Neural substrates underlying delusions in schizophrenia

Delusions are cardinal positive symptoms in schizophrenia; however, the neural substrates of delusions remain unknown. In the present study, we investigated the neural correlates of delusions in schizophrenia using multi-modal magnetic resonance imaging (MRI) techniques. Diffusion, structural and perfusion MRIs were performed in 19 schizophrenia patients with severe delusions, 30 patients without delusions and 30 healthy controls. Fractional anisotropy (FA), gray matter volume (GMV) and cerebral blood flow (CBF) were voxel-wisely compared among the three groups. Although patients without delusions exhibited decreased FA in white matter regions and decreased GMV in gray matter regions relative to controls, patients with severe delusions demonstrated comparable FA in all of these white matter regions and similar GMV in most of these gray matter regions. Both patient subgroups had less GMV in the amygdala and anterior cingulate cortex than controls. Although two patient subgroups showed consistent CBF changes relative to controls, only CBF in the anterior cingulate cortex was lower in patients with severe delusions than in patients without delusions. These findings suggest that schizophrenia patients with severe delusions have relatively normal structural integrity. Importantly, the excessively reduced perfusion in the anterior cingulate cortex may be associated with the development of delusions in schizophrenia.