Identifying a system of predominant negative symptoms: Network analysis of three randomized clinical trials

Stephen Z. Levine, Stefan Leucht

Research output: Contribution to journalArticlepeer-review


Background Reasons for the recent mixed success of research into negative symptoms may be informed by conceptualizing negative symptoms as a system that is identifiable from network analysis. We aimed to identify: (I) negative symptom systems; (I) central negative symptoms within each system; and (III) differences between the systems, based on network analysis of negative symptoms for baseline, endpoint and change. Methods Patients with chronic schizophrenia and predominant negative symptoms participated in three clinical trials that compared placebo and amisulpride to 60 days (n = 487). Networks analyses were computed from the Scale for the Assessment of Negative Symptoms (SANS) scores for baseline and endpoint for severity, and estimated change based on mixed models. Central symptoms to each network were identified. The networks were contrasted for connectivity with permutation tests. Results Network analysis showed that the baseline and endpoint symptom severity systems formed symptom groups of Affect, Poor responsiveness, Lack of interest, and Apathy-inattentiveness. The baseline and endpoint networks did not significantly differ in terms of connectivity, but both significantly (P < 0.05) differed to the change network. In the change network the apathy-inattentiveness symptom group split into three other groups. The most central symptoms were Decreased Spontaneous Movements at baseline and endpoint, and Poverty of Speech for estimated change. Conclusions Results provide preliminary evidence for: (I) a replicable negative symptom severity system; and (II) symptoms with high centrality (e.g., Decreased Spontaneous Movement), that may be future treatment targets following replication to ensure the curent results generalize to other samples.

Original languageEnglish
Pages (from-to)17-22
Number of pages6
JournalSchizophrenia Research
Issue number1-3
StatePublished - 1 Dec 2016

Bibliographical note

Publisher Copyright:
© 2016 Elsevier B.V.


  • Clinical trial
  • Network analysis
  • Predominant negative symptoms
  • Psychometrics
  • Scale for the assessment of negative symptoms
  • Symptom severity

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry


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