Large-scale brain dynamics are organized by a directional coordination hierarchy.

The cortical hierarchy is a central organizing feature of brain structure and function, yet whether it is continuously expressed in spontaneous neural activity remains unresolved. Here, we show that resting-state brain dynamics are organized along a directional coordination axis that recapitulates hierarchical information flow. Focusing on the directional dynamics of interregional coordination, we identify three recurrent coordination regimes: a feedback-dominated mode in which transmodal cortex leads sensory systems, a feedforward-dominated mode reflecting the reverse, and an integrative mode of balanced bidirectional exchange. These modes define a low-dimensional coordination landscape that replicates across four independent cohorts, establishing directional structure as a stable property of the adult brain. In schizophrenia, this landscape is selectively reorganized: feedback-dominated coordination becomes less persistent, integrative coordination becomes more persistent, and global dynamics shift toward faster convergence and reduced entropy, reflecting a loss of directional constraint and dynamical flexibility. These alterations track symptom severity, cognitive performance, and medication exposure. Mediation analyses suggest that medication-related reductions in integrative coordination are statistically routed through feedforward dynamics, consistent with dopaminergic modulation of recurrent cortical loops as a candidate mechanism. Together, these findings identify directional functional dynamics as a fundamental and clinically informative axis of large-scale brain organization.