Elsevier

Comprehensive Psychiatry

Volume 70, October 2016, Pages 209-215
Comprehensive Psychiatry

Formal thought disorder in first-episode psychosis

https://doi.org/10.1016/j.comppsych.2016.08.005Get rights and content

Abstract

Formal thought disorder (FTD) is one of the fundamental symptom clusters of schizophrenia and it was found to be the strongest predictor determining conversion from first-episode acute transient psychotic disorder to schizophrenia. Our goal in the present study was to compare a first-episode psychosis (FEP) sample to a healthy control group in relation to subtypes of FTD. Fifty six patients aged between 15 and 45 years with FEP and forty five control subjects were included in the study. All the patients were under medication for less than six weeks or drug-naive. FTD was assessed using the Thought and Language Index (TLI), which is composed of impoverishment of thought and disorganization of thought subscales. FEP patients showed significantly higher scores on the items of poverty of speech, weakening of goal, perseveration, looseness, peculiar word use, peculiar sentence construction and peculiar logic compared to controls. Poverty of speech, perseveration and peculiar word use were the significant factors differentiating FEP patients from controls when controlling for years of education, family history of psychosis and drug abuse.

Introduction

Formal thought disorder (FTD) is one of the fundamental symptom clusters of schizophrenia. Disorders of thought processes that are characterized by deficiency in organizing thought in a definite logical sequence for a certain goal are considered as FTD. Thomas and Frazer [1] defined FTD as multidimensional impairment including disorders in thought, language processing and social cognition.

Poverty of speech, poverty of content, pressure of speech, distractible speech, tangentiality, derailment, incoherence, illogicality, clanging, neologisms and word approximations were reported as more pathologic types of FTD [2]. Among types of FTD identified by Andreasen, derailment, loss of goal, poverty of content and tangentiality were stated to be the most frequently seen types in patients with schizophrenia [3].

FTD usually persists during the illness chronically in an attenuated form, yet it tends to deteriorate in acute episodes [4], [5]. Antipsychotic treatment reduces thought pathology associated with acute episodes of schizophrenia [6]. Negative FTD, identified with poverty of speech and poverty in content of speech, remains stable over the course of schizophrenia [7]. It is associated with poor response to treatment [8] and schizophrenia patients having negative FTD are less likely to attain remission [7]. Positive FTD, determined by features like derailment, perseveration, circumstantiality, tangentiality, blocking and incoherence usually declines or disappears as the acute episode alleviates [7], [9]. Patients with affective psychosis tend to have more explicit positive FTD in contrast to patients with schizophrenia who have more negative FTD [7]. Moreover, follow-up study of these patients indicated that patients with schizoaffective disorder and bipolar disorder with manic episode showed improvements in some subtypes of FTD over time, whereas patients with schizophrenia remained the same. The foremost determinant factor of this result was thought to be the existence of negative FTD present throughout schizophrenia [7].

FTD is reported to be highly heritable, being found in healthy relatives of patients with schizophrenia [10], [11]. Specifically, deficiency in verbal fluency [12], peculiar word use [13], deviant verbalization [10], and grammatical oversimplification [4] are explicit in relatives of patients with schizophrenia compared to healthy controls. Moreover, adoption studies provide a basis for minimizing the confounding effects of genetic and environmental factors. Adoptees with schizophrenia tend to have significant FTD compared to control adoptees and, likewise, biological relatives of adoptees with schizophrenia show more FTD than biological relatives of control adoptees [4], [14]. These results indicate that the genetic factors increase the liability for schizophrenia rather than the rearing experiences [14]. A previous genome-wide linkage analysis and whole-genome sequencing showed that impaired MEF2A activity and genetic variation in the region 6q26–27 may be biologically relevant high-risk factors for FTD in schizophrenia [15].

The aim of this study is to compare an FEP sample to a healthy control group in relation to subtypes of FTD.

Section snippets

Participants

Fifty six patients aged between 15 and 45 years with FEP were recruited from the inpatient unit of Manisa Psychiatric Hospital, which is a public psychiatric hospital in Turkey. First-time admitted patients during their first acute phase of psychotic illness were screened and the ones that fulfilled our inclusion criteria were included in the study. A trained psychologist (EA) carried out the clinical assessments (SCID, PANSS, TLI, neurocognitive battery). Diagnosis was made based on SCID-I

The study flowchart

Flowchart of the patients from screening to the study endpoint is shown in Fig. 1.

Demographic and clinical features

Demographic and clinical features of the FEP patients and the healthy controls are shown in Table 1. There were no significant group differences between patient and control groups in age or gender. The FEP patients had significantly less education in years compared to the control group. The mean duration of untreated psychosis (DUP) of patients was 10.91 months. Seven of the 56 FEP patients (12%) were abusing

Discussion

Our goal in the present study was to compare an FEP sample to a healthy control group in relation to subtypes of FTD. We described the demographic and clinical correlates of FTD and demonstrated how TLI items differentiate FEP patients from healthy controls when controlling for relevant demographic/clinical variables. In line with the vast amount of research on FTD, our results demonstrate that FEP patients had significant thought abnormalities compared to healthy controls in terms of

Conclusions

The results of this study implicate FTD in FEP patients. FTD seems to be a stable characteristic of the disorder. The evidence of disorganization and impoverishment in thought processes already present during first-episode provides important information for the clinical manifestations of the disorder. Understanding persistent FTD as a predictor of early stage of psychosis may help the identification of these patients and the application of appropriate treatment strategies.

Role of the funding source

Not applicable.

Conflict of interest

The authors report no conflicts of interest relevant to the subject matter discussed in the manuscript.

Acknowledgment

We would like to gratefully acknowledge the contribution of the Manisa Psychiatric Hospital patients and staff who participated in the research.

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