Auditory hallucinations and the P3a: Attention-switching to speech in schizophrenia

Background

In line with emerging research strategies focusing on specific symptoms rather than global syndromes in psychiatric disorders, we examined the functional neural correlates of auditory verbal hallucinations (AHs) in schizophrenia. Recent neuroimaging and behavioural evidence suggest altered early cognitive processes may be seen in patients with AH as a result of limited processing resources.

Methods

The P3a subcomponent of the P300, an event-related potential (ERP) index of early attention switching, was assessed in 12 hallucinating patients (HP), 12 non-hallucinating patients (NP) and 12 healthy controls (HC) within a passive two-tone auditory oddball paradigm using vowel phonemes. P3a amplitudes and latencies were measured in response to across-phoneme changes. Following P3a acquisition, patients indicated the duration, intensity and clarity of their auditory hallucinations during recording.

Results

Hallucinating patients exhibited smaller P3a amplitudes than non-hallucinating patients and healthy controls. In HPs, P3a amplitude was negatively correlated with AH trait scores.

Significance

These findings suggest that AHs are associated with impaired processing of speech as evidenced by altered P3a amplitudes to vowel phonemes. This finding may be due to limited cognitive resources available for incoming external stimuli due to a usurping of finite resources by AHs. The P3a may be a useful non-invasive tool for probing relationships between hallucinatory and neural states within schizophrenia and the manner in which auditory processing is altered in these afflicted patients.     

维持注意与选择注意具有不同的脑机制：来自事件相关电位的证据

BACKGROUND: At present, researches about attention mainly concentrate on the relationship between attention and other psychological phenomena, but studies concerning different types of attention itself (sustained attention versus selective attention) are few. OBJECTIVE: To investigate the brain mechanisms of sustained and selective attentions which have different roles in the cognitive process. METHODS: Event-related potentials (ERPs) were measured when 18 college students’ participants (half male and half female) were performing selective and sustained attention tasks. The program was written in E-Prime and displayed on a computer, and the experimental task was adapted from Karl et al. reported experimental paradigm, including selective attention and sustained attention tasks. The time of fixation point given was 500 ms, and the time of three randomly abreast pictures given was 300 ms. All the participants were asked to make rapid and accurate response as much as possible. RESULTS AND CONCLUSION: The ERPs elicited by the two attention tasks were different in the aspects of time process, wave crest and latency. The brain regions activated by the sustained attention were wider than those by selective attention. The ERPs elicited by the sustained attention mainly presents as positive waves, whereas those elicited by the selective attention were reflected as both positive and negative waves. The EPRs elicited by the sustained attention were N100 and N250, but in the metaphase, selective attention elicited the P180. These may indicate that event choice appears in the middle stage of the task. Besides, the reversion of EPRs elicited by the two attention tasks in the anterior and posterior scalp is likely to be a generality of all attentions. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Speech and non-speech processing in children with phonological disorders: an electrophysiological study

OBJECTIVE:

To determine whether neurophysiological auditory brainstem responses to clicks and repeated speech stimuli differ between typically developing children and children with phonological disorders.

INTRODUCTION:

Phonological disorders are language impairments resulting from inadequate use of adult phonological language rules and are among the most common speech and language disorders in children (prevalence: 8 ‐ 9%). Our hypothesis is that children with phonological disorders have basic differences in the way that their brains encode acoustic signals at brainstem level when compared to normal counterparts.

METHODS:

We recorded click and speech evoked auditory brainstem responses in 18 typically developing children (control group) and in 18 children who were clinically diagnosed with phonological disorders (research group). The age range of the children was from 7‐11 years.

RESULTS:

The research group exhibited significantly longer latency responses to click stimuli (waves I, III and V) and speech stimuli (waves V and A) when compared to the control group.

DISCUSSION:

These results suggest that the abnormal encoding of speech sounds may be a biological marker of phonological disorders. However, these results cannot define the biological origins of phonological problems. We also observed that speech‐evoked auditory brainstem responses had a higher specificity/sensitivity for identifying phonological disorders than click‐evoked auditory brainstem responses.

