Social-ecological perspective on the suicidal behaviour factors of early adolescents in China:a network analysis

Background In early adolescence,youth are highly prone to suicidal behaviours.Identifying modifiable risk factors during this critical phase is a priority to inform effective suicide prevention strategies.Aims To explore the risk and protective factors of suicidal behaviours(ie,suicidal ideation,plans and attempts)in early adolescence in China using a social-ecological perspective.Methods Using data from the cross-sectional project‘Healthy and Risky Behaviours Among Middle School Students in Anhui Province,China',stratified random cluster sampling was used to select 5724 middle school students who had completed self-report questionnaires in November 2020.Network analysis was employed to examine the correlates of suicidal ideation,plans and attempts at four levels,namely individual(sex,academic performance,serious physical llness/disability,history of self-harm,depression,impulsivity,sleep problems,resilience),family(family economic status,relationship with mother,relationship with father,family violence,childhood abuse,parental mental illness),school(relationship with teachers,relationship with classmates,school-bullying victimisation and perpetration)and social(social support,satisfaction with society).Results In total,37.9%,19.0%and 5.5%of the students reported suicidal ideation,plans and attempts in the past 6 months,respectively.The estimated network revealed that suicidal ideation,plans and attempts were collectively associated with a history of self-harm,sleep problems,childhood abuse,school bullying and victimisation.Centrality analysis indicated that the most influential nodes in the network were history of self-harm and childhood abuse.Notably,the network also showed unique correlates of suicidal ideation(sex,weight=0.60;impulsivity,weight=0.24;family violence,weight=0.17;relationship with teachers,weight=-0.03;school-bullying perpetration,weight=0.22),suicidal plans(social support,weight=-0.15)and suicidal attempts(relationship with mother,weight=-0.10;parental mental llness,weight=0.61).Conclusions This study identified the correlates of suicidal ideation,plans and attempts,and provided practical implications for suicide prevention for young adolescents in China.Firstly,this study highlighted the importance of joint interventions across multiple departments.Secondly,the common risk factors of suicidal ideation,plans and attempts were elucidated.Thirdly,this study proposed target interventions to address the unique influencing factors of suicidal ideation,plans and attempts.

Interaction between adolescent sleep rhythms and gender in an obese population

BACKGROUND The obesity rate of adolescents is gradually increasing,which seriously affects their mental health,and sleep plays an important role in adolescent obesity.AIM To investigate the relationship between sleep rhythm and obesity among adolescents and further explores the interactive effect of sleep rhythm and gender on adolescent obesity,providing a theoretical basis for developing interventions for adolescent obesity.METHODS Research data source Tianjin Mental Health Promotion Program for Students.From April to June 2022,this study selected 14201 students from 13 middle schools in a certain district of Tianjin as the research subject using the convenient cluster sampling method.Among these students,13374 accepted and completed the survey,with an effective rate of 94.2%.The demographic data and basic information of adolescents,such as height and weight,were collected through a general situation questionnaire.The sleep rhythm of adolescents was evaluated using the reduced version of the morningness-eveningness questionnaire.RESULTS A total of 13374 participants(6629 females,accounting for 49.56%;the average age is 15.21±1.433 years)were analyzed.Among them,the survey showed that 2942 adolescent were obesity,accounting for 22%and 2104 adolescent were overweight,accounting for 15.7%.Among them,1692 male adolescents are obese,with an obesity rate of 25.1%,higher than 18.9%of female adolescents.There is a statistically significant difference between the three groups(χ2=231.522,P<0.000).The obesity group has the smallest age(14.94±1.442 years),and there is a statistical difference in age among the three groups(F=69.996,P<0.000).Obesity rates are higher among individuals who are not-only-child,have residential experience within six months,have family economic poverty,and have evening-type sleep(P<0.05).Logistic regression analysis shows a correlation between sleep rhythm and adolescent obesity.Evening-type sleep rhythm can increase the risk of obesity in male adolescents[1.250(1.067-1.468)],but the effect on female obesity is not remarkable.Further logistic regression analysis in the overall population demonstrates that the interaction between evening-type sleep rhythm and the male gender poses a risk of adolescent obesity[1.122(1.043-1.208)].CONCLUSION Among adolescents,the incidence of obesity in males is higher than in females.Evening-type sleep rhythm plays an important role in male obesity but has no significant effect on female obesity.Progressive analysis suggests an interactive effect of sleep rhythm and gender on adolescent obesity,and the combination of evening-type sleep and the male gender promotes the development of adolescent obesity.In formulating precautions against adolescent obesity,obesity in male adolescents with evening-type sleep should be a critical concern.

