Symptom Dimensions as Predictors of Clinical Outcome, Duration of Hospitalization, and Aggressive Behaviours in Acutely Hospitalized Patients with Psychotic Exacerbation

Alessandro Colasanti1, 2, Silvia Paletta1, Donatella Moliterno1, Alessandra Mazzocchi1, Massimo Carlo Mauri1, *, Alfredo Carlo Altamura1
1 Clinical Psychiatry, Clinical Neuropsychopharmacology Unit, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F.Sforza 35, 20122 Milan, Italy
2 Neuropsychopharmacology Unit, Division of Experimental Medicine, Imperial College, Hammersmith Hospital, 160 Du Cane Road, W129LL, London, UK

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© Colasanti et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Clinical Neuropsychopharmacology Unit, University of Milan, IRCCS Ospedale Maggiore Policlinico, Via F.Sforza 35, 20122 Milan, Italy; Tel: 0039 0255035997; Fax: 0039 0255035990; E-mail:


In the present study we extract clusters of symptoms in acute hospitalized psychotic patients during a re-exacerbation phase, using factor analysis of BPRS-E. We aim to investigate the relative contribution of each symptom dimension in predicting the severity of symptoms at discharge, the length of acute hospitalization, and the occurrence of aggressive behaviours during acute hospitalization. The data are drawn from a prospective, naturalistic, observational study of 183 patients with Psychotic Disorders consecutively admitted to a psychiatric ward, during a re-exacerbation phase. General symptomatology has been measured through BPRS-E at admission and at discharge. Statistical analyses include principal component analysis and multiple linear regression.

We found symptoms of acute psychosis disorder to cluster together in four distinct domains, labelled "Excitement/Activation", "Positive symptoms", and "Negative symptoms", and "Depression/Anxiety".

Excitement/activation was the dimension most associated with occurrence of aggressive behaviours and severity of psychopathological symptoms at discharge. The negative symptoms dimension, also, predicted the severity of symptoms at discharge. Positive and negative symptoms dimensions were both predictors of duration of hospitalization. The depressive dimension was significantly associated only to self-aggression. These data indicate that during acute hospitalization due to re-exacerbation of psychosis each symptom dimension has a specific impact on distinct measures of outcome.

Keywords: Acute psychosis, schizophrenia, excitement, activation, hyperactivity, mania, positive and negative symptoms, depression, factor analysis, symptom clusters, duration of hospitalization, aggression, violence, inpatients.