***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 
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    Input: BACKGROUND Antipsychotic drugs are usually the first line of treatment for schizophrenia ; however , many patients refuse or discontinue their pharmacological treatment . We aim ed to establish whether cognitive therapy was effective in reducing psychiatric symptoms in people with schizophrenia spectrum disorders who had chosen not to take antipsychotic drugs . METHODS We did a single-blind r and omised controlled trial at two UK centres between Feb 15 , 2010 , and May 30 , 2013 . Participants aged 16 - 65 years with schizophrenia spectrum disorders , who had chosen not to take antipsychotic drugs for psychosis , were r and omly assigned ( 1:1 ) , by a computerised system with permuted block sizes of four or six , to receive cognitive therapy plus treatment as usual , or treatment as usual alone . R and omisation was stratified by study site . Outcome assessors were masked to group allocation . Our primary outcome was total score on the positive and negative syndrome scale ( PANSS ) , which we assessed at baseline , and at months 3 , 6 , 9 , 12 , 15 , and 18 . Analysis was by intention to treat , with an ANCOVA model adjusted for site , age , sex , and baseline symptoms . This study is registered as an International St and ard R and omised Controlled Trial , number 29607432 . FINDINGS 74 individuals were r and omly assigned to receive either cognitive therapy plus treatment as usual ( n=37 ) , or treatment as usual alone ( n=37 ) . Mean PANSS total scores were consistently lower in the cognitive therapy group than in the treatment as usual group , with an estimated between-group effect size of -6.52 ( 95 % CI -10.79 to -2.25 ; p=0.003 ) . We recorded eight serious adverse events : two in patients in the cognitive therapy group ( one attempted overdose and one patient presenting risk to others , both after therapy ) , and six in those in the treatment as usual group ( two deaths , both of which were deemed unrelated to trial participation or mental health ; three compulsory admissions to hospital for treatment under the mental health act ; and one attempted overdose ) . INTERPRETATION Cognitive therapy significantly reduced psychiatric symptoms and seems to be a safe and acceptable alternative for people with schizophrenia spectrum disorders who have chosen not to take antipsychotic drugs . Evidence -based treatments should be available to these individuals . A larger , definitive trial is needed . FUNDING National Institute for Health Research BACKGROUND The effectiveness of a psychosocial skills training ( PSST ) approach applied to chronic out- patients with schizophrenia was examined . We hypothesized that the PSST programme , which included treatment as usual ( TAU ) , PSST and family therapy ( FT ) , would reduce positive and negative symptoms , prevent relapse and rehospitalization , and improve psychosocial functioning ( PSF ) , global functioning and treatment adherence . METHOD Eighty-two patients were r and omly assigned to receive either TAU [ antipsychotic medication ( AP ) ; n=39 ] or the PSST approach ( TAU+PSST+FT ; n=43 ) . The two groups were assessed at intake and after completion of 1 year of treatment . RESULTS There were statistically significant differences between the two groups . Patients in the PSST group improved their symptomatology , psychosocial and global functioning ( symptoms and psychological , social and occupational functioning ) , showed lower relapse , rehospitalization and drop-out rates , a higher level of compliance with AP medication , and a high level of therapeutic adherence in comparison with TAU patients , whose symptoms also improved although they showed no improvement in any of the clinical or psychosocial variables . A comparison of the st and ardized effect sizes showed a medium and a large effect size of PSF and global functioning for the PSST group and a non-effect size for the TAU group . CONCLUSIONS A higher level of effectiveness was demonstrated when combining TAU , PSST and FT in comparison with AP medication alone . The PSST approach should be recommended for clinical practice OBJECTIVE The present study aims to assess the efficacy of a structured psychoeducational group intervention for adolescents with early-onset psychosis and their families . The intervention was implemented in parallel in 2 separate groups by focusing specifically on problem-solving strategies and structured psychosis-related information to manage daily life difficulties associated with the disease , to mitigate crises , and to prevent relapses . METHOD We performed a 9-month , r and omized , rater-blinded clinical trial involving 55 adolescent patients with early-onset psychosis and either or both of their parents . A psychoeducational