Symptom and Bayesian network analyses of positive and negative symptoms in psychotic- like experiences: A multicenter cross-sectional study of Chinese students at 19 cities

Psychoticlike experiences (PLEs) are perceived as early indicators for the progression to schizophrenia spectrum disorders, a grave concern in psychiatric research. Historically, the interconnectedness between positive and negative symptoms in PLEs has remained enigmatic. In this multicenter cross-sectional study, we aim to investigate the relationship between positive and negative symptoms in PLEs – crucial indicators of the transition to schizophrenia spectrum disorders.Our sample includes 37,443 high school/college students from 19 cities across four Chinese provinces (September 2017 to November 2019). Participants completed multiple assessments, such as the Prodromal Questionnaire-Brief Version and the Questionnaire for Negative Symptoms, Disorganization Symptoms, and General Symptoms.The analysis of symptom networks reveals that delusions and general negative symptoms emerge as central nodes in the network. Interestingly, the network demonstrates a clear separation of positive and negative symptoms while highlighting their close interconnections. Additionally, schizotypal personality disorder serve as bridging elements in this network. Using Bayesian network analysis, we further establish that negative symptoms drive the development of positive symptoms.These findings underscore the significance of exploring negative symptoms in PLEs and suggest their potential importance in early identification and intervention of schizophrenia spectrum disorders.