The clinical relevance of formal thought disorder in the early stages of psychosis: results from the PRONIA study

the PRONIA consortium, Oemer Faruk Oeztuerk*, Alessandro Pigoni, Julian Wenzel, Shalaila S. Haas, David Popovic, Anne Ruef, Dominic B. Dwyer, Lana Kambeitz-Ilankovic, Stephan Ruhrmann, Katharine Chisholm, Paris Lalousis, Sian Lowri Griffiths, Theresa Lichtenstein, Marlene Rosen, Joseph Kambeitz, Frauke Schultze-Lutter, Peter Liddle, Rachel Upthegrove, Raimo K.R. SalokangasChristos Pantelis, Eva Meisenzahl, Stephen J. Wood, Paolo Brambilla, Stefan Borgwardt, Peter Falkai, Linda A. Antonucci, Nikolaos Koutsouleris

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background: Formal thought disorder (FTD) has been associated with more severe illness courses and functional deficits in patients with psychotic disorders. However, it remains unclear whether the presence of FTD characterises a specific subgroup of patients showing more prominent illness severity, neurocognitive and functional impairments. This study aimed to identify stable and generalizable FTD-subgroups of patients with recent-onset psychosis (ROP) by applying a comprehensive data-driven clustering approach and to test the validity of these subgroups by assessing associations between this FTD-related stratification, social and occupational functioning, and neurocognition.

Methods: 279 patients with ROP were recruited as part of the multi-site European PRONIA study (Personalised Prognostic Tools for Early Psychosis Management; www.pronia.eu). Five FTD-related symptoms (conceptual disorganization, poverty of content of speech, difficulty in abstract thinking, increased latency of response and poverty of speech) were assessed with Positive and Negative Symptom Scale (PANSS) and the Scale for the Assessment of Negative Symptoms (SANS).

Results: The results with two patient subgroups showing different levels of FTD were the most stable and generalizable clustering solution (predicted clustering strength value = 0.86). FTD-High subgroup had lower scores in social (pfdr < 0.001) and role (pfdr < 0.001) functioning, as well as worse neurocognitive performance in semantic (pfdr < 0.001) and phonological verbal fluency (pfdr < 0.001), short-term verbal memory (pfdr = 0.002) and abstract thinking (pfdr = 0.010), in comparison to FTD-Low group.

Conclusions: Clustering techniques allowed us to identify patients with more pronounced FTD showing more severe deficits in functioning and neurocognition, thus suggesting that FTD may be a relevant marker of illness severity in the early psychosis pathway.

Original languageEnglish
Pages (from-to)403-413
Number of pages11
JournalEuropean Archives of Psychiatry and Clinical Neuroscience
Volume272
Early online date17 Sept 2021
DOIs
Publication statusPublished - Apr 2022

Bibliographical note

Funding Information:
We thank all subjects for their participation in the study. Oemer Faruk Oeztuerk and David Popovic are supported by International Max Planck Research School for Translational Psychiatry in the frame of Clinician Scientist Program funded by the Else-Kröner-Fresenius-Stiftung. Linda A. Antonucci’s salary is funded by the Structural European Funding of the Italian Minister of Education (Attraction and International Mobility—AIM—action, grant agreement No 1859959).

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • Clustering
  • Early psychosis
  • Formal thought disorder
  • Functioning
  • Neurocognition

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry
  • Pharmacology (medical)

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