***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study examined substance use among a group of 37 schizophrenia patients participating in a year-long fluphenazine decanoate ( FD ; Prolixin ) dosage reduction study ( Inderbitzin et al. ( 1994 ) Am . J. Psychiatry 151 , 1753 - 1759 ) . Ten ( 50 % ) of the 20 FD dose-reduced patients , and 6 ( 35 % ) of the 17 control group patients were identified as substance users . The dose-reduced and control groups did not differ significantly in substance use . We examine here the 37 patients regrouped by substance users ( n = 16 ) versus non-users ( n = 21 ) to determine the effects of substance use . In addition to identifying substance users and types of substances used , we hypothesize that substance users differ demographically from non-users , have worse symptomatology , worse compliance , higher rates of relapse , and therefore , can confound studies . Clinical and demographic data were obtained . At least half of the substance users were using alcohol or cocaine . The substance use group had a significantly higher severity of illness score on the BPRS at study onset . We found no significant differences between the two groups on other rating scales . The non-use group lived more independently , and the substance use group was younger . The substance use group had nearly twice as many hospitalizations in the 2 years prior to the study , a greater rate of missed appointments in the year before and during the study , and 4 times as many relapses during the year of the study than the non-use group . The key finding was that among 9 of the 37 patients who relapsed in the year of the study , 7 of the 9 had a history of substance use . Substance use was found to be a better predictor of relapse and hospitalization than gradual 50 % dosage reduction of FD in the related study . Substance use among schizophrenia patients is a major complicating factor OBJECTIVE Despite the frequent use of the Positive and Negative Syndrome Scale ( PANSS ) for rating the symptoms of schizophrenia , the clinical meaning of its total score and of the cut-offs that are used to define treatment response ( e.g. at least 20 % or 50 % reduction of the baseline score ) are as yet unclear . We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions ( CGI ) . METHOD PANSS and CGI ratings at baseline ( n = 4091 ) , and after one , two , four and six weeks of treatment taken from a pooled data base of seven pivotal , multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking . RESULTS Being considered " mildly ill " according to the CGI approximately corresponded to a PANSS total score of 58 , " moderately ill " to a PANSS of 75 , " markedly ill " to a PANSS of 95 and severely ill to a PANSS of 116 . To be " minimally improved " according to the CGI score was associated with a mean percentage PANSS reduction of 19 % , 23 % , 26 % and 28 % at weeks 1 , 2 , 4 and 6 , respectively . The corresponding figures for a CGI rating " much improved " were 40 % , 45 % , 51 % and 53 % . CONCLUSIONS The results provide a better framework for underst and ing the clinical meaning of the PANSS total score in drug trials of schizophrenia patients with acute exacerbations . Such studies may ideally use at least a 50 % reduction from baseline cut-off to define response rather than lower thresholds . In treatment resistant population s , however , even a small improvement can be important , so that a 25 % cut-off might be appropriate The purpose of this study is to compare the efficacy of olanzapine and risperidone for the acute treatment of first-episode schizophrenia patients with cannabis use disorders . This secondary analysis of a previously published study included 49 first-episode patients with a diagnosis of schizophrenia , schizophreniform disorder , or schizoaffective disorder and a co-occurring lifetime diagnosis of cannabis use disorders r and omly assigned to treatment with either olanzapine ( n=28 ) or risperidone ( n=21 ) for 16weeks . The olanzapine group did not differ significantly from the risperidone group for initial response rates of positive symptoms , and rates of cannabis use or alcohol use during the study . Positive symptoms and the Scale for Assessment of Negative Symptoms ( SANS ) global asociality-anhedonia scores improved over time but did not differ between study medications . In both groups , cannabis use during the study was higher in patients who used cannabis within three months of the admission . Thus , our results suggest that olanzapine and risperidone had a similar initial efficacy on psychotic symptoms and substance use in first-episode patients with co-occurring cannabis use disorders . If clinicians are choosing between olanzapine versus risperidone treatment for this population , their decision should be based upon factors other than symptom response and short-term substance misuse Psychotic disorders are characterized by significant deficits in attentional control , but the neurobiological mechanisms underlying these deficits early in the course of illness prior to extensive pharmacotherapy are not well understood . Moreover , little is known regarding the symptom and brain changes associated with amelioration of attentional impairments through antipsychotic pharmacotherapy . In this study 14 male patients experiencing a first-episode of psychosis with minimal prior antipsychotic treatment completed an  attentional control task while undergoing functional magnetic resonance imaging at the onset of treatment with a second generation antipsychotic ( risperidone or aripiprazole ) in a double blind r and omized clinical trial and then again following approximately 12 weeks of treatment . In addition , 14 age- , and performance-matched healthy male volunteers who were not treated completed the same task at a baseline timepoint and then again following 12 weeks . Patients showed significantly greater activation than healthy volunteers in the right globus pallidus , left thalamus , and right thalamus at the time of the baseline scan . Among patients there was a significant reduction in right globus pallidus blood-oxygen level dependent ( BOLD ) response following antipsychotic treatment that correlated significantly with improvement in response accuracy and reductions in thought disturbance . No changes in globus pallidus activation were observed in healthy volunteers over this time period . These preliminary findings suggest that improvement in attentional control and concomitant reductions in thought disturbance in first-episode psychosis may be associated with reductions in subcortical activity following administration of second-generation antipsychotics early in the course of illness . These findings have implication s for underst and ing how changes in basal ganglia activity may be linked to improvements in attentional control through antipsychotics Background : Second-generation antipsychotics , approved for the treatment of mania , are associated with adverse effects such as weight gain and metabolic disorders .  