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 Pantelis; Eva Meisenzahl; Stephen J Wood; Paolo Brambilla; Stefan Borgwardt; Peter Falkai; Linda A Antonucci; Nikolaos Koutsouleris; PRONIA Consortium

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

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, PRONIA Consortium

Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Nussbaumstr. 7, 80336, Munich, Germany. [email protected].; International Max Planck Research School for Translational Psychiatry, Munich, Germany. [email protected].; Max Planck Institute for Psychiatry, Munich, Germany. [email protected].
Department of Neurosciences and Mental Health, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Foundation Major Hospital Polyclinic, University of Milan , Milan , Italy; MoMiLab Research Unit, Institutions, Markets, Technologies (IMT) School for Advanced Studies Lucca , Lucca , Italy
Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA.
Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Nussbaumstr. 7, 80336, Munich, Germany.; International Max Planck Research School for Translational Psychiatry, Munich, Germany.
Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Nussbaumstr. 7, 80336, Munich, Germany.
Institute for Mental Health, University of Birmingham, Birmingham, UK,Centre for Human Brain Health, University of Birmingham, Birmingham, UK,Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, UK.
Department of Psychiatry, Medical Faculty, University of Turku , Turku , Finland
Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
School of Psychology, University of Birmingham, Birmingham, UK.; Orygen, The National Centre of Excellence for Youth Mental Health, Melbourne, Australia.; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
Department of Psychiatry, University Psychiatric Clinic, Psychiatric University Hospital, University of Basel, Basel, Switzerland
Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Nussbaumstr. 7, 80336, Munich, Germany.; Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy.; Department of Education, Psychology and Communication Science, University of Bari "Aldo Moro", Bari, Italy.
Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Nussbaumstr. 7, 80336, Munich, Germany.; Max Planck Institute for Psychiatry, Munich, Germany.; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

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
Journal	European Archives of Psychiatry and Clinical Neurosciene
Early online date	17 Sept 2021
DOIs	https://doi.org/10.1007/s00406-021-01327-y
Publication status	E-pub ahead of print - 17 Sept 2021

Bibliographical note

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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

UN SDGs

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

SDG 3 Good Health and Well-being

Keywords

Clustering
Early psychosis
Formal thought disorder
Functioning
Neurocognition

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10.1007/s00406-021-01327-yLicence: CC BY 3.0

The clinical relevance of formal thought disorder
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Final published version, 1.43 MBLicence: CC BY 3.0

Cite this

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., Salokangas, R. K. R., ... PRONIA Consortium (2021). The clinical relevance of formal thought disorder in the early stages of psychosis: results from the PRONIA study. European Archives of Psychiatry and Clinical Neurosciene. 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 (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. ",

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

author = "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 and \{PRONIA Consortium\}",

note = "This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Funding: Structural European Funding of the Italian Minister of Education (Attraction and International Mobility—AIM—action, grant agreement No 1859959",

year = "2021",

month = sep,

day = "17",

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

language = "English",

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

issn = "0940-1334",

publisher = "Springer",

}

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 & PRONIA Consortium 2021, 'The clinical relevance of formal thought disorder in the early stages of psychosis: results from the PRONIA study', European Archives of Psychiatry and Clinical Neurosciene. 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: results from the PRONIA study

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

AU - PRONIA Consortium

N1 - This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Funding: Structural European Funding of the Italian Minister of Education (Attraction and International Mobility—AIM—action, grant agreement No 1859959

PY - 2021/9/17

Y1 - 2021/9/17

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 (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.

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 (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.

KW - Clustering

KW - Early psychosis

KW - Formal thought disorder

KW - Functioning

KW - Neurocognition

UR - https://link.springer.com/article/10.1007%2Fs00406-021-01327-y

UR - https://www.scopus.com/pages/publications/85115228389

U2 - 10.1007/s00406-021-01327-y

DO - 10.1007/s00406-021-01327-y

M3 - Article

C2 - 34535813

SN - 0940-1334

JO - European Archives of Psychiatry and Clinical Neurosciene

JF - European Archives of Psychiatry and Clinical Neurosciene

ER -

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

Abstract

Bibliographical note

UN SDGs

Keywords

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