Interplay among positive and negative symptoms, neurocognition, social cognition, and functioning in clinically stable patients with schizophrenia: a network analysis

Abstract

Background: Schizophrenia has a broad range of interrelated symptoms and impairment in functioning. The objective of the study was to explore the interplay between positive symptoms, negative symptoms, neurocognition, social cognition and functional outcome in patients with schizophrenia using network analysis. Methods: Participants were 64 clinically stable patients with schizophrenia. Psychopathologic, neurocognition, social cognition, and functional outcome were measured using the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Addenbrooke’s Cognitive Examination III, Faces test, Reading the Mind in the Eyes test, and Personal Social Performance scale. Results: The network analysis suggested that functional outcome was the most central in the network followed by avolition and asociality. Functioning was directly connected to avolition, asociality, blunted affect, neurocognition and emotion recognition. The positive symptoms were the most remote and therefore the least important node. Conclusion: The high centrality of functioning suggests the need for improving of everyday life skills for patients with schizophrenia. Moreover, treatment of specific negative symptoms, neurocognition and emotion recognition could also enhance functional outcome.

Assessment of interrelationships between cognitive performance, symptomatic manifestation and social functioning in the acute and clinical stability phase of schizophrenia: Insights from a network analysis

“…Third, a network analysis did not analyze other important predictors of social functioning, e.g., those related to social cognition and metacognition. Nevertheless, it is important to note that impairments of social cognition and metacognition might be the consequence of neurocognitive de cits (10,11,12). Therefore, it is likely that inclusion of these variables would not change considerably the centrality measures.…”

“…Indeed, a recent meta-analysis of studies performed in people with early psychosis demonstrated that impairments across all domains of neurocognitive performance and social cognition are associated with lower psychosocial functioning both cross-sectionally and longitudinally (9). However, there is evidence that neurocognitive de cits might affect social functioning through the effects on social cognition (10,11,12). Other factors that have been associated with lower social functioning include earlier age of psychosis onset (13) and longer duration of untreated psychosis (14).…”

Decline in working memory in stable schizophrenia may be related to attentional impairment: mediating effects of negative symptoms

“…Historically, the treatment of schizophrenia has primarily focused on managing hallucinations and delusions, while negative and cognitive symptoms have proven more challenging to address than positive symptoms[16].However, numerous previous studies have underscored that negative and cognitive symptoms serve as the most robust predictors of functional outcomes in schizophrenia [17][18][19]. Consequently, targeted improvement of patients' negative symptoms may lead to concurrent enhancements in cognitive impairment symptoms.…”