Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jun 19, 2025; 15(6): 106775
Published online Jun 19, 2025. doi: 10.5498/wjp.v15.i6.106775
Cerebral hemodynamic characteristics of patients with auditory verbal hallucinations and the construction of nomogram models
Zi-Yao Cai, Ce Chen, Zi-Ye Huang, Xin-Wu Ye, Xiao-Zhuang Jin, Hao-Ran Chen, Jian-Min Sha
Zi-Yao Cai, Department of Traditional Chinese Medicine Psychiatry, Wenzhou Seventh People’s Hospital, Wenzhou 325000, Zhejiang Province, China
Ce Chen, Zi-Ye Huang, Xiao-Zhuang Jin, Hao-Ran Chen, Department of Psychiatry, Wenzhou Seventh People’s Hospital, Wenzhou 325000, Zhejiang Province, China
Xin-Wu Ye, Department of Geriatric Psychiatry Ward of the Psychiatry, Wenzhou Seventh People’s Hospital, Wenzhou 325000, Zhejiang Province, China
Jian-Min Sha, Department of Affective Disorders Ward of the Psychiatry, Wenzhou Seventh People’s Hospital, Wenzhou 325000, Zhejiang Province, China
Author contributions: Cai ZY wrote the paper and performed the research; Chen C, Huang ZY, and Ye XW contributed analytic tools; Jin XZ and Chen HR analyzed the data; Sha JM designed the research; all authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Wenzhou Seventh People’s Hospital, approval No. EC-20200610-02.
Informed consent statement: All subjects agreed to the study protocol.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Min Sha, Associate Professor, Department of Affective Disorders Ward of the Psychiatry, Wenzhou Seventh People’s Hospital, No. 158 Xueshiqian Village, Ouhai District, Wenzhou 325000, Zhejiang Province, China. shajm163@163.com
Received: March 12, 2025
Revised: April 7, 2025
Accepted: May 6, 2025
Published online: June 19, 2025
Processing time: 78 Days and 1.7 Hours
Abstract
BACKGROUND

The characteristics of cerebral hemodynamic indexes of patients with different types of auditory verbal hallucinations (AVHs) was not clear.

AIM

To explore the characteristics of cerebral hemodynamic indexes of patients with different types of AVHs and construct the risk nomogram prediction model of patients with different types of AVHs.

METHODS

Patients with different types of verbal hallucinations who visited Wenzhou Seventh People’s Hospital were retrospectively selected from March 2021 to March 2023, and these patients were classified into 117 cases of schizophrenia (SCZ) with AVHs, 108 cases of post-traumatic stress disorder (PTSD) with AVHs, and 105 cases of recurrent depressive disorder with AVHs according to type. Transcranial doppler was performed to measure the hemodynamic parameters of the anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), basilar artery (BA) and vertebral artery (VA). Logistic regression modelling was used to explore the factors affecting patients with different types of AVHs and odds ratio, 95% confidence interval (CI). A clinical prediction model was constructed, and the efficacy of the clinical prediction model was evaluated by using receiver operating characteristic, Hosmer-Lemeshow Goodness-of-Fit test, calibration curves and decision curve analysis.

RESULTS

The differences between the three groups of patients in mean velocity (Vm)-MCA, end-diastolic velocity (Vd)-MCA, Vm-ACA, pulsatility index (PI)-ACA, Vm-PCA, peak systolic velocity (Vs)-PCA, Vd-PCA, Vm-BA, Vs-BA, Vd-BA, PI-BA, resistance index (RI)-BA, Vm-VA, Vs-VA, Vd-VA, PI-VA, and RI-VA indexes were statistically significant. Rising Vm-ACA is an independent risk factor for SCZ with AVHs, and falling Vm-VA, Vd-MCA, and Vd-VA are independent risk factors for SCZ with AVHs. Rising Vm-ACA, Vm-PCA, Vs-PCA, Vd-PCA, Vm-BA, and Vs-BA are independent risk factors for PTSD with AVHs, and Vm-MCA, Vs-MCA, Vd-MCA, PI-PCA, and RI-BA are independent protective factors for PTSD with AVHs. Elevated Vm-MCA, Vd-MCA, RI-BA, Vm-VA, and Vd-VA were independent risk factors, and elevated Vm-ACA, Vs-ACA, Vm-PCA, Vs-PCA, and Vd-PCA were independent protective factors. The areas under the curve of the three models were 0.82 (95%CI: 0.76-0.87), 0.88 (95%CI: 0.83-0.92), and 0.81 (95%CI: 0.77-0.86), respectively; the Hosmer-Lemeshow Goodness-of-Fit test of the calibration curves of the three models suggests that P > 0.05.

CONCLUSION

Monitoring the cerebral hemodynamic indexes of patients with AVHs is of practical significance in determining the type of mental disorder, which helps clinicians identify the type of AVHs and adopt more efficient treatment strategies to help patients recover.

Keywords: Auditory verbal hallucinations; Schizophrenia; Posttraumatic stress disorder; Recurrent depressive disorder; Nomogram model

Core Tip: This study explores cerebral hemodynamic characteristics in patients with auditory verbal hallucinations (AVHs) across schizophrenia, post-traumatic stress disorder, and recurrent depressive disorder. Key findings include increased mean velocity-anterior cerebral artery and end-diastolic velocity-vertebral artery as independent risk factors for AVHs in schizophrenia, while decreased end-diastolic velocity-resistance index (middle cerebral artery) and mean velocity-vertebral artery serve as protective factors. Nomogram models were developed to predict the risks of AVHs, demonstrating high discriminative ability with an area under the curve greater than 0.80 and significant clinical utility, thereby supporting early diagnosis and intervention strategies.