Effective Connectivity Identifies Divergent Cerebro-Cerebellar Network Organization in Schizophrenia.

Introduction: Functional impairments in schizophrenia may arise from disruptions in large-scale brain networks. Emerging evidence highlights the cerebellum's role in cognitive and affective regulations, yet its directional influence remains poorly understood. This study examines effective connectivity within cortico-striato-cerebellar networks in schizophrenia and healthy adults. Methods: Resting-state functional magnetic resonance imaging data from the Centers of Biomedical Research Excellence (COBRE), including people with schizophrenia and healthy controls ( Results: Four clusters of cerebellar voxels showed lower ALFF/fALFF in schizophrenia compared to controls. GIMME revealed distinct intra-cerebellar and cerebello-prefrontal effective connectivity patterns in schizophrenia paths that were absent in controls. Cerebellar 13, associated with the control network, emerged as a central hub in schizophrenia. These patterns persisted across symptom-defined subgroups, suggesting core network reorganization. Conclusions: Findings support the cerebellum's involvement in disrupted network dynamics in schizophrenia, particularly in its directional influence over prefrontal targets. Effective connectivity analyses uncovered cerebellar reorganization that may underlie cognitive and affective deficits in schizophrenia, offering novel targets for circuit-level interventions.