations: insights from pharmacological functional MRI and perspectives for future research

Abstract

Experiencing auditory verbal hallucinations is a prominent symptom in schizophrenia that also occurs in subjects at enhanced risk for psychosis and in the general population. Drug treatment of auditory hallucinations is challenging, because the current understanding is limited with respect to the neural mechanisms involved, as well as how CNS drugs, such as antipsychotics, influence the subjective experience and neurophysiology of hallucinations. In this article, the authors review studies of the effect of antipsychotic medication on brain activation as measured with functional MRI in patients with auditory verbal hallucinations. First, the authors examine the neural correlates of ongoing auditory hallucinations. Then, the authors critically discuss studies addressing the antipsychotic effect on the neural correlates of complex cognitive tasks. Current evidence suggests that blood oxygen level-dependant effects of antipsychotic drugs reflect specific, regional effects but studies on the neuropharmacology of auditory hallucinations are scarce. Future directions for pharmacological neuroimaging of auditory hallucinations are discussed.

Keywords::

• antipsychotic medication
• auditory hallucinations
• fMRI
• psychosis
• schizophrenia

Financial & competing interests disclosure

The work presented in this review was funded by a grant to K Hugdahl from the European Research Council, AG 249516, and to E Johnsen from the Western Norway Regional Health Authority. E Johnsen has received honoraria for lectures given in meetings arranged by Bristol-Myers Squibb, Eli Lilly and AstraZeneca, and for a contribution to an information brochure by Eli Lilly. E Johnsen has been reimbursed by the Eli Lilly Company and the Janssen Cilag Company for attending conferences. RA Kroken has been reimbursed by the Eli Lilly Company, Janssen Cilag Company, Bristol-Myers Squibb and AstraZeneca for attending conferences. The other authors declare no conflicts of interest in relation to the manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.