problem-solving group intervention ( n = 27 ) was compared with a nonstructured group intervention ( n = 28 ) . The primary outcomes were number of hospitalizations , days of hospitalization , and visits to the emergency department . The secondary outcome measures were clinical variables and family environment . RESULTS Assessment s were performed before and after the intervention . At the end of the group intervention , 15 % of patients in the psychoeducational group and 39 % patients in the nonstructured group had visited the emergency department ( χ² = 3.62 , df = 1 , p = .039 ) . The improvement in negative symptoms was more pronounced in the psychoeducational group ( 12.84 [ 7.87 ] ) than in the nonstructured group ( 15.81 [ 6.37 ] ) ( p = .039 ) . CONCLUSION A parallel psychoeducational group intervention providing written instructions in a structured manner could help adolescents with early-onset psychosis and their parents to manage crises by implementing problem-solving strategies within the family , thus reducing the number of visits to the emergency department . Negative symptoms improved in adolescents in the psychoeducational group . Clinical trial registration information -- Intervention Module AGES ( AGES-CM ) ; http:// clinical trials.gov/ ; NCT02101372 . [ corrected ] Objectives : To investigate the effectiveness of a long established intervention , occupational therapy for people with psychotic conditions , and to inform future research design s. Design : A pilot r and omized controlled trial . Setting : Two community mental health teams in a UK city . Participants : Forty-four adults with schizophrenia or other psychotic conditions , and functional problems . Interventions : Twelve months of individualized occupational therapy in community setting s , as an adjunct to usual care and compared to treatment as usual . A two to one r and omization ratio was used in favour of occupational therapy . Outcome measures : Social Functioning Scale , Scale for the Assessment of Negative Symptoms and employment . Results : Both groups ' scores on Social Functioning Scale and Scale for the Assessment of Negative Symptoms showed significant improvement over 12 months . The Social Functioning Scale overall mean difference for occupational therapy was 2.33 , P=0.020 and for treatment as usual was 6.17 , P=0.023 . The Scale for the Assessment of Negative Symptoms total mean difference for occupational therapy was -16.25 , P<0.001 and for treatment as usual was -17.36 , P= 0.011 . There were no differences between the two groups on any of the outcome measures . After 12 months the occupational therapy group showed clinical ly significant improvements that were not apparent in the control group . These were in four subscales of the Social Functioning Scale : relationships , independence performance , independence competence and recreation . Out of 30 people receiving occupational therapy  those with a clinical level of negative symptoms reduced from 18 ( 64 % ) to 13 ( 46 % ) , P=0.055 . Conclusion : This pilot study suggested that individualized occupational therapy may contribute to recovery but more focus is recommended on people 's cognitive abilities and employment This r and omised clinical trial assessed the effects of a 16‐week cognitive remediation programme ( NEUROCOM ) combined with an early intervention service ( EIS ) vs. EIS alone BACKGROUND There is increasing evidence that cognitive-behavioural therapy can be an effective intervention for patients experiencing drug-refractory positive symptoms of schizophrenia . AIMS To investigate the effects of cognitive-behavioural therapy on in- patients with treatment-refractory psychotic symptoms . METHOD Manualised therapy was compared with supportive counselling in a r and omised controlled study . Both interventions were delivered by experienced psychologists over 16 sessions of treatment . Therapy fidelity was assessed by two independent raters . Participants underwent masked assessment at baseline , after treatment and at 6 months ' follow-up . Main outcome measures were the Positive and Negative Syndrome Scale and the Psychotic Symptoms Rating Scale . The analysis was by intention to treat . RESULTS Participants receiving cognitive cognitive-behavioural therapy had improved with regard to auditory hallucinations and illness insight at the post-treatment assessment , but these findings were not maintained at follow-up . CONCLUSIONS Cognitive-behavioural therapy showed modest short-term benefits over supportive counselling for treatment-refractory positive symptoms of schizophrenia OBJECTIVE Cognitive remediation ( CR ) approaches have demonstrated to be effective in improving cognitive functions in schizophrenia . However , there is a lack of integrated CR approaches that target multiple neuro- and social-cognitive