Altered Effective Connectivity in the Default Network of the Brains of First-Episode, Drug-Naïve Schizophrenia Patients With Auditory Verbal Hallucinations

Although the default mode network (DMN) is known to be abnormal in schizophrenia (SZ) patients with auditory verbal hallucinations (AVHs), it is still unclear whether AVHs that occur in SZ are associated with certain information flow in the DMN. This study collected resting-state functional magnetic resonance imaging data from 28 first-episode, drug-naïve SZ patients with AVHs, 20 SZ patients without AVHs, and 38 healthy controls. We used Granger causality analysis (GCA) to examine effective connectivity (EC) of two hub regions [posterior cingulate cortex (PCC) and anteromedial prefrontal cortex (aMPFC)] within the DMN. We used two-sample t-tests to compare the difference in EC between the two patient groups, and used Spearman correlation analysis to characterize the relationship between imaging findings and clinical assessments. The GCA revealed that, compared with the non-AVHs group, EC decreased from aMPFC to left inferior temporal gyrus (ITG) and from PCC to left cerebellum posterior lobe, ITG, and right middle frontal gyrus in SZ patients with AVHs. We also found significant correlations between clinical assessments and mean strengths of connectivity from aMPFC to left ITG and from PCC to left ITG. Moreover, receiver operating characteristic analysis revealed that the above-mentioned effective connectivities had a diagnostic value for distinguishing SZ patients with AVHs from non-AVHs patients. These findings suggest that AVHs in SZ patients may be associated with the aberrant information flows of the DMN, and the left ITG may probably serve as a potential biomarker for the neural mechanisms underlying AVHs in SZ patients.