Safety and effectiveness of lurasidone in the treatment of Chinese schizophrenia patients:An interim analysis of post-marketing surveillance

BACKGROUND Schizophrenia is a psychiatric disorder characterized by chronic or recurrent symptoms.Lurasidone was licensed in China in 2019 for the treatment of adult schizophrenia in adults with a maximum dose of 80 mg/d.However,post-market surveillance(PMS)with an adequate sample size is required for further validation of the drug’s safety profile and effectiveness.AIM To conduct PMS in real-world clinical settings and evaluate the safety and effectiveness of lurasidone in the Chinese population.METHODS A prospective,multicenter,open-label,12-wk surveillance was conducted in China's Mainland.All patients with schizophrenia from 10 sites who had begun medication with lurasidone between September 2019 and August 2022 were eligible for enrollment.Safety assessments included adverse events(AEs),adverse drug reactions(ADRs),extrapyramidal symptoms(EPS),akathisia,use of EPS drugs,weight gain,and laboratory values as metabolic parameters and the QTc interval.The effectiveness was assessed using the brief psychiatric rating scale(BPRS)from baseline to the end of treatment.RESULTS A total of 965 patients were enrolled in the full analysis set and 894 in the safety set in this interim analysis.The average daily dose was 61.7±19.08 mg(mean±SD)during the treatment.AEs and ADRs were experienced by 101 patients(11.3%)and 78 patients(8.7%),respectively,which were mostly mild.EPS occurred in 25 individuals with a 2.8%incidence,including akathisia in 20 individuals(2.2%).Moreover,59 patients received drugs for treating EPS during the treatment,with an incidence of 6.6%which dropped to 5.4%at the end of the treatment.The average weight change was 0.20±2.36 kg(P=0.01687)with 0.8%of patients showing a weight gain of≥7%at week 12 compared with that at the baseline.The mean values of metabolic parameters and the QTc interval at baseline and week 12 were within normal ranges.The mean changes in total BPRS scores were-8.9±9.76(n=959),-13.5±12.29(n=959),and-16.8±13.97(n=959)after 2/4,6/8,and 12 wk,respectively(P<0.001 for each visit compared with the baseline)using the last-observation-carried-forward method.CONCLUSION The interim analysis of the PMS of adult patients with schizophrenia demonstrate the safety and effectiveness of lurasidone in the Chinese population.No new safety or efficacy concerns were identified.

Circular RNAs in early brain development and their influence and clinical significance in neuropsychiatric disorders

Neuropsychiatric disorders represent a set of severe and complex mental illnesses,and the exact etiologies of which are unknown.It has been well documented that impairments in the early development of the brain contribute to the pathogenesis of many neuropsychiatric disorders.Currently,the diagnosis of neuropsychiatric disorders largely relies on subjective cognitive assessment,because there are no widely accepted biochemical or genetic biomarkers for diagnosing mental illness.Circular RNAs (circRNAs) are a novel class of endogenous non-coding RNA (ncRNA) with a closed-loop structure.In recent years,there have been tremendous advances in our understanding of the expression profiles and biological roles of circRNAs.In the brain,circRNAs are particularly enriched and are expressed more abundantly in contrast to linear counterpart transcripts.They are highly active at neuronal synapses.These features make circRNAs uniquely crucial for understanding brain health,disease,and neuropsychiatric disorders.This review focuses on the role of circRNAs in early brain development and other brain-related processes that have been associated with the development of neuropsychiatric disorders.In addition,we discuss the potential for blood or cerebrospinal fluid circRNAs to be used as novel biomarkers in the early diagnosis of neuropsychiatric disorders.The findings reviewed here may provide new insight into the pathological mechanisms underlying the onset and progression of neuropsychiatric disorders.

