Shedding light on the dynamic interplay of positive and negative symptoms of psychosis with Behavioral Tractography

Our understanding of the interplay between positive and negative psychosis symptoms is constrained by reliance on retrospective assessments, which fail to capture dynamic, short-term symptom-context interactions. Ecological-Momentary-Assessment (EMA) offers real-time symptom tracking in naturalistic settings, but its validity and clinical utility remain uncertain. We address this using a recently developed Behavioral-Tractography approach in individuals with 22q11.2 Deletion Syndrome, a high-risk group for psychosis. Through Network-Dimensionality-Reduction, we found that dynamic EMA patterns closely mirror positive/negative symptom structure derived from gold-standard interviews, suggesting shared latent mechanisms across and within individuals and validating EMA’s assessment of dynamic psychosis symptom processes. Behavioral-Tractography provided informative dissection of symptom interactions—particularly between psychotic symptoms and motivational deficits—modulated by psychosis severity and distinguishing predominantly positive-vs-negative profiles. Vulnerability to psychological consequences varied independently of average symptom intensity, supporting the added value of EMA and Behavioral-Tractography for complementing clinical assessments and offering a novel lens on psychosis pathophysiology.