Aripiprazole , a recently introduced second-generation antipsychotic , are thought to account for its low propensity for weight gain , metabolic disturbances and sedation . The purpose of this study was to investigate the effect of risperidone versus aripiprazole in the treatment of acute mania . Material s and Methods : Fifty patients with acute episodes of mania were enrolled in this study , and they were r and omly assigned into a risperidone group of 24 cases and an aripiprazole group of 26 cases . In group A , aripiprazole with a dose of 5 - 30 mg/day and in group B , risperidone with a dose of 2 - 8 mg/day was given to patients . The average dose of aripiprazole was 27 mg/day , and the average dose of risperidone was 6 mg/day . The effects of each drug for the treatment of acute mania were assessed on the 1st day of admission and on days 2 , 4 , 6 , 8 and at weeks 2 , 4 and 6 after therapy using the young mania rating scale ( YMRS ) and at the baseline and on weeks 3 and 6 after admission using the clinical global impression ( CGI ) scale . Results : The mean age of the group of risperidone was 34 ± 8.6 years and in a group of aripiprazole it was 34 ± 9.1 years ( P = 0.83 ) . Comparison of YMRS scores over the period of 6 weeks revealed a statistically significant difference in both groups ( P < 0.0001 ) . There was also a statistically significant difference in YMRS scores between risperidone and aripiprazole at day 8 ( P = 0.026 ) and weeks 2 ( P = 0.035 ) and 4 ( P = 0.042 ) . There was also a statistically significant difference in CGI-Severity scale score at weeks 3 ( P = 0.003 ) and 6 ( P = 0.000 ) and in CGI-Improvement scale score at weeks 3 ( P = 0.005 ) and 6 ( P = 0.002 ) . The most common side-effect observed in both groups was headache ( 0%15/4 in aripiprazole vs. % 16/7 in risperidone ) Conclusion : Aripiprazole that is readily available in our market , could be considered more effective than risperidone in the treatment of acute mania BACKGROUND Many patients recovering from a first psychotic episode will discontinue medication against medical advice , even before a 1-year treatment course is completed . Factors associated with treatment adherence in patients with chronic schizophrenia include beliefs about severity of illness and need for treatment , treatment with typical versus atypical antipsychotic and medication side effects . METHOD In this 2-year prospect i ve study of 254 patients recovering from a first episode of schizophrenia , schizophreniform , or schizoaffective disorder we examined the relationship between antipsychotic medication non-adherence and patient beliefs about : need for treatment , antipsychotic medication benefits , and negative aspects of antipsychotic medication treatment . We also examined the relationship between medication non-adherence and treatment with either haloperidol or olanzapine , and objective measures of symptom response and side effects . RESULTS The likelihood of becoming medication non-adherent for 1 week or longer was greater in subjects whose belief in need for treatment was less ( HR=1.75 , 95 % CI 1.16 , 2.65 , p=0.0077 ) or who believed medications were of low benefit ( HR=2.88 , 95 CI 1.79 - 4.65 , p<0.0001 ) . Subjects r and omized to haloperidol were more likely to become medication non-adherent for > or=1 week than subjects r and omized to olanzapine ( HR-1.51 , 95 % CI 1.01 , 2.27 , p=0.045 ) . CONCLUSION Beliefs about need for treatment and the benefits of antipsychotic medication may be intervention targets to improve likelihood of long-term medication adherence in patients recovering from a first episode of schizophrenia , schizoaffective , or schizophreniform disorder OBJECTIVE This double-blind study compared a second generation ( atypical ) antipsychotic drugs compared to a representative older agent for patients with schizophrenia who use or avoid illicit substances . METHODS Schizophrenic subjects were recruited at 57 U.S. sites and r and omly assigned to olanzapine , perphenazine , quetiapine , risperidone or ziprasidone for up to 18 months . The primary aim of this analysis was to delineate differences between the overall effectiveness of these five treatments among patients who used or did not use illicit substances . RESULTS There were no significant differences between treatment groups in time to all-cause treatment discontinuation among patients who use illicit drugs ( median 3.3 to 6.8 months ) . Among non-users time to treatment discontinuation was significantly longer for patients treated with olanzapine ( median 13.0 months ) than perphenazine ( 5.9 months ) , risperidone ( 5.6 months ) , or quetiapine ( 5.0 months ) ; time to discontinuation for ziprasidone ( 4.3 months ) was even shorter , although the latter difference was not significant . The difference between risperidone and quetiapine , although small , was significant . All remaining differences were non-significant . Similar results were found for discontinuation due to inefficacy . There were no differences between illicit users and non-users in symptom reduction and global improvement , after adjustment for differential duration of treatment . Differences in discontinuation results were attenuated by non-compliance , but the trends persisted after controlling for treatment compliance . CONCLUSIONS Among patients with chronic schizophrenia who avoid use of illicit drugs , olanzapine was more effective than other antipsychotics as reflected by longer time to all-cause discontinuation , but illicit substance abuse attenuated this advantage , reinforcing the need for concurrent substance abuse treatment OBJECTIVE To compare olanzapine and risperidone in the treatment of nonpsychotic acute manic or mixed episodes . METHOD This 3-week , r and omized , controlled , double-blind , parallel multicenter study compared  olanzapine ( 5 - 20 mg/day ; N = 165 ) and risperidone ( 1 - 6 mg/day ; N = 164 ) among hospital in patients who met DSM-IV criteria for bipolar I disorder , manic or mixed episode , without psychotic features . 
    Output:
    
Risperidone was compared to  clozapine , olanzapine , perphenazine , quetiapine and ziprasidone .
AUTHORS ' CONCLUSIONS There is not sufficient good- quality evidence available to determine the effects of risperidone compared with other antipsychotics in people with a dual diagnosis .