CONCLUSIONS:

Early stages of the auditory pathway processing of an acoustic stimulus are not similar in typically developing children and those with phonological disorders. These findings suggest that there are brainstem auditory pathway abnormalities in children with phonological disorders.     

Noise-induced tinnitus: auditory evoked potential in symptomatic and asymptomatic patients

OBJECTIVES:

We evaluated the central auditory pathways in workers with noise-induced tinnitus with normal hearing thresholds, compared the auditory brainstem response results in groups with and without tinnitus and correlated the tinnitus location to the auditory brainstem response findings in individuals with a history of occupational noise exposure.

METHOD:

Sixty individuals participated in the study and the following procedures were performed: anamnesis, immittance measures, pure-tone air conduction thresholds at all frequencies between 0.25–8 kHz and auditory brainstem response.

RESULTS:

The mean auditory brainstem response latencies were lower in the Control group than in the Tinnitus group, but no significant differences between the groups were observed. Qualitative analysis showed more alterations in the lower brainstem in the Tinnitus group. The strongest relationship between tinnitus location and auditory brainstem response alterations was detected in individuals with bilateral tinnitus and bilateral auditory brainstem response alterations compared with patients with unilateral alterations.

CONCLUSION:

Our findings suggest the occurrence of a possible dysfunction in the central auditory nervous system (brainstem) in individuals with noise-induced tinnitus and a normal hearing threshold.     

The influence of (central) auditory processing disorder on the severity of speech-sound disorders in children

OBJECTIVE:To identify a cutoff value based on the Percentage of Consonants Correct-Revised index that could indicate the likelihood of a child with a speech-sound disorder also having a (central) auditory processing disorder.METHODS:Language, audiological and (central) auditory processing evaluations were administered. The participants were 27 subjects with speech-sound disorders aged 7 to 10 years and 11 months who were divided into two different groups according to their (central) auditory processing evaluation results.RESULTS:When a (central) auditory processing disorder was present in association with a speech disorder, the children tended to have lower scores on phonological assessments. A greater severity of speech disorder was related to a greater probability of the child having a (central) auditory processing disorder. The use of a cutoff value for the Percentage of Consonants Correct-Revised index successfully distinguished between children with and without a (central) auditory processing disorder.CONCLUSIONS: The severity of speech-sound disorder in children was influenced by the presence of (central) auditory processing disorder. The attempt to identify a cutoff value based on a severity index was successful.     

Electrophysiologic assessment of central auditory processing by auditory brainstem responses in children with autism spectrum disorders

In addition to aberrant features in the speech, children with Autism Spectrum Disorder (ASD) may present unusual responses to sensory stimuli, especially to auditory stimuli. We investigated the auditory ability of children with ASD by using Auditory Brainstem Responses (ABR) as they can directly judge both hearing status and the integrity of auditory brainstem pathways. One hundred twenty-one children (71: ASD; M 58/ F 13, mean age; 41.8 months, 50: control group; M 41/ F 9, mean age; 38 months) were included in the study. As compared with the values in the control group, the latency of wave V, wave I-V, and wave III-V inter-peak latencies were significantly prolonged (p<0.05) in the ASD group. The findings indicate that children with ASD have a dysfunction or immaturity of the central auditory nervous system. We suggest any children with prolonged III-V inter-peak latencies, especially high functioning children should be further evaluated for central auditory processing to set up a more appropriate treatment plan.     

Physiological variability of peak latency in evoked potentials: use of a property of asynchronous averaging

A method for estimating the physiological variability of peak latency in an evoked potential, of whom the peak latency and amplitude varied, by using the property of asynchronous averaging was proposed. A point estimate of the physiological variability was obtained by minimizing the mean square error between a standard waveform and the asynchronously averaged waveform. An interval estimate was obtained by using the relationship between the signal-to-noise ratio and the standard deviation of the point estimate for the variability of peak latency. The proposed method was evaluated by using simulation data, and was successfully applied to actual P300 data of six normal subjects. The method gave accurate estimates for the physiological variability of peak latency of P300, and would also be effectively applicable to any other evoked potential records for estimating the physiological variability.     

