title: Evidence for an agitated-aggressive syndrome predating the onset of psychosis.
abstract: BACKGROUND
  Aggression and suicidality prior to the initiation of treatment are frequent phenomena in psychosis patients. Increased scores in the Brief Psychiatric Rating Scale Excited Component (BPRS-EC) have been shown to predict involuntary treatment, aggression, and suicide in first-episode psychosis (FEP) patients. However, it is unclear if an agitated-aggressive syndrome as measured with the BPRS-EC is already present in at-risk mental state (ARMS).
  
  
  METHODS
  BPRS-EC scores from 43 ARMS patients, 50 FEP patients, and 25 healthy controls (HC) were analyzed. Multivariate analyses were performed to review if group differences were mediated by potential confounders. In addition, the association of BPRS-EC scores with clinical variables was examined.
  
  
  RESULTS
  BPRS-EC scores were significantly different across diagnostic groups (H(2)=22.1; p<.001), and post-hoc analyses showed significantly higher BPRS-EC scores for ARMS (p=.001) and for FEP patients (p<.001) compared to HC. Differences remained significant after controlling for gender, years of education, and intelligence. No significant differences emerged between ARMS and FEP patients. BPRS-EC was significantly correlated with lower intelligence (r=-.27; p=.008), reduced level of functioning (r=-.44; p<.001), and with smoking behavior (r=.22; p=.019).
  
  
  CONCLUSIONS
  ARMS and FEP patients in our sample had significantly higher BPRS-EC scores compared to HC. This may constitute a correlate of an agitated-aggressive syndrome and an increased risk for aggression and suicidality.
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland. Electronic address: christian.huber@upkbs.ch.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Huber
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland.
authors.forename: Renata
authors.initials: R
authors.lastname: Smieskova
authors.affiliation: Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Schroeder
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland.
authors.forename: Erich
authors.initials: E
authors.lastname: Studerus
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Harrisberger
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Aston
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland.
authors.forename: Anna
authors.initials: A
authors.lastname: Walter
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Walter
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland.
authors.forename: Anita
authors.initials: A
authors.lastname: Riecher-Rössler
authors.affiliation: Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, CH-4012 Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Borgwardt
mesh_terms: D000293:Adolescent; D000328:Adult; D000374:Aggression; D010054:Brief Psychiatric Rating Scale; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D008875:Middle Aged; D015999:Multivariate Analysis; D062706:Prodromal Symptoms; D011595:Psychomotor Agitation; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D012306:Risk; D013405:Suicide; D013577:Syndrome; D055815:Young Adult
keywords: Aggression; Agitation; PANSS-EC; Ultra-high risk