A network analysis of psychotic symptoms, neurocognition, alexithymia, empathy, and suicidal intent in patients with chronic schizophrenia.

BACKGROUND

Chronic schizophrenia represents a major global health burden. However, the symptom-level interrelationships among its multiple clinical features remain insufficiently understood. This study aimed to examine the interconnections among psychotic symptoms, neurocognition, alexithymia, and empathy (PNAE), and to further explore their associations with suicidal intent in patients with chronic schizophrenia.

METHODS

A total of 845 patients with chronic schizophrenia were recruited in China. Participants were assessed using the 19-item Beck Scale for Suicidal Ideation, the 20-item Toronto Alexithymia Scale, the Interpersonal Reactivity Inventory, the Repeatable Battery for the Assessment of Neuropsychological Status, and the Positive and Negative Syndrome Scale (PANSS). A symptom network of PNAE was constructed, and expected influence (EI) and bridge expected influence (BEI) were calculated to identify central and bridge symptoms.

RESULTS

The prevalence of suicidal intent in this sample was 13.1% (n = 111). Within the PNAE network, difficulty identifying feelings (DIF) emerged as the most central symptom, followed by immediate memory (IM). Personal distress (PD) was identified as the primary bridge symptom, with DIF serving as a secondary bridge symptom. The PNAE network showed good stability and accuracy. In addition, the PANSS mood factor (PMF), PANSS positive factor (PPF), and PD showed the strongest associations with suicidal intent.

CONCLUSION

These findings underscore the importance of carefully assessing DIF, PD, and IM in patients with chronic schizophrenia. Mood-related symptoms, positive psychotic symptoms, and personal distress may serve as clinically relevant indicators for the identification of suicidal intent in this population.