老年慢性精神分裂症患者的听觉P300初步研究

应用丹表仪器，完成３４例患者和４０例正常老人的Ｐ３００检测。结果表明与正常老人比较，患者组靶潜伏期主成分（Ｎ１－Ｐ２－Ｎ２－Ｐ３）前移（Ｐ＜０．０１），靶波幅Ｐ２和Ｐ３降低（Ｐ＜０．０１）。非靶改变同靶刺激。提示老年慢性精神分裂症患者的听觉Ｐ３００仍有待进一步研究。     

Hyperactive auditory processing in Williams syndrome: Evidence from auditory evoked potentials

The neurophysiologic aberrations underlying the auditory hypersensitivity in Williams syndrome (WS) are not well defined. The P1‐N1‐P2 obligatory complex and mismatch negativity (MMN) response were investigated in 18 participants with WS, and the results were compared with those of 18 age‐ and gender‐matched typically developing (TD) controls. Results revealed significantly higher amplitudes of both the P1‐N1‐P2 obligatory complex and the MMN response in the WS participants than in the TD controls. The P1‐N1‐P2 complex showed an age‐dependent reduction in the TD but not in the WS participants. Moreover, high P1‐N1‐P2 complex was associated with low verbal comprehension scores in WS. This investigation demonstrates that central auditory processing is hyperactive in WS. The increase in auditory brain responses of both the obligatory complex and MMN response suggests aberrant processes of auditory encoding and discrimination in WS. Results also imply that auditory processing may be subjected to a delayed or diverse maturation and may affect the development of high cognitive functioning in WS.     

Auditory evoked potentials in children and adolescents with Down syndrome

Down syndrome, or trisomy 21, is the most common genetic alteration in humans. The syndrome presents with several features, including hearing loss and changes in the central nervous system, which may affect language development in children and lead to school difficulties. The present study aimed to investigate group differences in the central auditory system by long‐latency auditory evoked potentials and cognitive potential. An assessment of 23 children and adolescents with Down syndrome was performed, and a control group composed of 43 children and adolescents without genetic and/or neurological changes was used for comparison. All children underwent evaluation with pure tone and vocal audiometry, acoustic immitance measures, long‐latency auditory evoked potentials, and cognitive potential. Longer latencies of the waves were found in the Down syndrome group than the control group, without significant differences in amplitude, suggesting that individuals with Down syndrome have difficulty in discrimination and auditory memory. It is, therefore, important to stimulate and monitor these children in order to enable adequate development and improve their life quality. We also emphasize the importance of the application of auditory evoked potentials in clinical practice, in order to contribute to the early diagnosis of hearing alterations and the development of more research in this area.     

Brain potentials associated with expected and unexpected good and bad outcomes

The error-related negativity (ERN) is an event-related brain potential observed when subjects receive feedback indicating errors or monetary losses. Evidence suggests that the ERN is larger for unexpected negative feedback. The P300 has also been shown to be enhanced for unexpected feedback, but does not appear to be sensitive to feedback valence. The present study evaluated the role of expectations on the ERN and P300 in two experiments that manipulated the probability of negative feedback (25%, 50%, or 75%) on a trial-by-trial basis in experiment 1, and by varying the frequency of positive and negative feedback across blocks of trials in experiment 2. In both experiments, P300 amplitude was larger for unexpected feedback; however, the ERN was equally large for expected and unexpected negative feedback. These results are discussed in terms of the potential role of expectations in processing errors and negative feedback.     

