title: The prognostic value of formal thought disorder following first episode psychosis.
abstract: Formal thought disorder (FTD) is associated with poor outcome in established psychotic illnesses and it can be assessed as a categorical or dimensional variable. However, its influence on functional outcome and hospitalisation patterns in early psychosis has not been investigated. We evaluated the relationship between FTD and these outcomes in a first episode psychosis (FEP) sample.
  
  
  
  A mixed diagnostic FEP cohort was recruited through an Early Intervention in Psychosis Service in Ireland. Participants were assessed at initial presentation and one year later with the MIRECC GAF to evaluate social and occupational functioning domains. Disorganisation (disFTD), verbosity (verFTD) and poverty (povFTD) dimensions of FTD were examined at both time points, as well as a unitary FTD construct. Analyses were controlled for demographic, clinical and treatment variables.
  
  
  
  DisFTD was the only FTD dimension associated with functional outcome, specifically social functioning, on multivariate analysis (beta=0.13, P<0.05). The unitary FTD construct was not associated with functional outcome. DisFTD at FEP presentation predicted a greater number of hospitalisations (adjusted beta=0.24, P<0.001) and prolonged inpatient admission (adjusted OR=1.08, 95% CI 1.02-1.15, P<0.05) following FEP.
  
  
  
  Longitudinal and dimensional evaluation of FTD has a clinical utility that is distinct from a cross-sectional or unitary assessment. Dimensions of FTD may map onto different domains of functioning. These findings are supportive of some of the changes in DSM-V with an emphasis on longitudinal and dimensional appraisal of psychopathology. Communication disorders may be considered a potential target for intervention in psychotic disorders.
authors.affiliation: DETECT Early Intervention in Psychosis Service, Blackrock Business Park, Blackrock, Dublin, Ireland. Electronic address: eric.bruce.roche@gmail.com.
authors.forename: Eric
authors.initials: E
authors.lastname: Roche
authors.affiliation: Royal College of Surgeons in Ireland and North Dublin Mental Health Services, Ashlin Centre, Beaumont Road, Dublin 9, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Lyne
authors.affiliation: Orygen, National Centre for Excellence in Youth Mental Health, Melbourne, Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: O'Donoghue
authors.affiliation: Centre for Support and Training in Analysis and Research, University College Dublin, Ireland.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Segurado
authors.affiliation: DETECT Early Intervention in Psychosis Service, Blackrock Business Park, Blackrock, Dublin, Ireland.
authors.forename: Caragh
authors.initials: C
authors.lastname: Behan
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, UK.
authors.forename: Laoise
authors.initials: L
authors.lastname: Renwick
authors.affiliation: DETECT Early Intervention in Psychosis Service, Blackrock Business Park, Blackrock, Dublin, Ireland.
authors.forename: Felicity
authors.initials: F
authors.lastname: Fanning
authors.affiliation: DETECT Early Intervention in Psychosis Service, Blackrock Business Park, Blackrock, Dublin, Ireland.
authors.forename: Kevin
authors.initials: K
authors.lastname: Madigan
authors.affiliation: DETECT Early Intervention in Psychosis Service, Blackrock Business Park, Blackrock, Dublin, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Clarke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007494:Ireland; D007806:Language Disorders / Q000150:complications* / Q000175:diagnosis*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000150:complications / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D015203:Reproducibility of Results; D055815:Young Adult
keywords: Dimensional psychopathology; First episode psychosis; Formal thought disorder; Functioning; Hospitalisation