The Neurodynamic Organization of Modality-Dependent Hallucinations

Hallucinations in psychosis may arise when the brain's default-mode network (DMN) disengages abnormally, similar to its response to real external stimuli. In 20 drug-free adolescents with brief psychotic disorder, multimodal MRI showed that during auditory, visual, and multisensory hallucinations, cortical thickness was reduced and blood oxygen level-dependent signal increased in modality-dependent association sensory cortices, while primary sensory cortex recruitment was not systematic and linked to greater vividness. DMN disengagement coincided with hallucinations, and spatial and temporal instabilities of the DMN correlated with hallucination severity and persisted even without symptoms. This suggests hallucinations emerge from spontaneous DMN withdrawal, offering a model beyond the auditory modality.

Study at a glance

Abstract

The pathophysiology of hallucinations remains mysterious. This research aims to specifically explore the interaction between hallucinations and spontaneous resting-state activity. We used multimodal magnetic resonance imaging during hallucinations occurrence in 20 drug-free adolescents with a "brief psychotic disorder." They were furthermore compared with 20 matched controls at rest or during exteroceptive stimuli. Anatomical and functional symptom-mapping demonstrated reduced cortical thickness and increased blood oxygen level-dependent signal in modality-dependent association sensory cortices during auditory, visual, and multisensory hallucinations. On the contrary, primary-sensory-cortex recruitment was not systematic and was shown to be associated with increased vividness of the hallucinatory experiences. Spatiotemporal activity patterns in the default-mode network (DMN) during hallucinations and symptom-free periods in patients were compared with patterns measured in healthy individuals. A disengagement of the DMN was concomitant to hallucinations, as for exogenous stimulations in healthy participants. Specifically, spatial and temporal instabilities of the DMN correlated with the severity of hallucinations but persisted during symptom-free periods. These results suggest that hallucinatory experiences emerge from a spontaneous DMN withdrawal, providing a convincing model for hallucinations beyond the auditory modality.