| Summary: | Background: Impaired verbal communication is a prominent feature in patients with schizophrenia. Verbal communication difficulties adversely affect psychosocial outcomes and worsen schizophrenia's clinical manifestation. In the present study, we aimed to investigate associations among gray matter (GM) volumes in language processing areas (LPAs), verbal ability, and positive symptoms in first-episode patients (FEPs) with schizophrenia spectrum psychosis. Methods: We enrolled 94 FEPs and 52 healthy controls (HCs) and subjected them to structural magnetic resonance imaging. The GM volumes of the bilateral pars opercularis (POp), pars triangularis (PTr), planum temporale (PT), Heschl's gyrus (HG), insula, and fusiform gyrus (FG), were estimated and compared between the FEPs and HCs. Verbal intelligence levels and positive symptom severity were examined for correlations with the left LPA volumes. Results: The GM volumes of the left POp, HG, and FG were significantly smaller in the FEPs than in the HCs, while the right regions showed no significant between-group difference. A multiple linear regression model revealed that larger left PT volume was associated with better verbal intelligence in FEPs. In exploratory correlation analysis, several LPAs showed significant correlations with the severity of positive symptoms in FEPs. The left FG volume had a strong inverse correlation with the severity of auditory verbal hallucinations, while the left PT volume was inversely associated with the severity of positive formal thought disorder and delusions. Moreover, the volume of the left insula was positively associated with the severity of bizarre behavior. Conclusions: The present study suggests that GM abnormalities in the LPAs, which can be detected during the early stage of illness, may underlie impaired verbal communication and positive symptoms in patients with schizophrenia spectrum psychosis. Keywords: Schizophrenia spectrum, Language processing areas, Planum temporale, Fusiform gyrus, Verbal intelligence, Positive symptoms
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