Serotonin regulates brain-derived neurotrophic factor expression in select brain regions during acute psychological stress

Previous studies suggest that serotonin （5-HT） might interact with brain-derived neurotrophic factor （BDNF） during the stress response. However, the relationship between 5-HT and BDNF expression under purely psychological stress is unclear. In this study, one hour before psychological stress exposure, the 5-HT1A receptor agonist 8-OH-DPAT or antagonist MDL73005, or the 5-HT2A receptor agonist DOI or antagonist ketanserin were administered to rats exposed to psychological stress. Immunohistochemistry and in situ hybridization revealed that after psychological stress, with the exception of the ventral tegmental area, BDNF protein and mRNA expression levels were higher in the 5-HT1A and the 5-HT2A receptor agonist groups compared with the solvent control no-stress or psychological stress group in the CA1 and CA3 of the hippocampus, prefrontal cortex, central amygdaloid nucleus, dorsomedial hypothalamic nucleus, dentate gyrus, shell of the nucleus accumbens and the midbrain periaqueductal gray. There was no significant difference between the two agonist groups. In contrast, after stress exposure, BDNF protein and mRNA expression levels were lower in the 5-HT1A and 5-HT2A receptor antagonist groups than in the solvent control non-stress group, with the exception of the ventral tegmental area. Our findings suggest that 5-HT regulates BDNF expression in a rat model of acute psychological stress.

Mental healthcare for psychiatric inpatients during the COVID-19 epidemic

During this 2019 coronavirus disease(COVID-19)pneumonia epidemic,some experts have expressed concern for the mental healthcare of different types of population groups.However,hospitalised patients with severe mental illness are seemingly overlooked.Psychiatric patients are still a vulnerable group who need to obtain more attention and respect,particularly during the COVID-19 outbreak in China.In this commentary,we briefly introduce the situation of hospitalized patients with severe mental illness and suggest some effective measures that should be rapidly undertaken to reverse current challenges.

Handgrip strength and the risk of major depressive disorder:a two-sample Mendelian randomisation study

Background Major depressive disorder(MDD)is a common psychiatric disease and a leading cause of disability worldwide.Handgrip strength(HGS)as an objective physical fitness test is a practical index for identifying many diseases.Previous studies drew different conclusions about the relationship between HGS and MDD.Aims We aim to explore whether HGS has an effect on the risk of MDD.Methods HGS-related single-nucleotide polymorphisms identified by a genome-wide association study were used as instrumental variables in this Mendelian randomisation(MR)study.Summary data on MDD were obtained from the Psychiatric Genomics Consortium.Four methods were applied,including inverse variance weighted(IVW),MR Egger,weighted median and weighted mode.Additional sensitivity analyses,including leave-one-out,heterogeneity test,pleiotropy test and confounders identification,were conducted to test the robustness of our results.Results Each 1 kg increase in left HGS is associated with a 21.95%reduction in the risk of MDD(OR_(IVW)=0.781,95%CI:0.650 to 0.937,p=0.009),while no significant correlation exists in the estimation of right HGS(p=0.146).Sensitivity analyses demonstrated statistical significance(β_(IVW)=−0.195,p=0.023)after excluding some genetic loci that cause pleiotropy.Conclusions Increased left HGS is associated with a reduced risk of MDD.In the future,it may be used as an index for the clinical screening,observation and treatment of MDD.

Dissecting the association between gut microbiota,body mass index and specific depressive symptoms:a mediation Mendelian randomisation study

Background Observational studies highlight the association between gut microbiota(GM)composition and depression;however,evidence for the causal relationship between GM and specific depressive symptoms remains lacking.Aims We aimed to evaluate the causal relationship between GM and specific depressive symptoms as well as the mediating role of body mass index(BMI).Methods We performed a two-sample Mendelian randomisation(MR)analysis using genetic variants associated with GM and specific depressive symptoms from genome-wide association studies.The mediating role of BMI was subsequently explored using mediation analysis via two-step MR.Results MR evidence suggested the Bifidobacterium genus(β=0.03;95%CI-0.05 to-0.02;p<0.001 andβ=0.03;95%CI-0.05 to-0.02;p<0.001)and Actinobacteria phylum(β=-0.04;95%CI-0.06 to-0.02;p<0.001 andβ=-0.03;95%CI-0.05 to-0.03;p=0.001)had protective effects on both anhedonia and depressed mood.The Actinobacteria phylum also had protective effects on appetite changes(β=-0.04;95%CI-0.06 to-0.01;p=0.005),while the FamilyⅪhad an antiprotective effect(β=0.03;95%CI 0.01 to 0.04;p<0.001).The Bifidobacteriaceae family(β=-0.01;95%CI-0.02 to-0.01;p=0.001)and Actinobacteria phylum(β=-0.02;95%CI-0.03 to-0.01;p=0.001)showed protective effects against suicidality.The two-step MR analysis revealed that BMl also acted as a mediating moderator between the Actinobacteria phylum and appetite changes(mediated proportion,34.42%)and that BMI partially mediated the effect of the Bifidobacterium genus(14.14%and 8.05%)and Actinobacteria phylum(13.10%and 8.31%)on both anhedonia and depressed mood.Conclusions These findings suggest a potential therapeutic effect of Actinobacteria and Bifidobacterium on both depression and obesity.Further studies are required to translate these findings into clinical practice.

