Associations between sense of agency and psychotic symptoms in patients with schizophrenia: A network analysis

Schizophrenia, characterized by prominent positive and negative symptoms, is associated with disturbances in agency. However, the interrelationships between agency and psychotic symptoms remain poorly understood. This network analysis investigated the structural associations between agency measures-encompassing feeling of agency and judgment of agency-and symptom dimensions. Initially, 103 patients meeting the diagnostic criteria for schizophrenia were included in the present study; after quality-control screening, 8 participants were excluded (7 for incomplete data due to comprehension failure or premature withdrawal, 1 for outliers exceeding ±3 SDs), yielding a final analytic sample of 95. This final dataset was complete across all network variables, with no missing values and no imputation required. Judgment of agency was assessed via self-reported agency ratings, while feeling of agency was measured using intentional binding. Psychotic symptom was assessed with the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms, respectively. Participants' daily living abilities were assessed using the Activity of Daily Living Scale. Centrality indices, network stability and accuracy were estimated. Network estimation demonstrated a negative partial association between judgment of agency and feeling of agency in schizophrenia. Avolition ranked highest in both strength centrality and expected influence within the estimated network. Judgment of agency displayed negative partial edges with avolition, whereas feeling of agency indicators presented negative partial associations with delusions and alogia. These findings highlight distinct pathways linking implicit and explicit agency processing to discrete symptom clusters. Avolition emerged as the most central node within the symptom network, suggesting its potential as a candidate target warranting validation through future longitudinal and experimental designs.