INTER-RELATIONSHIPS AMONG PSYCHOPATHOLOGY, COGNITION, AND REAL-LIFE FUNCTIONING IN DIFFERENT STAGES OF SCHIZOPHRENIA: A NETWORK ANALYSIS APPROACH

State of the art and purpose: Many illness-related factors contribute to the reduction of the real-life functioning observed in people with schizophrenia (SZ). These include the psychopathological dimensions of the disorder, such as positive, negative, disorganization, and depressive symptoms, as well as impairment in neurocognition, social cognition, and metacognition. The associations between some of these variables change with the duration of illness (DOI), but this aspect has not been explored using a network approach. This thesis work aimed at describing and comparing the interrelationships between psychopathological, cognitive, and functioning variables in early (DOI ≤ 5 years) and late (DOI > 5 years) phase SZ using network analyses, and at assessing which variables were more strictly and directly associated with real-life functioning. Methods: A network representation of the relationships between variables and the calculation of centrality indices were performed within each group. The two groups were compared with a network comparison test. Results: Seventy-five patients with early-stage SZ and ninety-two with late-stage SZ were included. No differences were found in the global network structure and strength between the two groups. In both groups, visual learning and disorganization exhibited high centrality indices, and disorganization, negative symptoms, and metacognition were directly and strongly associated with real-life functioning. Additions to the current state of the art: Regardless of the DOI, a rehabilitation aimed at improving visual learning and disorganization (i.e., the most central variables) might reduce the strength of the associations that compose the network and, therefore, indirectly facilitate functional recovery. Simultaneously, therapeutic interventions targeting disorganization and metacognition might directly improve real-life functioning.