Eric Roche1, John Paul Lyne2, Brian O'Donoghue3, Ricardo Segurado4, Anthony Kinsella5, Ailish Hannigan6, Brendan D Kelly7, Kevin Malone8, Mary Clarke9. 1. Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland; School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin, Ireland. Electronic address: eric.roche@sjog.ie. 2. Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland; North Dublin Mental Health Services, Beaumont Hospital, Dublin 9, Ireland. Electronic address: johnlyne@mail.com. 3. Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland; School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin, Ireland; Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia. Electronic address: briannoelodonoghue@gmail.com. 4. UCD CSTAR, School of Public Health, Physiotherapy and Population Science, University College Dublin, Belfield, Dublin, Ireland. Electronic address: ricardo.segurado@ucd.ie. 5. Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland. Electronic address: akinsella@rcsi.ie. 6. Graduate Entry Medical School, University of Limerick, Limerick, Ireland. Electronic address: ailish.hannigan@ul.ie. 7. School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland. Electronic address: brendankelly35@gmail.com. 8. School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin, Ireland; St Vincent's University Hospital, Dublin, Ireland. Electronic address: k.malone@svuh.ie. 9. Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland; School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin, Ireland. Electronic address: mary.clarke@sjog.ie.
Abstract
BACKGROUND: Formal thought disorder (FTD) is a core feature of psychosis, however there are gaps in our knowledge about its prevalence and factor structure. We had two aims: first, to establish the factor structure of FTD; second, to explore the clinical utility of dimensions of FTD in order to further the understanding of its nosology. METHODS: A cross-validation study was undertaken to establish the factor structure of FTD in first episode psychosis (FEP). The relative utility of FTD categories vs. dimensions across diagnostic categories was investigated. RESULTS: The prevalence of clinically significant FTD in this FEP sample was 21%, although 41% showed evidence of disorganised speech, 20% displayed verbosity and 24% displayed impoverished speech. A 3-factor model was identified as the best fit for FTD, with disorganisation, poverty and verbosity dimensions (GFI=0.99, RMR=0.07). These dimensions of FTD accurately distinguished affective from non-affective diagnostic categories. A categorical approach to FTD assessment was useful in identifying markers of clinical acuteness, as identified by short duration of untreated psychosis (OR=2.94, P<0.01) and inpatient treatment status (OR=3.98, P<0.01). CONCLUSION: FTD is moderately prevalent and multi-dimensional in FEP. Employing both a dimensional and categorical assessment of FTD gives valuable clinical information, however there may be a need to revise our conceptualisation of the nosology of FTD. The prognostic value of FTD, as well as its neural basis, requires elucidation.
BACKGROUND: Formal thought disorder (FTD) is a core feature of psychosis, however there are gaps in our knowledge about its prevalence and factor structure. We had two aims: first, to establish the factor structure of FTD; second, to explore the clinical utility of dimensions of FTD in order to further the understanding of its nosology. METHODS: A cross-validation study was undertaken to establish the factor structure of FTD in first episode psychosis (FEP). The relative utility of FTD categories vs. dimensions across diagnostic categories was investigated. RESULTS: The prevalence of clinically significant FTD in this FEP sample was 21%, although 41% showed evidence of disorganised speech, 20% displayed verbosity and 24% displayed impoverished speech. A 3-factor model was identified as the best fit for FTD, with disorganisation, poverty and verbosity dimensions (GFI=0.99, RMR=0.07). These dimensions of FTD accurately distinguished affective from non-affective diagnostic categories. A categorical approach to FTD assessment was useful in identifying markers of clinical acuteness, as identified by short duration of untreated psychosis (OR=2.94, P<0.01) and inpatient treatment status (OR=3.98, P<0.01). CONCLUSION:FTD is moderately prevalent and multi-dimensional in FEP. Employing both a dimensional and categorical assessment of FTD gives valuable clinical information, however there may be a need to revise our conceptualisation of the nosology of FTD. The prognostic value of FTD, as well as its neural basis, requires elucidation.
Authors: Frederike Stein; Elena Buckenmayer; Katharina Brosch; Tina Meller; Simon Schmitt; Kai Gustav Ringwald; Julia Katharina Pfarr; Olaf Steinsträter; Verena Enneking; Dominik Grotegerd; Walter Heindel; Susanne Meinert; Elisabeth J Leehr; Hannah Lemke; Katharina Thiel; Lena Waltemate; Alexandra Winter; Tim Hahn; Udo Dannlowski; Andreas Jansen; Igor Nenadić; Axel Krug; Tilo Kircher Journal: Schizophr Bull Date: 2022-06-21 Impact factor: 7.348