Orbitofrontal thickness and network associations as transdiagnostic signature of negative symptoms along the bipolar-schizophrenia spectrum

Negative symptoms are core features of schizophrenia (SCZ) and also prevalent in bipolar disorder (BD). While orbitofrontal cortex (OFC) alterations have been implicated in the development of negative symptoms, their contributions across disorders remain to be established. Here, we tested how OFC thickness and related network associations relate to severity of negative symptom dimensions across the BD-SCZ spectrum. We included 50 individuals with SCZ, 49 with BD, alongside 122 controls. We assessed amotivation and diminished expression and estimated thickness in the medial and lateral OFC as regions-of-interest as well as 64 other cortical regions. Across BD and SCZ, reduced right lateral and bilateral medial OFC thickness were specifically associated with amotivation, but not diminished expression or other clinical factors. We then generated OFC structural co-variation networks to evaluate how the system-level embedding of the OFC would link to brain-wide cortical maps of negative symptoms. We found that medial OFC co-variation networks spatially correlated with the cortical maps of both negative symptom dimensions. Confirmatory analyses in independent SCZ data from the ENIGMA consortium (n=4,474) revealed similar associations with lateral OFC co-variation networks. Finally, the brain-wide cortical alteration pattern of amotivation was significantly correlated with normative functional and structural white-matter connectivity profiles of the right medial and left lateral OFC as well as adjacent prefrontal and limbic regions. Our work identifies OFC alterations as a possible transdiagnostic signature of amotivation and provide insights into network associations underlying the system-wide cortical alterations of negative symptoms across SCZ and BD.