Schizophrenia is marked by major impairments in psychosocial functioning. Disability arises from intertwined processes, notably impairments in cognition, motivation, social interactions, and metacognition. The Evaluation of Cognitive Processes involved in Disability in Schizophrenia (ECPDS) is a 13-item scale completed by relatives, focusing on these four processes in daily life. Network analysis provides a framework to examine their interconnections, identify central nodes as potential intervention targets and explore links with external factors.

We tested whether clustering from a network analysis of the ECPDS provides insights beyond its established four-factor structure, identifies items associated with neurocognition, global functioning, quality of life and anticholinergic burden, in order to define intervention targets to guide innovative approaches for psychosocial disability in schizophrenia.

Data came from the FondaMental FACE-SZ cohort, including patients with schizophrenia spectrum disorders; after exclusions, analyses focused on 429. Networks were estimated as regularized partial correlation networks (EBICglasso), with edge and centrality stability assessed via bootstrapping. External variables were a global neurocognition score, the Personal and Social Performance scale (PSP, a clinician-rated measure of overall psychosocial functioning in domains conceptually distinct from the ECPDS, which captures relatives’ perspectives on underlying cognitive and motivational processes), the Subjective Quality of Life scale (SQOL), and the Salahudeen anticholinergic burden scale.

Three clusters emerged in the ECPDS network (image 1): (1) Cognitive Impairments, (2) Avolition, (3) Socio-Metacognitive Deficits. Strongest ECPDS nodes were “Routine organization”, “Adaptation”, “Curiosity”, and “Perspective-taking”. Neurocognition was linked with “Routine organization”, “Non-routine organization”, and “Learning”. PSP connected with “Initiative”, “Project”, and “Use of time” (image 2). For SQOL, only “Use of time” showed a reliable association(image 3). Salahudeen scale related to “Organization”, “Adaptation”, “Learning”, and “Attention”. Bootstrap analyses confirmed stability of centrality estimates.Image 1:

Relatives’ assessments with the ECPDS provide specific insights into psychosocial disability. Difficulties in “organization” and “learning”, when reported by relatives, may help detect patients needing extended neuropsychological assessment. ECPDS scores may also reflect treatment effects, improving with adequate dosing but impaired by anticholinergic burden. Neurocognition, psychosocial functioning and quality of life each captured different aspects, underlining the composite nature of the ECPDS and its potential to guide targeted interventions, with consequences for cognition, functioning, and quality of life.

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