domains with a special focus on the generalization of therapy effects to functional outcome . METHOD This 8-site r and omized controlled trial evaluated the efficacy of a novel CR group therapy approach called integrated neurocognitive therapy ( INT ) . INT includes well-defined exercises to improve all neuro- and social-cognitive domains as defined by the Measurement And Treatment Research to Improve Cognition in Schizophrenia ( MATRICS ) initiative by compensation and restitution . One hundred and fifty-six out patients with a diagnosis of schizophrenia or schizoaffective disorder according to DSM-IV-TR or ICD-10 were r and omly assigned to receive 15 weeks of  INT or treatment as usual ( TAU ) . INT patients received 30 bi-weekly therapy sessions . Each session lasted 90min . Mixed models were applied to assess changes in neurocognition , social cognition , symptoms , and functional outcome at post-treatment and at 9-month follow-up . RESULTS In comparison to TAU , INT patients showed significant improvements in several neuro- and social-cognitive domains , negative symptoms , and functional outcome after therapy and at 9-month follow-up . Number-needed-to-treat analyses indicate that only 5 INT patients are necessary to produce durable and meaningful improvements in functional outcome . CONCLUSIONS Integrated interventions on neurocognition and social cognition have the potential to improve not only cognitive performance but also functional outcome . These findings are important as treatment guidelines for schizophrenia have criticized CR for its poor generalization effects BACKGROUND There is good evidence now that cognitive behaviour therapy ( CBT ) is effective in the treatment of people suffering from schizophrenia . There is also some evidence that the benefits of CBT persist after the end of treatment and that the direct costs of providing CBT as an adjunct to st and ard care are no higher than the direct costs of st and ard care alone . The aims of the present study were to discover if the benefits of CBT for acute schizophrenia which were found 1 year after index admission persist for another year , and to evaluate the comparative costs of providing CBT . METHOD Consecutive admissions meeting criteria were recruited . After screening , 43 were assigned at r and om to a treatment-as-usual ( TAU ) control group and 47 were assigned to TAU plus CBT .  Patients ( 73 % of original ) were rated on symptoms and social functioning 2 years after index admission . An evaluation of the direct costs of services was also completed . RESULTS The CBT group had maintained its advantage over the TAU group on negative symptoms and social functioning but had lost the advantage it previously enjoyed in positive symptoms . The difference between groups in total direct costs over the 2 years was not statistically significant despite the cost of providing CBT . CONCLUSIONS Some of the benefits of CBT for patients suffering acute psychotic episodes persist for 2 years . After the end of regular treatment , CBT should probably be targeted on the appearance of early signs of relapse to forestall the re-emergence of positive symptoms Background : Lifestyle moderate-intensity physical activity can lower the risk of over twenty chronic health conditions , whilst inactivity reduces daily functioning and physical health of individuals living with schizophrenia . This study conducted in 2014 examines the effect of structured walking participation on QOL , psychosocial functioning and symptoms in Hospital Permai , one of the largest psychiatry institution in Asia Method : Chronic patients with schizophrenia ( n=104 ) who met inclusion criteria were r and omised to either a 3-month structured walking intervention or a treatment-as-usual arm . The Positive and Negative Syndrome Scale ( PANSS ) , global functioning ( PSP ) and QOL ( SF-36 ) were measured at baseline and after the 3-month interval . Results : At 3 month follow-up , there were significant within group differences in QOL ( SF-36 ) , psychiatric symptoms ( PANSS ) , and personal and social performance ( PSP ) . There were statistically significant increase in the median SF-36 scores , with increases shown in physical functioning ( p<.001 ) , physical role limitations ( p<.05 ) , social functioning ( p<.01 ) in the intervention group compared to treatment-as-usual group . Statistically significant reduction of median PANSS score of the intervention group were noted in positive ( p<0.001 ) and negative ( p<0.01 ) symptom , and general psychopathology ( p<0.01 ) scales . Statistically significant increase in the median PSP score ( p<0. 
    Output:
    
Conclusions Specific psychological and psychosocial interventions have utility in ameliorating negative symptoms in psychosis and should be included in the treatment of negative symptoms .