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. Salokangas; Christos Pantelis; Eva Meisenzahl; Stephen J. Wood; Paolo Brambilla; Stefan Borgwardt; Peter Falkai; Linda A. Antonucci; Nikolaos Koutsouleris

doi:10.1007/s00406-021-01327-y

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 journal › Article › peer-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 (p_fdr < 0.001) and role (p_fdr < 0.001) functioning, as well as worse neurocognitive performance in semantic (p_fdr < 0.001) and phonological verbal fluency (p_fdr < 0.001), short-term verbal memory (p_fdr = 0.002) and abstract thinking (p_fdr = 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 language	English
Pages (from-to)	403-413
Number of pages	11
Journal	European Archives of Psychiatry and Clinical Neuroscience
Volume	272
Early online date	17 Sept 2021
DOIs	https://doi.org/10.1007/s00406-021-01327-y
Publication status	Published - 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)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

the PRONIA consortium, Oeztuerk, O. F., Pigoni, A., Wenzel, J., Haas, S. S., Popovic, D., Ruef, A., Dwyer, D. B., Kambeitz-Ilankovic, L., Ruhrmann, S., Chisholm, K., Lalousis, P., Griffiths, S. L., Lichtenstein, T., Rosen, M., Kambeitz, J., Schultze-Lutter, F., Liddle, P., Upthegrove, R., ... Koutsouleris, N. (2022). The clinical relevance of formal thought disorder in the early stages of psychosis: results from the PRONIA study. European Archives of Psychiatry and Clinical Neuroscience, 272, 403-413. Advance online publication. https://doi.org/10.1007/s00406-021-01327-y

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

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.",

keywords = "Clustering, Early psychosis, Formal thought disorder, Functioning, Neurocognition",

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

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-Kr{\"o}ner-Fresenius-Stiftung. Linda A. Antonucci{\textquoteright}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: {\textcopyright} 2021, The Author(s).",

year = "2022",

month = apr,

doi = "10.1007/s00406-021-01327-y",

language = "English",

volume = "272",

pages = "403--413",

journal = "European Archives of Psychiatry and Clinical Neuroscience",

issn = "0940-1334",

publisher = "Springer",

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the PRONIA consortium, Oeztuerk, OF, Pigoni, A, Wenzel, J, Haas, SS, Popovic, D, Ruef, A, Dwyer, DB, Kambeitz-Ilankovic, L, Ruhrmann, S, Chisholm, K, Lalousis, P, Griffiths, SL, Lichtenstein, T, Rosen, M, Kambeitz, J, Schultze-Lutter, F, Liddle, P, Upthegrove, R, Salokangas, RKR, Pantelis, C, Meisenzahl, E, Wood, SJ, Brambilla, P, Borgwardt, S, Falkai, P, Antonucci, LA & Koutsouleris, N 2022, 'The clinical relevance of formal thought disorder in the early stages of psychosis: results from the PRONIA study', European Archives of Psychiatry and Clinical Neuroscience, vol. 272, pp. 403-413. https://doi.org/10.1007/s00406-021-01327-y

TY - JOUR

T1 - The clinical relevance of formal thought disorder in the early stages of psychosis

T2 - results from the PRONIA study

AU - the PRONIA consortium

AU - Oeztuerk, Oemer Faruk

AU - Pigoni, Alessandro

AU - Wenzel, Julian

AU - Haas, Shalaila S.

AU - Popovic, David

AU - Ruef, Anne

AU - Dwyer, Dominic B.

AU - Kambeitz-Ilankovic, Lana

AU - Ruhrmann, Stephan

AU - Chisholm, Katharine

AU - Lalousis, Paris

AU - Griffiths, Sian Lowri

AU - Lichtenstein, Theresa

AU - Rosen, Marlene

AU - Kambeitz, Joseph

AU - Schultze-Lutter, Frauke

AU - Liddle, Peter

AU - Upthegrove, Rachel

AU - Salokangas, Raimo K.R.

AU - Pantelis, Christos

AU - Meisenzahl, Eva

AU - Wood, Stephen J.

AU - Brambilla, Paolo

AU - Borgwardt, Stefan

AU - Falkai, Peter

AU - Antonucci, Linda A.

AU - Koutsouleris, Nikolaos

N1 - 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).

PY - 2022/4

Y1 - 2022/4

N2 - 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.

AB - 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.

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KW - Early psychosis

KW - Formal thought disorder

KW - Functioning

KW - Neurocognition

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EP - 413

JO - European Archives of Psychiatry and Clinical Neuroscience

JF - European Archives of Psychiatry and Clinical Neuroscience

ER -

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

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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Cite this