局限性癫痫患儿体感诱发电位特征及临床应用

目的：探讨局限性癫痫患儿体感诱发电位特征及应用价值。方法：依据头颅ＣＴ结果分组观测５１例局限性癫痫患儿及３０例正常儿童的双侧正中神经短潜伏期体感诱发电位（ＳＬＳＥＰ）各指标的差异，并与常规脑电图结果进行了比较。结果：与对照组相比，脑部ＣＴ未发现病变组Ｎ２０波幅在癫痫灶侧明显高于对侧；而癫痫灶侧大脑病变组的病灶侧Ｎ２０波幅却明显低于对侧。在部分脑电图未显示局灶性异常的病例也同样显示了这种差异。结论：对于局限性癫痫患儿进行正中神经ＳＬＳＥＰ检查可有助于早期判断症状性癫痫和特发性癫痫，在某种意义上它可能较常规脑电图检查具有更高的敏感性     

Clinical significance of focal topographic changes in the electroencephalogram (EEG) and evoked potentials (EP) of psychiatric patients

Summary The relationship between psychiatric symptoms that respond to anticonvulsants and epileptic activity is still debated. Evidence linking electroencephalographic changes to treatment response is scarce and controvertial, partly because of the poor scalp representation of limbic electrical activity. We studied the clinical relevance of focal topographic changes in the resting EEG, the visual evoked potential and the P300 response in 90 psychiatric patients, by evaluating response to anticonvulsants and development of neurological complications. The group with focal changes was compared to a group with epileptiform activity but no focal changes and a group with normal or diffusely altered EEG. Focal EEG and EP changes predicted good response to anticonvulsants, while the presence of epileptiform activity did not. Clinical seizures developed only in patients with focal changes and no anticonvulsants medication. Structural abnormalities and selective neuropsychological deficits were seen only in the focal group. There was an association of symptom type and the site of focus. We concluded that focal EEG and EP changes in psychiatric patients have important theoretical as well as practical implications.We would like to thank the Hospital Español de Mexico Psychiatry Department for their help in the evaluation and follow-up of patients for this study.     

Stability of Late Event-Related Potentials: Topographical Descriptors of Motor Control Compared with the P300 Amplitude

The P300-amplitude evoked with an acoustic oddball-paradigm is considered the most stable late event-related potential (ERP). This amplitude-index has become a standard parameter in electrophysiology. Recently, a robust ERP-parameter (NoGo-anteriorization, NGA) has been introduced, which reflects spatial brain electrical changes in relation to execution and inhibition of a motor response elicited with a Continuous Performance Test (CPT). The current study refers to the stability of this new topographical ERP-parameter compared to the stability of the classical P300-amplitude. For that purpose, 12 healthy subjects were investigated with both paradigms during recording of a 21-channel EEG. Analysis of the resulting ERPs revealed a very high stability for both, topographical and amplitude index: In every single subject, the brain electrical fields were characterized by a more anterior location in the NoGo- compared to the Go-condition (=NGA) and by higher amplitudes after target compared to distractor condition. T-tests, analyses of the effect size and of the power revealed equivalent differences between the two contrasting conditions for the topographical compared to the amplitude index. These results indicate that the stability of the topographical ERP-parameters elicited with the CPT is sufficient for an electrophysiological standard-index. The possibility to elicit a robust and specific spatial brain activation with the CPT is an ideal completion to the classical P300 amplitude effect and, therefore, hopefully will be a useful expansion of the standard paradigms in electrophysiological laboratories.     

Auditory event-related potentials in humans and rats: effects of task manipulation

The purpose of this study was to compare components of the rat and human auditory event-related potential (ERP) as generated in active oddball and passive single-stimulus tasks. The rats were trained to discriminate between target and standard stimuli in an oddball task, whereas the human subjects received instructions. Task effects on various ERP components were found in both species. Interestingly, effects on the P3 component were similar in the species with regard to amplitude: Target stimuli elicited a higher amplitude in the oddball task than did standard stimuli. This might indicate that the P3 shares the same characteristics between species. However, the first four components occurred 1.82 times earlier in rats than in humans, expecting a P3 of about 200 ms in rats. The P3 in rats appeared at 380 ms. We conclude that either the relation between human and rat peak latencies is not linear, or the P3 in rats is not the equivalent of the human P3.     

