Hallucinations, thought disorders, and the language domain in schizophrenia

Auditory hallucinations and formal thought disorders are major diagnostic features of schizophrenia. From a neurobiological point of view, they are of particular interest since both can be attributed to the language domain of human communication. In the last decade, brain imaging studies have contributed to the understanding of the functional dynamics underlying these phenomena. In particular, auditory hallucinations were found to involve the regions generating inner speech as well as the primary acoustical cortex and the intrahemispheric fiber bundles connecting the left frontal with the temporal lobe. In patients with formal thought disorders, on the other hand, the left temporal language area showed structural deficits and functional abnormalities, i.e., reduced reactivity to stimulation and increased activity at rest; left frontal language regions were also hyperactive at rest but showed no structural deficits. The available evidence indicates a dynamic imbalance of the language system, triggered by subtle structural changes, as the possible common neurobiological basis of hallucinations and formal thought disorders.