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

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 PantelisEva Meisenzahl, Stephen J Wood, Paolo Brambilla, Stefan Borgwardt, Peter Falkai, Linda A Antonucci, Nikolaos Koutsouleris,

Research output: Contribution to journalArticlepeer-review


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; 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 languageEnglish
JournalEuropean Archives of Psychiatry and Clinical Neurosciene
Early online date17 Sept 2021
Publication statusE-pub ahead of print - 17 Sept 2021

Bibliographical note

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Funding: Structural European Funding of the Italian Minister of Education (Attraction and International Mobility—AIM—action, grant agreement No 1859959


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


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