Increased Local Spontaneous Neural Activity in the Left Precuneus Specific to Auditory Verbal Hallucinations of Schizophrenia

Background： Auditory verbal hallucinations （AVHs） of schizophrenia have been associated with structural and functional alterations of some brain regions. However, the brain regional homogeneity （ReHo） alterations specific to AVHs of schizophrenia remain unclear. In the current study, we aimed to investigate ReHo alterations specific to schizophrenic AVHs. Methods： Thirty-five schizophrenic patients with AVH, 41 schizophrenic patients without AVHs, and fifty healthy subjects underwent resting-state functional magnetic resonance imaging. ReHo differences across the three groups were tested using a voxel-wise analysis. Results： Compared with the healthy control group, the two schizophrenia groups showed significantly increased ReHo in the right caudate and inferior temporal gyrus and decreased ReHo in the bilateral postcentral gyrus and thalamus and the right inferior occipital gyrus （false discovery rate corrected, P 〈 0.05）. More importantly, the AVH group exhibited significantly increased ReHo in the left precuneus compared with the non-AVH group. However, using correlation analysis, we did not find any correlation between the auditory hallucination rating scale score and the ReHo of brain regions. Conclusions： Our results suggest that increased ReHo in the left precuneus may be a pathological feature exclusive to schizophrenic AVHs.

A Systematic Characterization of Structural Brain Changes in Schizophrenia

A systematic characterization of the similarities and differences among different methods for detecting structural brain abnormalities in schizophrenia,such as voxel-based morphometry(VBM),tensor-based morphometry(TBM),and projection-based thickness(PBT),is important for understanding the brain pathology in schizophrenia and for developing effective biomarkers for a diagnosis of schizophrenia.However,such studies are still lacking.Here,we performed VBM,TBM,and PBT analyses on T1-weighted brain MR images acquired from 116 patients with schizophrenia and 116 healthy controls.We found that,although all methods detected wide-spread structural changes,different methods captured different information-only 10.35%of the grey matter changes in cortex were detected by all three methods,and VBM only detected 11.36%of the white matter changes detected by TBM.Further,pattern classification between patients and controls revealed that combining different measures improved the classification accuracy(81.9%),indicating that fusion of different structural measures serves as a better neuroimaging marker for the objective diagnosis of schizophrenia.

Impaired brain white matter and functional networks in healthy individuals with auditory verbal hallucinations

To the Editor:Auditory verbal hallucinations (AVHs) are experienced concomitantly with various neuropsychiatric diagnoses including schizophrenia,bipolar disorder,major depression disorder,post-traumatic stress disorder,and borderline personality disorder.

Brain function differences in drug-nave first-episode auditory verbal hallucination-schizophrenia patients with versus without insight

Background:Few studies have reported brain function differences in drug-na(i)ve first-episode schizophrenia patients who had auditory verbal hallucinations (AVH) with insight vs.those without insight.This study aimed to investigate brain function differences between drug-naive first-episode AVH-schizophrenia patients with and without insight.Methods:Forty first-episode drug-naive AVH-schizophrenia patients with or without insight and 40 healthy controls between December 2016 and December 2018 were recruited in this study.The auditory hallucinations rating scale (AHRS) was used to assess AVH severity,while the insight and treatment attitudes questionnaire was used to distinguish insight.The global functional connectivity density (gFCD) between different groups was compared using a voxel-wise one-way analysis of covariance.The relationship between gFCD and AHRS total scores were analyzed using voxel-wise multiple regression.Results:Finally,13 first-episode drug-naive AVH-schizophrenia patients with insight,15 AVH-schizophrenia patients without insight,and 20 healthy controls were included for analysis.Except for global assessment of functioning scores,there were no significant differences in sociodemographic information between the AVH-schizophrenia and healthy groups (P > 0.05).Compared to the healthy controls,AVH-schizophrenia patients with insight demonstrated a decreased gFCD in the supramarginal gyrus within the primary auditory cortex,while those without insight demonstrated an increased gFCD in the inferior frontal gyrus and superior temporal gyrus and decreased gFCD in the supplemental motor area.Compared to the AVH-schizophrenia patients with insight,those without insight demonstrated an increased gFCD in the supra-marginal gyrus and posterior superior temporal lobule and a decreased gFCD in the frontal lobe.No significant correlation between gFCD and AVH severity (AHRS total score:r =0.23,P =0.590;and frequency:r =0.42,P =0.820) was found in both AVH-schizophrenia groups.Condusions:The gFCD-aberrant brain regions in the AVH-schizophrenia patients without insight were wider compared to those with insight,although the AHRS scores were not significandy different.The AVH-schizophrenia patients without insight had wide functional impairment in the frontal lobule,which may underlie the lack of insight and the abnormal hyperactivity in the inferior frontal gurus and temporal lobe related to the AVH symptoms.

