Decoding activity in Broca's area predicts the occurrence of auditory hallucinations across subjects

STRUCTURED ABSTRACT BACKGROUND Functional magnetic resonance imaging (fMRI) capture aims at detecting auditory-verbal hallucinations (AVHs) from continuously recorded brain activity. Establishing efficient capture methods with low computational cost that easily generalize between patients remains a key objective in precision psychiatry. To address this issue, we developed a novel automatized fMRI-capture procedure for AVHs in schizophrenia patients. METHODS We used a previously validated, but labor-intensive, personalized fMRI-capture method to train a linear classifier using machine-learning techniques. We benchmarked the performances of this classifier on 2320 AVH periods vs. resting-state periods obtained from schizophrenia patients with frequent symptoms (n=23). We characterized patterns of BOLD activity that were predictive of AVH both within- and between-subjects. Generalizability was assessed with a second independent sample gathering 2000 AVH labels (n=34 schizophrenia patients), while specificity was tested with a nonclinical control sample performing an auditory imagery task (840 labels, n=20). RESULTS Our between-subject classifier achieved high decoding accuracy (area-under-the-curve, AUC = 0.85) and discriminated AVH from rest and verbal imagery. Optimizing the parameters on the first schizophrenia dataset and testing its performance on the second dataset led to a 0.85 out-of-sample AUC (0.88 for the converse test). We showed that AVH detection critically depends on local BOLD activity patterns within Broca’s area. CONCLUSIONS Our results demonstrate that it is possible to reliably detect AVH-states from BOLD signals in schizophrenia patients using a multivariate decoder without performing complex preprocessing steps. These findings constitute a crucial step toward brain-based treatments for severe drug-resistant hallucinations.