Method comparisons for differentiation of Schizophrenia and Bipolar based on rs-fMRI Intrinsic and Functional Networks

Psychosis as a symptom manifests in schizophenia and bipolar disorder, two highly heterogeneous psychiatric illnesses with overlapping clinical manifestations. Resting-state functional Magnetic Resonance Imaging (rsfMRI), represents a promising tool for identifying objective biomarkers of functional brain alterations to aid differential diagnosis. In this work, we comparatively evaluate multiple rs-fMRI representations for differentiating schizophrenia and bipolar disorder using intrinsic connectivity network (ICN) temporal profiles and several functional network connectivity (FNC) approaches, including static, dynamic, and high-order connectivity analyses. The study was conducted on a cohort of 371 subjects with psychosis, while evaluation was performed using a separate held-out cohort of 315 subjects. We investigated convolutional neural network architectures applied to ICN temporal profiles, spectrograms, and scalograms, alongside classical machine learning models trained on connectivity-derived features. Across the evaluated approaches, ICN temporal profiles provided the most consistent discriminative performance, with a 1D convolutional neural network achieving the strongest overall results under the benchmark protocol. Among connectivity-based methods, static functional connectivity generally outperformed dynamic and high-order representations, suggesting that increased representational complexity did not necessarily translate into improved generalization. Although the obtained classification performance remained modest, the results highlight the challenges of robust psychosis differentiation using rs-fMRI while emphasizing the relative stability of low-order connectivity representations and temporal ICN features. These findings contribute to ongoing efforts toward reproducible and interpretable neuroimaging biomarkers for psychiatric disorders.