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Comparative Study
. 2025 May 8;51(3):672-683.
doi: 10.1093/schbul/sbae135.

Comparison of Negative Symptom Network Structures Between Patients With Early and Chronic Schizophrenia: A Network and Exploratory Graph Analysis

Harry Kam Hung Tsui  1 , Ting Yat Wong  2 , Min Yi Sum  1 , Sin Ting Chu  1 , Christy Lai Ming Hui  1 , Wing Chung Chang  1   3 , Edwin Ho Ming Lee  1 , Yinam Suen  1 , Eric Yu Hai Chen  1 , Sherry Kit Wa Chan  1   3
Affiliations
Comparative Study

Comparison of Negative Symptom Network Structures Between Patients With Early and Chronic Schizophrenia: A Network and Exploratory Graph Analysis

Harry Kam Hung Tsui et al. Schizophr Bull. .

Abstract

Background and hypothesis: Despite the clinical relevance of negative symptoms in schizophrenia, our understanding of negative symptoms remains limited. Although various courses and stages of schizophrenia have been identified, variations in the negative symptom networks between distinct stages of schizophrenia remain unexplored.

Study design: We examined 405 patients with early schizophrenia (ES) and 330 patients with chronic schizophrenia (CS) using the Scale for the Assessment of Negative Symptoms. Network analysis and exploratory graph analysis were used to identify and compare the network structures and community memberships of negative symptoms between the two groups. Further, associations between communities and social functioning were evaluated. The potential influences of other symptom domains and confounding factors were also examined.

Study results: Multidimensional differences were found in the networks of negative symptoms between ES and CS. The global connectivity strength was higher in the network of ES than in the network of CS. In ES, central symptoms were mainly related to expressive deficits, whereas in CS they were distributed across negative symptom domains. A three-community structure was suggested across stages but with different memberships and associations with social functioning. Potential confounding factors and symptom domains, including mood, positive, disorganization, and excitement symptoms, did not affect the network structures.

Conclusion: Our findings revealed the presence of stage-specific network structures of negative symptoms in schizophrenia, with negative symptom communities having differential significance for social functioning. These findings provide implications for the future development of tailored interventions to alleviate negative symptoms and improve functionality across stages.

Keywords: chronic schizophrenia; community detection; early schizophrenia; negative symptoms; network analysis; social functioning.

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Conflict of interest statement

The authors have declared that there are no conflicts of interest in relation to the subject of this study.

Figures

Fig. 1.
Fig. 1.
Estimated negative symptom networks from the SANS in patients with ES and CS.
Fig. 2.
Fig. 2.
Standardized centrality plots for the negative symptom network from the SANS in patients with ES and CS.
Fig. 3.
Fig. 3.
EGA for community detection of negative symptoms only and with social functioning in patients with ES and CS. Note: SANS, Scale for the Assessment of Negative Symptoms; SOFAS, Social and Occupational Functioning Assessment Scale. For patients with CS, item 8 (poverty of speech), item 10 (blocking), and item 18 (sexual interest and activity) were excluded from the graph analysis due to ineffective loading or cross-loading.
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