Auditory event-related potentials and alpha oscillations in the psychosis prodrome: Neuronal generator patterns during a novelty oddball task

Prior research suggests that event-related potentials (ERP) obtained during active and passive auditory paradigms, which have demonstrated abnormal neurocognitive function in schizophrenia, may provide helpful tools in predicting transition to psychosis. In addition to ERP measures, reduced modulations of EEG alpha, reflecting top-down control required to inhibit irrelevant information, have revealed attentional deficits in schizophrenia and its prodromal stage. Employing a three-stimulus novelty oddball task, nose-referenced 48-channel ERPs were recorded from 22 clinical high-risk (CHR) patients and 20 healthy controls detecting target tones (12% probability, 500 Hz; button press) among nontargets (76%, 350 Hz) and novel sounds (12%). After current source density (CSD) transformation of EEG epochs (− 200 to 1000 ms), event-related spectral perturbations were obtained for each site up to 30 Hz and 800 ms after stimulus onset, and simplified by unrestricted time–frequency (TF) principal components analysis (PCA). Alpha event-related desynchronization (ERD) as measured by TF factor 610–9 (spectral peak latency at 610 ms and 9 Hz; 31.9% variance) was prominent over right posterior regions for targets, and markedly reduced in CHR patients compared to controls, particularly in three patients who later developed psychosis. In contrast, low-frequency event-related synchronization (ERS) distinctly linked to novels (260–1; 16.0%; mid-frontal) and N1 sink across conditions (130–1; 3.4%; centro-temporoparietal) did not differ between groups. Analogous time-domain CSD-ERP measures (temporal PCA), consisting of N1 sink, novelty mismatch negativity (MMN), novelty vertex source, novelty P3, P3b, and frontal response negativity, were robust and closely comparable between groups. Novelty MMN at FCz was, however, absent in the three converters. In agreement with prior findings, alpha ERD and MMN may hold particular promise for predicting transition to psychosis among CHR patients.     

Daytime sleepiness, psychomotor performance, waking EEG spectra and evoked potentials in women with severe premenstrual syndrome

We assessed daytime sleepiness using objective and subjective measures in women with severe premenstrual syndrome (PMS) compared with women without significant premenstrual symptoms. Nine women with severe PMS and eight controls (aged 18−40 years) completed a laboratory-based daytime protocol including the maintenance of wakefulness test (MWT), psychomotor vigilance task (PVT), quantitative waking electroencephalogram (EEG), auditory and visual event-related potentials (ERPs), and sleepiness and mood scales during the mid-follicular and late-luteal (premenstrual) phases of the menstrual cycle. In association with increased perceived sleepiness, fatigue and other premenstrual symptoms in the late-luteal phase, women with PMS performed more poorly on the PVT, with increased lapses and slower reaction times ( P  <   0.05), compared with the follicular phase and controls. However, there were no significant group or menstrual phase differences in latency to sleep on the MWT. Waking spectral EEG power and ERP measures also did not differentiate PMS women when symptomatic. Both groups of women displayed increased spectral power in the delta/theta frequencies (2−6 Hz) and fast alpha frequency (11−12 Hz) in the late-luteal phase relative to the follicular phase. Trait-like differences were apparent in that women with PMS had increased beta1 (12−16 Hz) power and smaller P300 amplitude than controls in both menstrual cycle phases. Our findings indicate that women with severe PMS are subjectively sleepy and fatigued, and show psychomotor slowing when symptomatic compared with when they are symptom-free and compared with controls. However, the ability to maintain wakefulness under soporific conditions, spectral properties of waking EEG and cognitive processing do not vary in synchrony with premenstrual symptoms.     

Physiological correlates of learning by performance feedback in children: a study of EEG event-related potentials and evoked heart rate

In this study we measured event-related potentials (ERPs) and evoked heart rate (EHR) to investigate performance monitoring in 10-12-year-old children. The children received feedback on their performance while conducting a probabilistic learning task. Error-related ERP components time-locked to the response increased in amplitude when the children had learned the task, whereas the feedback-locked components decreased. Concerning EHR, there was a general reduction in feedback-related heart rate deceleration when the children had learned. Moreover, a prolonged heart rate deceleration was observed at negative feedback onset in comparison to positive feedback, which shifted in timing when the task progressed. Together, the ERP and EHR-measures suggest a shift from external to internal monitoring when the children are learning by performance feedback. The data suggest that error- and feedback-related EHR deceleration is a reflection of the same error monitoring system that is responsible for the emergence of the error-related negativity (ERN).     

