Presentation made by Dr. Ralph Hoffman at the May 28, 2014 Live Webinar hosted by the Schizophrenia Forum - http://schizophreniaforum.org/for/live/detail.asp?liveID=92

1. Perceiving social salience: a research
domain linking normal and
pathological hallucination
Ralph Hoffman MD
Department of Psychiatry
Yale University School of Med
28 May 2014
ralph.hoffman@yale.edu

2. AVHs in Sz achieve high
“social salience”
• Acoustic “voiceprint” connotes specific speakers;
• particular sounding voices have distinctive
characteristics – “their own personality…”
• attributed to specific persons/agents, angels, God,
the dead, or the devil, often given names;
• typically patient has conversations with voices…

3. Normal AHs prompted by ↑
social salience
• Erroneously hearing one’s name in
public (57% college students; Posey
and Losch 1983);
• vibration and pager tone hallucinations
– 80-90% of medical interns, not
correlated with anxiety or depression
(Lin et al. 2013).
• Bereavement hallucinations, typically
AVHs; fills in for lost loved one

4. Social withdrawal precedes and is
possible risk factor for AVHs
• 87% of first-episode patients w/SZ reported prior
social withdrawal vs 3% for non-psychotic patients
(Tan 2001);
• 71% of SZ pts with AVHs report significant drop-off in
social involvement 1-6 month before first onset
• Move to new city, new school, solo travel in Europe or across
the US, peace corp duty, dissertation takes over…

5. • Phantom limb following amputation
• Charles Bonnet Syndrome
Sensory deafferentation:
hallucinations due to network
reorganization filling in for
absent percepts

6. What about “social
deafferentation?”
• Brain is dedicated to social meaning;
• high levels of plasticity in “social brain”
regions
• What happens when brain deprived of
social experience??
• Could AVHs with high social salience
“fill in” for absent social connection

7. Suggestive evidence
• Baseline active social avoidance (ASA)
during the prodrome correlated with
hallucinations (PRIME study, unpublished)
• at baseline, correlation = 0.18;
• at 1 year, correlation = 0.54.
• Prisoners in solitary confinement: 36%
had auditory/verbal hallucinations
(Grassian Am J Psychiatry 1983); mean
age 28, 11 days to 10 months SC
• What other factors besides social
disconnection might come into play???

8. Greater dendritic length in amygdala neurons in
socially isolated rats (Wang et al. 2011)

9. New-born
hippocampal
neurons
after
knockdown
of DISC-1
gene
expression
Duan et al. Cell, 2007
oncoretrovirus-
mediated RNA
interference