Reduction of Interhemispheric Functional Connectivity in Sensorimotor and Visual Information Processing Pathways in Schizophrenia

Background： Previous studies have demonstrated interhemispheric functional connectivity alterations in schizophrenia. However, the relationship between these alterations and the disease state of schizophrenia is largely unknown. Therefore, we aimed to investigate this relationship using voxel-mirrored homotopic connectivity （VMHC） method. Methods： This study enrolled 36 schizophrenia patients with complete remission, 58 schizophrenia patients with incomplete remission and 55 healthy controls. The VMHC was calculated based on resting-state functional magnetic resonance imaging data. Differences in VMHC among three groups were compared using one-way analysis of variance. A brain region with a significant difference in VMHC was defined as a region of interest （ROI）, and the mean VMHC value in the ROI was extracted for the post hoc analysis, i.e., pair-wise comparisons across the three groups. Results： VMHC in the visual region （inferior occipital and fusiform gyri） and the sensorimotor region （paracentral lobule） showed significant differences among the three groups （P 〈 0.05, a false discovery rate method corrected）. Pair-wise comparisons in the post hoc analysis showed that VMHC of the visual and sensorimotor regions in schizophrenia patients with complete remission and incomplete remission was lower than that in healthy controls （P 〈 0.05, Bonferroni corrected）; however, there was no significant difference between the two patient subgroups. Conclusions： Interhemispheric functional connectivity in the sensorimotor and visual processing pathways was reduced in patients with schizophrenia, but this reduction was unrelated to the disease state; thus, this reduction may serve as a trait marker of schizophrenia.

Nonspecific Effect of Stress on Brain Gray Matter Volume in Drug-naive Female Patients with First Depressive Episode

Background： This study aimed to observe the differences in brain gray matter volume in drug-naive female patients after the first episode of major depression with and without stressful life events （SLEs） before the onset of depression.Methods： Forty-three drug-naive female patients voluntarily participated in the present study after the first major depressive episode.The life event scale was used to evaluate the severity of the impact of SLEs during 6 months before the onset of the major depressive episode.High-field magnetic resonance imaging （MRI） scans were obtained, and the VBM and SPM8 software process were used to process and analyze the MRI.Results： Compared to that in patients without SLEs, the volume of brain gray matter was lower in the bilateral temporal lobe, right occipital lobe, and right limbic lobe in the SLE group.However, the gray matter volume did not differ significantly between the two groups after the application of false discovery rate （FDR） correction.Conclusions： Although the results of the present study suggest the absence of significant differences in brain gray matter volume between female drug-naive patients after the first episode of major depression with and without SLEs after FDR correction, the study provides useful information for exploring the definitive role of stress in the onset of depression.

Testing the role of genetic variation of the MC4R gene in Chinese population in antipsychotic-induced metabolic disturbance

