Abstract
BackgroundFormal 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.Methods279 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).ResultsThe 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.ConclusionsClustering 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.
Highlights
Psychotic disorders are closely linked with neurocognitive and functional impairments [17, 49] that frequently precede disease onset and persist after remission of the acute illness [22, 37]
We found a similar pattern of results in the phonological verbal fluency and semantic fluency scores, as well as in the forward and backward digit span scores, i.e., Formal thought disorder (FTD)-High individuals always performed worse than FTD-Low group in these neurocognitive domains
The presented multi-step clustering study demonstrated subgroups of patients with distinct clinical presentations of FTD who may have divergent preventive and therapeutic needs related to differential FTD severity
Summary
Psychotic disorders are closely linked with neurocognitive and functional impairments [17, 49] that frequently precede disease onset and persist after remission of the acute illness [22, 37]. Cognitive basic symptoms including subjective thought blockage, interference and pressure as well as disturbances of abstract thinking and expressive and receptive speech that might be regarded as subclinical presentations of observable FTD have been demonstrated to predict subsequent psychosis [45] These findings may point towards FTD playing an important role in explaining the behavioural, psychopathological and functional heterogeneity of disease manifestations in both early and prodromal phases of psychosis. This aspect has remained under-investigated, [42, 43] as research on clinical markers of psychosis has focused rather on positive and negative symptoms as well as on cognitive phenotypes of the disorders [44]. Conclusions Clustering techniques allowed us to identify patients with more pronounced FTD showing more severe deficits in functioning and neurocognition, suggesting that FTD may be a relevant marker of illness severity in the early psychosis pathway
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