Do you hear what I hear? Neural correlates of thought disorder during listening to speech in schizophrenia

Thought disorder is a fundamental symptom of schizophrenia, observable as irregularities in speech. It has been associated with functional and structural abnormalities in brain regions involved in language processing, including left temporal regions, during language production tasks. We were interested in the neural correlates of thought disorder during receptive language processing, as this function is relatively preserved despite relying on the same brain regions as expressive language. Twelve patients with schizophrenia and 11 controls listened to 30-s speech samples while undergoing fMRI scanning. Thought disorder and global symptom ratings were obtained for each patient. Thought disorder but not global symptomatology correlated positively with the BOLD response in the left posterior superior temporal lobe while listening to comprehensible speech (cluster-level corrected p = .023). The pattern of brain activity associated with thought disorder during listening to comprehensible speech differs from that seen during language generation tasks, where a reduction of the leftward laterality of language has often been observed. As receptive language is spared in thought disorder, we propose that the increase in activation reflects compensatory processing allowing for normal performance.