Antipsychotic-induced metabolic disturbance(AIMD) is a common adverse effect of antipsychotics with genetics partly underpinning variation in susceptibility among schizophrenia patients. Melanocortin4 receptor(MC4 R) gene, one of the candidate genes for AIMD, has been under-studied in the Chinese patients. We conducted a pharmacogenetic study in a large cohort of Chinese patients with schizophrenia. In this study, we investigated the genetic variation of MC4 R in Chinese population by genotyping two SNPs(rs489693 and rs17782313) in 1,991 Chinese patients and examined association of these variants with the metabolic effects that were often observed to be related to AIMD. Metabolic measures, including body mass index(BMI), waist circumference(WC), glucose, triglyceride, high-density lipoprotein(HDL), and low-density lipoprotein(LDL) levels were assessed at baseline and after 6-week antipsychotic treatment. We found that interaction of SNP×medication status(drug-na?ve/medicated) was significantly associated with BMI, WC, and HDL change %, respectively. Both SNPs were significantly associated with baseline BMI and WC in the medicated group. Moderate association of rs489693 with WC, Triglyceride, and HDL change % were observed in the whole sample. In the drug-na?ve group, we found recessive effects of rs489693 on BMI gain more than 7%, WC and Triglyceride change %, with AA incurring more metabolic adverse effects. In conclusion, the association between rs489693 and the metabolic measures is ubiquitous but moderate. Rs17782313 is less involved in AIMD. Two SNPs confer risk of AIMD to patients treated with different antipsychotics in a similar way.

Interaction Between Variations in Dopamine D2 and Serotonin 2A Receptor is Associated with Short-Term Response to Antipsychotics in Schizophrenia

Dear Editor,Schizophrenia is a chronic and debilitating brain disorder,which has a strong genetic component with heritability ranging from 66%to 85%[1,2].Currently,antipsychotic drugs remain the most effective treatment for the psychotic symptoms of schizophrenia[3].Because of the severe sideeffects of first-generation antipsychotics(FGAs),secondgeneration antipsychotics(SGAs)have become more widely used in the treatment of schizophrenia.

Brain Impairment in Chronic Schizophrenia Patients with Depressive Symptoms Differs from Brain Impairment in Chronic Depression Patients with Psychotic Symptoms

Numerous studies have identified many specific structural alterations in the brains of patients with schizophrenia and depression. Schizophrenia is associated with gray matter volume （GMV） impairment in certain key brain regions, which progresses in the first 2-3 years after the first episode of schizophrenic symptoms,m Schizophrenia has also been shown to be associated with concurrent white matter （WM） alterations. The fasciculus uncinatus and arcuate fasciculus have been proposed to be a part of the quality index for schizophrenia.12j Similar to schizophrenia, major depressive disorder （MDD） is associated with a GMV reduction and aberrant WM. GMV reductions in the bilateral middle temporal gyrus left ventral medial prefrontal gyrus, left lingual gyms, and dorsal medial prefrontal gyrus have been correlated with the severity of the depressive symptoms. Schizophrenic and depressive symptoms usually coexist in schizophrenia and MDD. In this pilot study, we compared the GMV and WM differences in the brains of chronic schizophrenia patients with depressive symptoms with those of chronic depression patients with psychotic symptoms.

Specific White Matter Impairments in Patients with Treatment-Refractory First-Episode Schizophrenia： A 1-Year Follow-up Pilot Study

To the Editor： In the last 10 years, mounting evidence has confirmed that schizophrenia is associated with white matter （WM） impairment; this impairment exists even before the occurrence of an episode of schizophrenic symptoms. Widespread WM fiber tracts were affected in patients, especially in certain key brain regions, such as the arcuate fasciculus, fasciculi longitudinalis superior, and corpus callosum. A previous study reported that although there was no more than 1% WM impairments in schizophrenic patients, it is nonetheless a stable and specific aberrant pathological feature of schizophrenia.

Aberrant Functional Connectivity Patterns of Default Mode Network May Play a Key Role in the Interaction between Auditory Verbal Hallucinations and Insight

Previous studies have reported that auditory verbal hallucinations （AVHs） may be caused by resting-state neuronal hyperactivity in the default mode network （DMN）. Abnormally increased functional connectivity （FC） between the DMN and other cortical regions may cause disturbances in neuronal network architecture and interactions. Subsequently, disturbed neuronal network architecture and interactions may induce increased activation in auditory and speech perception areas in the absence of external auditory stimuli as well as reduced activation in the same areas in the presence of external auditory stimuli.

Exploring neuroimaging-genetic co-alteration features of auditory verbal hallucinations in different subjects for the establishment of a predictive model

To the Editor: Auditory verbal hallucination (AVH) is defined as the hearing of voices in the absence of any external auditory stimulus.[1,2,3] Most AVH content is related to the experiencer, and these events usually cause serious distress. AVHs can occur in patients with a broad range of mental disorders and neurological diseases, such as schizophrenia, bipolar disorder (BP), major depressive disorder (MDD), post-traumatic stress disorder (PTSD), borderline personality disorder (BPD), and in healthy individuals.[2,3,4]