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OBJECTIVE: We aimed to present the scalability and cut-off score for the presence of aggression on the Brief Psychiatric Rating Scale-Excited Component (BPRS-EC) in schizophrenia patients. METHODS: From the Research on Asian Psychotropic Prescription Patterns for Antipsychotics, 1,438 Asian patients with schizophrenia were recruited in present study. The Mokken analysis was used to evaluate scalability of the BPRS-EC. The receiver operating characteristic (ROC) curve was used to establish the optimal cut-off score for the presence of aggression on the BPRS-6 in schizophrenia patients. RESULTS: The Mokken model presented that the scalability of the BPRS-EC was considered to have a strong “unidimensionality” (coefficient of scalability = 0.57). The ROC curve showed that, with the cut-off score of 5, the total score on the BPRS-EC distinguished the absence and presence of aggression in schizophrenia patients. CONCLUSION: The BPRS-EC can be used as a supplementary scale for evaluating aggression in patients with schizophrenia.

We hereby report a case of a patient with Wilson’s disease, presenting only with psychiatric symptoms without significant hepatic or neurological symptoms. A 27-year-old woman was admitted to the psychiatric ward with symptoms of somatic preoccupation, auditory hallucinations, suicidal behaviour, regressed behaviour, and severe anxiety. She suffered from paralyzing sensation in both big toes, without any abnormal findings in nerve conduction tests or any neurological signs and symptoms. Also, no significant hepatic impairment was presented. Psychiatric symptoms improved with antipsychotics, mood stabilizers, and other psychotropic agents, but dysphagia and general weakness developed later. She had a family history of Wilson’s disease. High signal intensities in the basal ganglia, midbrain, and pons were observed with fluid-attenuated inversion-recovery (FLAIR) imaging. Based on abnormal findings in the urine copper and serum ceruloplasmin tests, as well as the presence of the ATP7B mutation, a diagnosis of Wilson’s disease was made. Therefore, our case report suggests that future studies should consider the evaluation of psychiatric symptoms in the diagnostic conceptualization of Wilson’s disease.