Columbia University researchers explain the connection between auditory hallucinations and dopamine levels in the body

Researchers at Columbia University Irving Medical Center (CUIMC) and New York State Psychiatric Institute (NYSPI) found that people with schizophrenia who experience auditory hallucinations tend to hear what they expect, an exaggerated version of a perceptual distortion that is common among other people without hallucinations. Those with hallucinations and other psychotic symptoms are known to have elevated dopamine, the main area of focus for available treatments for psychosis, but it was unclear how this could lead to hallucinations. The researchers found that elevated dopamine could make some patients rely more on expectations, which could then result in hallucinations.

Guillermo Horga MD PhD © CU

The findings, published recently in Current Biology (link is external and opens in a new window), explain why treatments targeting the production of dopamine could help alleviate this condition.

“Our brain uses prior experiences to generate sensory expectations that help fill in the gaps when sounds or images are distorted or unclear,” said Guillermo Horga, MD, PhD, assistant professor of clinical psychiatry at CUIMC and a research psychiatrist at NYSPI. “In individuals with schizophrenia, this process appears to be altered, leading to extreme perceptual distortions, such as hearing voices that are not there. Furthermore, while such hallucinations are often successfully treated by antipsychotic drugs that block the neurotransmitter dopamine in a brain structure known as the striatum, the reason for this has been a mystery since this neurotransmitter and brain region are not typically associated with sensory processing.”

The researchers designed an experiment that induces an auditory illusion in both healthy participants and participants with schizophrenia. They examined how building up or breaking down sensory expectations can modify the strength of this illusion. They also measured dopamine release before and after administering a drug that stimulates the release of dopamine.

Patients with hallucinations tended to perceive sounds in a way that was more similar to what they had been cued to expect, even when sensory expectations were less reliable and illusions weakened in healthy participants. This tendency to inflexibly hear what was expected was worsened after giving a dopamine-releasing drug, and more pronounced in participants with elevated dopamine release, and more apparent in participants with a smaller dorsal anterior cingulate (a brain region previously shown to track reliability of environmental cues).

“All people have some perceptual distortions, but these results suggest that excess dopamine can exacerbate our distorted perceptions,” said Dr. Horga. “Novel therapies should aim to improve the processing of contextual information by targeting the dopamine system or downstream pathways associated with modulation of perceptual processing, which likely include the dorsal anterior cingulate cortex.”

The study is titled “A perceptual inference mechanism for hallucinations linked to striatal dopamine.”

Source: CU

Related: Guide to the Brain Part 8

Even when you’re taking steps to work on your mental health, ‘coming clean’ about what’s going on can feel tricky in the workplace.

There’s the very real fear of judgement. Worries that you’ll be seen as less capable.

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Concerns like these are common, but dangerous. Because if there’s one place we need to be talking about mental health and the impact high-stress careers can have, it’s the workplace.

The Green Ribbon Campaign aims to take down the silence.

The campaign, created by The Lord Mayor’s Appeal charity, encouraged people to wear green ribbons to work, to encourage a work culture where people can freely discuss mental health.

Each green ribbon comes branded with the words: ‘Together we can #endthestigma’ – message in partnership with the This is Me initiative (which is working to end the stigma around mental health in high-powered careers).

To get involved, bosses and managers are being asked to order batches of green ribbons for their offices, which workers can then wear throughout Mental Health Awareness Week (that’s 8 May to 14 May) to show anyone struggling alone that it’s okay to open up.

‘Imagine everywhere you go during Mental Health Awareness Week you see thousands of people showing they want to help #endthestigma of mental health by wearing a green ribbon,’ explains the website.

‘We are asking organisations to invite their employees to wear a green ribbon as a visible sign of support and to help destigmatise mental health by: Creating a visible movement of support for ending the stigma, showing those struggling that there is support and they are not alone, demonstrating the level of support for this issue in your organisation, [and] encouraging people to share their story and to create an inclusive cultures workplace.’

Along with a box of ribbons, workplaces that get involved will also receive resources for starting conversations around mental health.

