More than the sum of their parts: Behavioral Tractography analysis of distress wellbeing and context reveal dynamic signatures of psychosis and autism

Abstract Current psychiatric assessments oversimplify mental health phenomena. Ecological-Momentary-Assessment (EMA) captures richer dynamic interactions between psychological and contextual variables, but the resulting complexity currently hinders clinical translation. Here we propose an innovative approach to integrate dynamic data in clinical practice by accounting for variations within and across symptom clusters over time. We term this approach Behavioral Tractography (BT). We validate BT in independent typically-developing samples and in the clinically-challenging differential diagnosis of psychosis genetic vulnerability in 22q11.2 Deletion Syndrome (22q11DS) and idiopathic Autism Spectrum Disorder (ASD). A novel 2-dimensional rationality/valence structure predicted psychological-contextual fluctuations with striking consistency across typically-developing and clinical samples. Characterizing dynamic interactions between variables within such shared coordinate system, provided an intuitive 3D-view of transdiagnostic and population-specific psychological-contextual pathways. 22q11DS and ASD presented opposite psychological-contextual dynamics, recapitulating Bayesian models of psychosis and autism, and were further differentiated by pathways mediating emergence and consequences of motivational and social wellbeing.