Formal thought disorder and prognosis following first episode psychosis
Poster A31, Thursday, October 20, 11:30 am - 1:00 pm, Le Baron
Eric Roche1, John Lyne2, Ricardo Segurado3, Caragh Behan1, Brian O'Donoghue4, Laoise Renwick5, Kevin Madigan1, Felicity Fanning1, Mary Clarke1; 1DETECT Early Intervention in Psychosis Service, Dublin, Ireland, 2North Dublin Mental Mental Health Service, Dublin, Ireland, 3CSTAR, University College Dublin, Ireland, 4Orygen, National Centre for Excellence in Youth Mental Health, Melbourne, Australia, 5School of Nursing, Midwifery and Social Work, University of Manchester, UK
Background: Formal thought disorder (FTD) is associated with poor outcome in established psychotic illnesses. However, its influence on functional outcome and re-hospitalisation patterns in early psychosis has not been investigated. We aimed to evaluate these outcomes in a first episode psychosis (FEP) sample. Methods: A mixed diagnostic FEP cohort was recruited through an Early Intervention in Psychosis Service in Dublin, Ireland. Participants were evaluated at initial presentation and 1 year later with the MIRECC GAF to evaluate social and occupational functioning domains. FTD was assessed with the SAPS and SANS: disorganisation (disFTD), verbosity (verFTD) and poverty (povFTD) dimensions were identified. FTD as a unitary construct was identified with the SCID-IV. Analyses were controlled for demographic, clinical and treatment variables. Results: Total n=240 participants were assessed at baseline and 1 year. Persistent or emergent disFTD was the only FTD dimension to predict functional outcome, specifically social functioning, on multivariate analysis (beta = 0.13, P<0.05). The unitary FTD construct did not have predictive value in relation to functional outcome. DisFTD at FEP presentation was predictive of a greater number of re-hospitalisations (beta=0.24, P<0.001) and prolonged inpatient admission (OR=1.08, 95% CI 1.02-1.15, P<0.05) following FEP. Conclusions: Longitudinal and dimensional evaluation of FTD has clinical utility that is distinct from a cross sectional or unitary assessment. These findings are supportive of some changes in DSM-V i.e. an emphasis on longitudinal and dimensional appraisal of psychopathology. Communication disorders may be considered a potential target for intervention in psychotic disorders.
Topic Area: Diagnosis and Phenomenology