Which Came First: The Hallucination or the Neural Alteration?

摘要: Efforts to understand the etiology of psychosis spectrum symptoms, including hallucinations, indicate these experiences likely arise from a confluence of risk factors, such as pathophysiological, genetic, and environmental risk factors (Figure 1). To better understand the pathogenesis of these symptoms, research has increasingly examined early pathophysiological markers of subthreshold psychosis spectrum symptoms, or psychotic-like experiences. Large population-based samples, such as Generation R, are needed to understand small effect-sized associations, such as those between neural metrics and psychopathology symptoms. As this research unfolds, we still do not fully understand the temporal ordering of these associations, as there has been a paucity of research formally examining whether neural impairments precede the development of psychotic-like experiences. A paper in this issue by Steenkamp and colleagues made important first steps longitudinally examining whether structural neural metrics predict hallucinations, or whether there was stronger evidence for early hallucinations predicting structural neural metric impairments (1). This commentary will reflect on the advances made by this paper, as well as potential future directions to expand upon the findings.The research by Steenkamp and colleagues (1) found evidence that smaller global volume and surface area in middle childhood predicted endorsement of hallucinations in early adolescence. These volumetric impairments were widespread, encompassing frontal, parietal, temporal, and occipital regions. Cortical thickness was not strongly associated with later …