![]() Therefore, there is an urgent need to elucidate the neural mechanisms for the reciprocal deterioration of the concurrent symptoms, as to identify novel therapeutic targets and treatments for schizophrenia (Krynicki et al., 2018 McGinty & Upthegrove, 2020). ![]() The severe brain damage can make treatment more difficult, leading to the high morbidity and mortality rates associated with the disease (Maximilian et al., 2017). Moreover, we noticed that first‐episode schizophrenia patients with concurrent AVHs and depressive symptoms had an average global GM atrophy of 1.6%, significantly higher than that of 0.58% in patients with depressive symptoms alone. We found that gray matter (GM) damage was more severe in first‐episode schizophrenia patients with AVHs and depressive symptoms, with reductions in GM volume in the parietal lobe, frontal lobe, and temporal lobe, especially in the Broca and Wernicke areas, and prefrontal lobe. Due to our long‐standing interest in this topic, we used brain imaging techniques to identify structural and functional brain imaging signatures and to investigate the neural mechanisms that underline AVHs and depressive symptoms in schizophrenia. Studies from the past 5 years have suggested that AVHs and depressive symptoms reciprocally worsen the mental state of patients with schizophrenia, resulting in further aggravation of cognitive impairment and decline of social functioning (Chiang et al., 2018 Helfer et al., 2016 Janaki et al., 2017 Liu et al., 2019 Wang et al., 2019). Recent studies have shown that depressive symptoms and AVHs often co‐occur in a proportion of patients with schizophrenia (Krynicki et al., 2018 McGinty & Upthegrove, 2020), and the concurrence greatly increases the risk of self‐harm and suicide (Gardsjord et al., 2016 Kelleher et al., 2013). It has also been noted that depressive symptoms can increase the risk of self‐harm and suicide in schizophrenia patients with concurrent depression. Studies over the past 5 years have shown that depressive symptoms play a destructive role in the prognosis of patients with schizophrenia, decreasing the efficacy of treatment (Bosanac & Castle, 2012 Fusar‐Poli et al., 2013). In addition to AVHs, depressive symptoms are common in schizophrenia, with up to 80% of patients with schizophrenia experiencing depressive episodes during the early stages of the disease (Bosanac & Castle, 2012 Fusar‐Poli et al., 2013). Therefore, there is an urgent need to understand the underlying neural mechanisms to identify therapeutic targets for the effective treatment of AVHs (Fujita et al., 2015 Hugdahl, 2015). Insulting “voices” can lead to self‐harm, suicidal attempts, suicide, and extreme violence in patients with schizophrenia (Dugré et al., 2018). As such, AVHs can cause considerable mental distress to patients, especially when they are an initial symptom. Notably, AVHs in schizophrenia are characterized by negative “voices” against the patients themselves or hostile comments, which may be satirizing, insulting, and commanding. ![]() ![]() Patients with AVHs usually hear unreal “voices” in the absence of any external sound stimulation, according to the International Consortium on Hallucination Research (Waters et al., 2014). Auditory verbal hallucinations (AVHs) are a characteristic symptom in schizophrenia, occurring in approximately 70% of patients. ![]()
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