人工耳蜗置入后患儿有意义听觉整合量表分数的变化

BACKGROUND: At present, neither medications nor hearing aids can improve auditory sense of patients with severe sensorineural deafness, and these patients are mostly treated by multi-channel cochlear implantation to restore their auditory sense and promote the development of language ability.   OBJECTIVE: To identify the developmental law and influencing factors related to the rehabilitation of language ability in children with severe sensorineural deafness after cochlear implantation and to analyze the correlation of these influencing factors with speech rehabilitation in children.   METHODS: Totally 138 children under 7 years old suffering from severe sensorineural deafness received cochlear implantation. Their auditory sense were accessed using the Meaningful Auditory Integration Scale (MAIS) before and after implantation, and their age, gender, nature of deafness, presence or absence of pre-operative language intervention, age of cochlear implantation, education level of their parents, family economic status, and post-operative rehabilitation approach were analyzed to find a correlation between these factors and their MAIS scores.   RESULTS AND CONCLUSION: Gender, length of time after implantation, and development of cochlear showed no effect on MAIS scores of these children (P > 0.05); age of the patient was positively correlated with the MAIS score (P=0), and pre-operative single-ear or double-ear language intervention showed beneficial effect on the MAIS score (P=0.018, P=0), but no significant difference was detected between single-ear and double-ear interventions (P > 0.05); higher family income and higher education level of the parents were correlated with higher MAIS score (P=0, P=0); and those receiving professional in-school rehabilitation training got higher scores than those receiving only family rehabilitation training (P=0). These results suggest that the cochlear implantation significantly improves language development of children with severe sensorineural deafness, and better rehabilitation can be achieved if the child is treated at relatively older age, received pre-operative language intervention, and has a family with high income and parents with higher education level. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Working alliance in online cognitive behavior therapy for anxiety disorders in youth: comparison with clinic delivery and its role in predicting outcome

Background

Substantial evidence exists that positive therapy outcomes are related to the therapist–client working alliance.

Objectives

To report two studies that examined (1) the quality of the working alliance in online cognitive behavior therapy (CBT), with minimal therapist contact, for anxiety disorders in youth, and (2) the role of working alliance and compliance in predicting treatment outcome.

Methods

Study 1 participants were 73 adolescents aged 12 to 18 years who met diagnostic criteria for an anxiety disorder, plus one or more of their parents. Participants were randomly assigned to clinic or online delivery of CBT, with working alliance being assessed for youth and parents after session 3. Study 2 participants were 132 children and adolescents aged 7 to 18 years who met diagnostic criteria for an anxiety disorder, plus one or more of their parents. Youths and parents participated in a minimally therapist-assisted online CBT program supported by brief, weekly emails and a single, short phone call.

Results

Study 1 revealed a strong working alliance for both online and clinic CBT, with no significant difference in working alliance between conditions for adolescents (F _1,73 = 0.44, P = .51, η_p ² = 0.006, Cohen d = 0.15). Parents also reported high working alliance in both conditions, although a slight but significantly higher working alliance in clinic-based therapy (F _1,70 = 6.76, P = .01, η_p ² = 0.09, Cohen d = 0.64). Study 2 showed a significant and substantial decrease in anxiety symptoms following online therapy (P < .001 for all outcome measures). Adolescents improved significantly more in overall functioning when working alliance (beta = .22, t ₇₉ = 2.21, P = .03) and therapy compliance (beta = .22, t ₈₄ = 2.22, P = .03) were higher, with working alliance also predicting compliance (beta = .38, F _1,80 = 13.10, P = .01). No such relationships were evident among younger children.

Conclusions

Working alliance is important in determining clinical outcome for online treatment for anxiety among adolescents, with minimal therapist assistance, although this was not the case for younger children.

Trial Registration

Australian New Zealand Clinical Trials Registry: ACTRN12611000900910; http://www.anzctr.org.au/trial_view.aspx?ID=343375 (Archived by WebCite at http://www.webcitation.org/674C4N3JJ)