Buchwald, KhanSiegert, Richard JVignes, MatthieuNarayanan, AjitSandham, Margaret2026-02-042026-02-042026-01-20BJPsych Open, ISSN: 2056-4724 (Print); 2056-4724 (Online), Royal College of Psychiatrists, 12(1), e42-. doi: 10.1192/bjo.2025.109292056-47242056-4724http://hdl.handle.net/10292/20586BACKGROUND: People diagnosed with schizophrenia can have functional impairments in multiple domains. Cognitive impairment is central to schizophrenia and has substantial prognostic value compared with other symptoms of schizophrenia. However, no study has previously investigated directed relationships in a complex system of cognitive, sociodemographic, clinical and quality of life (QOL) variables in people diagnosed with schizophrenia. AIMS: To identify the complex relationships of components of cognition with other cognitive components, as well as with clinical and QOL variables. METHOD: This study included data from 1450 participants in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. The present study reconstructed a Bayesian network from this data using cognition, clinical, sociodemographic and QOL variables. RESULTS: Processing speed was centrally associated with all other cognitive domains. Cognitive domains were conditionally independent of positive symptoms but moderately associated with negative symptoms (β = -0.25; P < 0.001). The positive symptoms subscale was independent of QOL, conditioning on third variables. Negative symptoms were moderately associated with QOL (β = -0.33; P < 0.001), and processing speed had a weak association with QOL (β = -0.12; P < 0.001). Processing speed was a central variable in the network. CONCLUSIONS: Intervening with respect to processing speed may be the most beneficial way of improving other cognitive functions. More research is needed on directed networks that include social cognition and global levels of functioning.© The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists. Creative Commons. This is an open access article distributed under the terms of the Creative Commons CC BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. You are not required to obtain permission to reuse this article.Bayesian networkSchizophreniacognitionpsychosissymptom network3214 Pharmacology and Pharmaceutical Sciences32 Biomedical and Clinical SciencesSocial Determinants of HealthBasic Behavioral and Social ScienceMental IllnessSerious Mental IllnessBrain DisordersClinical ResearchNeurosciencesClinical Trials and Supportive ActivitiesMental HealthBehavioral and Social Science1103 Clinical Sciences1117 Public Health and Health Services3202 Clinical sciences4203 Health services and systemsJournal ArticleOpenAccess10.1192/bjo.2025.10929