Published online Jun 19, 2025. doi: 10.5498/wjp.v15.i6.106775
Revised: April 7, 2025
Accepted: May 6, 2025
Published online: June 19, 2025
Processing time: 78 Days and 1.7 Hours
The characteristics of cerebral hemodynamic indexes of patients with different types of auditory verbal hallucinations (AVHs) was not clear.
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.
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.
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.
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.
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.