So the campaign is more than just sticking a ribbon on your lapel and being done with it.

If you fancy getting involved, get your boss to order a box of green ribbons (batches of 50 cost 35p per ribbon) before 24 April.

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Poppy Jaman, chief executive of the not-for-profit Mental Health First Aid England (MHFAE), believes Theresa May meant business when she pledged in January to make mental health a priority. Despite ministers being accused of breaking their promises after £800m in cash earmarked for mental health was last month redirected to offsetting wider NHS budget problems, Jaman argues that the government will come good.

“I think this government has already set a precedent for change, with two consecutive prime ministers making commitments to improve the outlook for those with mental health issues and attending to the prevention agenda,” says Jaman, referring to NHS England’s Mental Health Taskforce national strategy published in 2016. “I think it’s massively a great step that the current PM has made a public commitment to mental health.”

MHFAE runs training courses in how to identify the warning signs of mental ill health in others and help steer them towards appropriate support. Jaman has headed the social enterprise for almost 10 years, since it evolved from a government initiative within the Department of Health. She says she’s “feeling confident” the Conservatives recognise the significant toll mental health problems can take on individuals and wider society. By way of illustration she points to the imminent roll-out for secondary school staff of a government-funded schools training course delivered by MHFAE to address mental health issues among young people. The goal is to have “mental health first aiders” in place who can help to identify pupils with mental health challenges, ideally before they reach a crisis point. The programme aims to train staff in more than 1,000 schools by 2020.

Evidence over the past decade from MHFAE’s training to more than 150,000 individuals – such as NHS staff, charity workers and employees at large corporations including Unilever and WH Smith – shows it can contribute to the broader “public health prevention” and wellbeing agenda, says Jaman, by “giving people the tools” to recognise signs of mental difficulty.

The mental heath first aid approach is ostensibly an adjunct to standard first aid and Jaman has been campaigning to put the two on a par. This includes supporting a push to amend regulations around first aid within the Health and Work Act, so that all organisations are required to have mental health first aiders in place, and an obligation to deliver mental as well as physical first aid. An early day motion last year calling for such a transformation was backed by about 500 MPs, including Norman Lamb and Frank Field. Implementing it would be “a big leap for equality” and parity of esteem between mental and physical health, Jaman argues.

“I truly believe that making this legislative change would have a big positive impact because it would shift the dial on how employers have to think about the mental and physical health needs of their workforce.”

A third-generation British Bangladeshi, Jaman, 40, says her early grassroots professional work, coupled with having experience of depression as a young woman, helped her to develop an understanding of the challenges facing people with mental health problems, especially among diverse groups. And having grown up in a deprived ward in Portsmouth and left school at 16 (she later got an MBA), she says she is cognisant of how poverty and racial inequalities affect mental wellbeing and access to care. “There is a plethora of data on health outcomes, job outcomes and opportunities for the black and minority ethnic community and when you overlay that with the prevalence of mental ill health and outcomes, the odds are stacked against them.”

So it’s no surprise that Jaman does not underestimate the significant impact of current government policies such as sanctions and fitness-for-work tests for people living with mental health problems. One area in which she is anxious to see improvements is help for people who are unemployed, many of whom have a mental health diagnosis.

She refers to a recent public call by an alliance of mental health professional organisations including the British Psychological Society for a suspension of the government’s sanctions programme because of its negative impact on mental wellbeing and for statutory support for creating psychologically healthy workplaces.

The same group also recommended increased mental health awareness training for jobcentre staff, which Jaman agrees is necessary. “It [the jobcentre] service needs people who understand mental health so that people are getting the right support,” she says. Asked how this is conceivable in a jobseekers system that advocates have repeatedly argued is hostile to mentally vulnerable people, she responds that change needs to come from “the leadership” at the Department for Work and Pensions. “I think there is a wave of change coming around this,” she insists.

When it comes to nudging the government in the right direction, Jaman is clearly a pragmatist. It is important to challenge government policies “where we don’t think things are right”, she argues, but ultimately, “for me it’s about ‘let’s work with whoever we need to work with’.”