Network structure of psychotic symptoms and childhood trauma in first-episode versus treatment-resistant schizophrenia

Objective: The study aims to examine the network structures of childhood trauma (CT) and psychotic symptoms in patients with first-episode schizophrenia (FES) and treatment-resistant schizophrenia (TRS). Specifically, it seeks to elucidate how different dimensions of CT influence symptoms across FES and TRS. Methods: 289 patients with FES and 50 patients with TRS were assessed using Positive and Negative Syndrome Scale (PANSS) and Childhood Trauma Questionnaire. Partial correlation was used to elucidate the network connections between CT and symptoms in FES and TRS patients. Betweenness, closeness coefficient, and community detection were further calculated to investigate the interactions between CT and psychotic symptoms. Results: The analysis revealed three key findings: (1) Symptom-trauma networks differ between FES and TRS patients; (2) Based on network analysis, CT in TRS forms tight interlinks, as evidenced by a larger value of closeness coefficient, which influences psychotic symptoms in TRS compared to FES. Sexual abuse plays a vital role in the TRS network while emotional neglect is more important in FES; and (3) The divergent community structures suggest distinct pathways through which CT and symptoms in FES and TRS patients. Specifically, in the FES symptom-CT network, CT influences the symptoms through traditional symptom patterns, while in TRS the pathway cannot be divided by traditional divisions and it involves a complex manner. Conclusion: The findings suggest that the pathways linking childhood trauma experiences and clinical symptoms differ between FES and TRS patients, providing valuable insights into how early traumatic stress may contribute to symptom evolution in schizophrenia.