Ann K. Shinn, MD, MPH

Dr. Shinn’s primary line of investigation is to better understand auditory hallucinations in psychotic disorders. While psychosis research has traditionally focused on diagnostic categories like schizophrenia, which are heterogeneous and may consist of multiple different though related disorders, Dr. Shinn has focused her investigations on a symptom dimension. She and her colleagues have provided additional evidence that auditory hallucinations—even “first-rank” auditory hallucinations, once considered to be pathognomonic of schizophrenia—are prevalent across disorders including schizophrenia, schizoaffective disorder, and psychotic bipolar disorder.

In related work, Dr. Shinn and her colleagues provided evidence in support of the DSM-5 Psychotic Disorders Work Group’s decision to eliminate the special treatment of first-rank auditory hallucinations (e.g., voices conversing or giving a running commentary) and bizarre delusions in the diagnostic criteria for schizophrenia. In this work, Dr. Shinn and collaborators showed that few patients receive a diagnosis of schizophrenia based on first-rank auditory hallucinations alone.

In addition to describing clinical features of voice hearing, she has contributed to insights about the neurobiology underlying auditory hallucinations. Building on the existing postmortem, structural MRI, and symptom capture fMRI literature suggesting that abnormalities of the primary auditory cortex are important in the pathogenesis of auditory hallucinations, Dr. Shinn studied whole-brain functional connectivity abnormalities associated with the primary auditory cortex, specifically left Heschl’s gyrus, in schizophrenia. In an extension of this work, Dr. Shinn and colleagues used machine learning of resting state fMRI to perform classification of schizophrenia patients with and without lifetime auditory hallucinations, showing that it is possible to discriminate the two groups with high accuracy. They showed that discrimination between patients with and without lifetime auditory hallucinations was highest, while discrimination between schizophrenia patients and healthy control participants was worst, suggesting that classification by auditory hallucinations may be more valid than discrimination based on traditional diagnostic categories.

Currently, Dr. Shinn is the principal investigator of a five-year NIH K23 Patient-Oriented Career Development Award to understand how the brain is functionally and structurally connected in patients who are prone to auditory hallucinations. The current work has the potential to provide deeper understanding of the pathophysiology underlying auditory hallucinations at the circuit level, including new knowledge about dynamic task-related aspects of brain connectivity in patients prone to auditory hallucinations. As of December 2018, participant recruitment and data collection are close to completion.

Dr. Shinn is also an investigator on a federally funded project (led by principal investigators Margaret Niznikiewicz, PhD, and Susan Whitfield-Gabrieli, PhD) to investigate the effect of real-time fMRI neurofeedback on engagement and modulation of the superior temporal gyrus, a region of the brain that plays a central role in auditory and language processing in schizophrenia patients with auditory hallucinations.

More recently, Dr. Shinn has collaborated with Milissa Kaufman, MD, PhD, and colleagues in McLean’s Dissociative Disorders and Trauma Research Program to explore auditory hallucinations—and voice hearing experiences more broadly—in individuals with trauma spectrum disorders, including post-traumatic stress disorder and dissociative disorders.

Dr. Shinn’s work also concerns investigations into abnormalities of the cerebellum in psychotic disorders. There is growing evidence that the cerebellum, which is reciprocally connected to higher-level association areas such as the prefrontal cortex, is involved in both non-motor as well as motor functions. Unlike most psychiatric neuroimaging studies that treat the cerebellum as a single homogeneous structure, she systematically investigated the topographic representations of cerebro-cerebellar resting state networks within the cerebellum in schizophrenia and found selective alterations in specific networks. Dr. Shinn and her collaborators conducted a similar study of cerebro-cerebellar functional connectivity also in individuals with bipolar disorder with psychotic features.

Currently, Dr. Shinn is conducting a pilot study in collaboration with transcranial magnetic stimulation (TMS) experts at Massachusetts General Hospital to investigate the effect of cerebellar stimulation on psychotic symptoms, including auditory hallucinations, in individuals with schizophrenia and bipolar disorder.