Contributions of emotional prosody comprehension deficits to the formation of auditory verbal hallucinations in schizophrenia

Roskamp Laboratory of Brain Development, Modulation and Repair. Department of Psychiatry and Neurosciences, Morsani College of Medicine, University of South Florida, FL, USA.
Clinical psychology review (Impact Factor: 7.18). 02/2012; 32(4):244-50. DOI: 10.1016/j.cpr.2012.02.003
Source: PubMed


Deficits in emotional processing have been widely described in schizophrenia. Associations of positive symptoms with poor emotional prosody comprehension (EPC) have been reported at the phenomenological, behavioral, and neural levels. This review focuses on the relation between emotional processing deficits and auditory verbal hallucinations (AVH). We explore the possibility that the relation between AVH and EPC in schizophrenia might be mediated by the disruption of a common mechanism intrinsic to auditory processing, and that, moreover, prosodic feature processing deficits play a pivotal role in the formation of AVH. The review concludes with proposing a mechanism by which AVH are constituted and showing how different aspects of our neuropsychological model can explain the constellation of subjective experiences which occur in relation to AVH.

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Available from: Lucy Alba-Ferrara
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    • "Such areas include the insula bilaterally, left amygdala, left inferior frontal gyrus (IFG), parahippocampal gyrus, anterior and posterior cingulate cortex (ACC and PCC), thalamus, cerebellum, and precuneus (Allen et al., 2008; García-Martí et al., 2012). More specifically, the insula and the amygdala—key regions for emotional regulation—are postulated to be involved in the commonly observed emotional load of AVH (Alba-Ferrara et al., 2012), while dysfunction of the PCC—known to constitute a basic component in generating a model of the self—is responsible for defective self-referential processing (Northoff and Bermpohl, 2004). "
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    ABSTRACT: Auditory verbal hallucinations (AVH) are one of the most common and most distressing symptoms of schizophrenia. Despite fundamental research, the underlying neurocognitive and neurobiological mechanisms are still a matter of debate. Previous studies suggested that "hearing voices" is associated with a number of factors including local deficits in the left auditory cortex and a disturbed connectivity of frontal and temporoparietal language-related areas. In addition, it is hypothesized that the interhemispheric pathways connecting right and left auditory cortices might be involved in the pathogenesis of AVH. Findings based on Diffusion-Tensor-Imaging (DTI) measurements revealed a remarkable interindividual variability in size and shape of the interhemispheric auditory pathways. Interestingly, schizophrenia patients suffering from AVH exhibited increased fractional anisotropy (FA) in the interhemispheric fibers than non-hallucinating patients. Thus, higher FA-values indicate an increased severity of AVH. Moreover, a dichotic listening (DL) task showed that the interindividual variability in the interhemispheric auditory pathways was reflected in the behavioral outcome: stronger pathways supported a better information transfer and consequently improved speech perception. This detection indicates a specific structure-function relationship, which seems to be interindividually variable. This review focuses on recent findings concerning the structure-function relationship of the interhemispheric pathways in controls, hallucinating and non-hallucinating schizophrenia patients and concludes that changes in the structural and functional connectivity of auditory areas are involved in the pathophysiology of AVH.
    Full-text · Article · Feb 2014 · Frontiers in Human Neuroscience
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    • "It is well established that individuals with schizophrenia (SZ) have deficits in social cognition, with the most severe deficits in the domains of emotion perception (Kohler and Brennan, 2004; Kohler et al., 2010; Salva et al., in press). Deficits in emotion perception have been found across a range of basic emotions in tasks requiring labeling, discrimination, and matching across auditory, visual, and combined audio-visual sensory modalities (de Gelder et al., 2005; Martin et al., 2005; de Jong et al., 2009; Strauss et al., 2010; Combs et al., 2011; Salgado-Pineda et al., 2011; Alba-Ferrara et al., 2012; Gold et al., 2012; Surguladze et al., 2012). Impairments in processing neutral or ambiguous facial stimuli are also well-documented, and analyses of error types made to neutral facial stimuli have indicated that individuals with SZ are more likely to misattribute negative emotions to neutral stimuli (Hooker et al., 2011; Pinkham et al., 2011). "
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    ABSTRACT: Emotion perception deficits are a well-established feature of schizophrenia (SZ). Individuals with SZ have difficulty labeling emotional stimuli across auditory, visual, and audio-visual modalities and also misattribute threat towards neutral stimuli. The relationship between a history of psychosis and similar abnormalities in bipolar disorder (BD) is less clear. The current study set out to examine emotion perception across sensory modalities in a sample of 24 stabilized individuals meeting criteria for SZ, 24 remitted individuals meeting criteria for BD with psychotic features, 24 remitted individuals meeting criteria for BD without psychotic features, and 24 healthy controls. Results indicated that the bipolar with psychotic features group had intermediary performance between the SZ group and the other two groups for auditory, visual, and audio-visual items, with particularly poor performance in identifying angry stimuli. The SZ group misattributed neutral stimuli as negative when they were in visual format, but as positive when they were in auditory or audio-visual formats. The bipolar with psychotic features group had a trend towards misattributing more neutral visual stimuli as negative. These findings indicate that emotion perception deficits are present in BD with psychotic features and comparatively spared in BD without psychotic features, and that a similar bias of misattributing negative emotions to neutral visual stimuli may be present across diagnostic boundaries.
    Full-text · Article · Apr 2013 · Schizophrenia Research
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    • "Surprisingly few studies have disambiguated the role of voice specifically in AVH, from that of speech and language activation (see Koeda et al., 2006, for a neuroimaging example of how this can be done). Of those that have examined voice, the vast majority have investigated the processing of emotion in voice (emotional prosody) (Hoekert et al., 2007; Shea et al., 2007; Leitman et al., 2010, 2011; Alba-Ferrara et al., 2012a; Gold et al., 2012; Kantrowitz et al., 2013) rather than the recognition or discrimination of speaker identity. Given the partial segregation of emotion and identity in human voice perception (as shown in Figure 1), it is possible that processing of emotional prosody could be impaired in schizophrenia (as the literature suggests) with the representation of speaker identity being relatively spared. "
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    ABSTRACT: The current review focuses on the perception of voice identity in clinical and non-clinical voice hearers. Identity perception in auditory verbal hallucinations (AVH) is grounded in the mechanisms of human (i.e., real, external) voice perception, and shapes the emotional (distress) and behavioral (help-seeking) response to the experience. Yet, the phenomenological assessment of voice identity is often limited, for example to the gender of the voice, and has failed to take advantage of recent models and evidence on human voice perception. In this paper we aim to synthesize the literature on identity in real and hallucinated voices and begin by providing a comprehensive overview of the features used to judge voice identity in healthy individuals and in people with schizophrenia. The findings suggest some subtle, but possibly systematic biases across different levels of voice identity in clinical hallucinators that are associated with higher levels of distress. Next we provide a critical evaluation of voice processing abilities in clinical and non-clinical voice hearers, including recent data collected in our laboratory. Our studies used diverse methods, assessing recognition and binding of words and voices in memory as well as multidimensional scaling of voice dissimilarity judgments. The findings overall point to significant difficulties recognizing familiar speakers and discriminating between unfamiliar speakers in people with schizophrenia, both with and without AVH. In contrast, these voice processing abilities appear to be generally intact in non-clinical hallucinators. The review highlights some important avenues for future research and treatment of AVH associated with a need for care, and suggests some novel insights into other symptoms of psychosis.
    Full-text · Article · Apr 2013 · Frontiers in Human Neuroscience
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