Comparison of clinical symptoms and symptom structure across different onset ages in schizophrenia inpatients.

Objective: This study aimed to explore differences in clinical symptom profiles and symptom network structures of inpatients with schizophrenia among early-onset schizophrenia (EOS), typical-onset schizophrenia (TOS), and late-onset schizophrenia (LOS) patients.

Methods: Symptom severity was assessed using the Positive and Negative Syndrome Scale (PANSS) in 654 EOS, 1664 TOS, and 369 LOS inpatients with schizophrenia from an open dataset. Symptom severity comparisons were conducted among the three age of onset groups. Symptom networks were constructed, and measurements such as betweenness and closeness centrality were employed to investigate the interconnectivity between symptoms.

Results: EOS inpatients exhibited significantly more severe symptoms compared to TOS and LOS, primarily attributable to more severe negative symptoms and general psychopathology. Analysis of the symptom networks revealed that uncontrolled hostility emerged as a core feature across EOS, TOS, and LOS. In the EOS network, anxiety domain served as bridge symptoms, while positive and disorganized thought were strongly associated with disease manifestations. TOS inpatients exhibited a similar pattern to EOS, but TOS showed higher betweenness and lower closeness in positive and negative symptoms, indicating that these domains play a crucial role in the overall network connectivity. In LOS, positive symptoms showed high betweenness centrality, suggesting their pivotal role in network connectivity.

Conclusions: These findings suggest that the symptom severity and symptoms network structure differ across different age of onset groups in schizophrenia inpatients. A deeper understanding of these network-level differences could shed light on the distinct pathogenesis mechanisms and guide the development of personalized treatment strategies for schizophrenia.

Hypothesis: It has been consistently observed that inpatients with early-onset schizophrenia (EOS) have poorer treatment outcomes compared to typical-onset schizophrenia patients (TOS), while those with late-onset schizophrenia (LOS) tend to have better outcomes than typical-onset inpatients. The reasons behind these phenomena remain unclear. In this work, we aim to utilize network analysis to uncover potential symptom interactions that may contribute to the different treatment outcomes observed across different ages of onset schizophrenia inpatient groups.