***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: Schizophrenia is a disruptive and distressing illness , not only for the person affected but also for family members . Family intervention , particularly in a group format using a diverse range of modalities , is thought to effectively satisfy the informational needs of families and enhance their coping abilities when caring for a relative with schizophrenia , and thus reduce a patient ’s relapse from illness . This study tested the hypothesis that participants in a family psychoeducation and mutual support group would demonstrate significant improvements in levels of patient and family functioning and shorter duration of re-hospitalization than families in routine care . A r and omized controlled trial was conducted with a sample of 68 Chinese families of schizophrenia sufferers in Hong Kong , who were r and omly assigned to either a  family psychoeducation and support group  ( n = 34 ) , or a  routine care group  ( n = 34 ) . The interventions were delivered at two psychiatric outpatient clinics over a nine-month period . Results of multivariate analyses of variance test indicated that the psychoeducation and support group reported greater improvements on family and patient functioning and shorter lengths of patient hospitalizations at the two post-tests ( one month and one year after completion of the intervention ) , compared with the routine care group . The findings substantiate that within a Chinese context , psychoeducation and mutual support group intervention can effectively help families care for a mentally ill relative 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 ] BACKGROUND Family intervention reduces relapse rates in psychosis .  Cognitive-behavioural therapy ( CBT ) improves positive symptoms but effects on relapse rates are not established . AIMS To test the effectiveness of CBT and family intervention in reducing relapse , and in improving symptoms and functioning in patients who had recently relapsed with non-affective psychosis . METHOD A multicentre r and omised controlled trial ( IS RCT N83557988 ) with two pathways : those without carers were allocated to treatment as usual or CBT plus treatment as usual , those with carers to treatment as usual , CBT plus treatment as usual or family intervention plus treatment as usual . The CBT and family intervention were focused on relapse prevention for 20 sessions over 9 months . RESULTS A total of 301 patients and 83 carers participated . Primary outcome data were available on 96 % of the total sample . The CBT and family intervention had no effects on rates of remission and relapse or on days in hospital at 12 or 24 months . For secondary outcomes , CBT showed a beneficial effect on depression at 24 months and there were no effects for family intervention . In people with carers , CBT significantly improved delusional distress and social functioning . Therapy did not change key psychological processes . CONCLUSIONS Generic CBT for psychosis is not indicated for routine relapse prevention in people recovering from a recent relapse of psychosis and should currently be reserved for those with distressing medication-unresponsive positive symptoms . Any CBT targeted at this acute population requires development . The lack of effect of family intervention on relapse may be attributable to the low overall relapse rate in those with carers BACKGROUND Family intervention in schizophrenia can reduce patient relapse and improve medication adherence , but few studies on this have involved a Chinese population . AIMS To examine the effects of a mutual support group for Chinese families of people with schizophrenia , compared with psychoeducation and st and ard care . METHOD R and omised controlled trial in Hong Kong with 96 families of out- patients with schizophrenia , of whom 32 received mutual support , 33 psychoeducation and 31 st and ard care .  The psychoeducation group included patients in all the sessions , the mutual support group did not . Intervention was provided over 6 months , and patient- and family-related psychosocial outcomes were compared over an 18-month follow-up . RESULTS Mutual support consistently produced greater improvement in patient and family functioning and caregiver burden over the intervention and follow-up periods , compared with the other two conditions . The number of readmissions did not decrease significantly , but their duration did . CONCLUSIONS Mutual support for families of Chinese people with schizophrenia can substantially benefit family and patient functioning and caregiver burden Background Caring for a young person experiencing first-episode psychosis is challenging and can affect carers ’ well-being adversely . While some face-to-face approaches have achieved promising outcomes , they are costly and re source -intensive to provide , restricting their reach and penetration . Guided self-help in book-form ( or bibliotherapy ) is an alternative but untested approach in these circumstances . In this study , we aim ed to evaluate carers ’ beliefs about the usefulness of problem-solving guided self-help manual for primary carers of young people with first-episode psychosis . Methods A qualitative process evaluation nested in a r and omised controlled trial , conducted across two early intervention psychosis services in Melbourne , Australia . 124 carers were r and omised to problem-solving guided self-help intervention or treatment as usual .  We also undertook a qualitative process evaluation , using individual interviews , with a r and om sample of 24 of the intervention group . A thematic analysis of the qualitative data was undertaken , which is the subject of this paper . Interviews were conducted between January 2009 and September 2010 . Results Three themes were abstract ed from the data , reflecting carers ’ beliefs about the usefulness of the manual : promoting carers ’ well-being , increasing carers ’ underst and ing of and support for the young person with first-episode psychosis , and accessibility and delivery modes of the programme . Conclusion This process evaluation highlights that guided self-help is useful in informing and supporting carers of affected young people . While there is scope for broadening the delivery modes , the approach is easy to use and accessible , and can be used as a cost-effective adjunct to st and ard support provided to carers , by community mental health nurses and other clinicians . Trial registration Abstract Aim Caring for young people with first‐episode psychosis is difficult and dem and ing , and has detrimental effects on carers ' well‐being , with few evidence ‐based re sources available to assist carers to deal with the problems they are confronted with in this situation . We aim ed to examine if completion of a self‐directed problem‐solving bibliotherapy by first‐time carers of young people with first‐episode psychosis improved their social problem solving compared with carers who only received treatment as usual . Methods A r and omized controlled trial was carried out through two early intervention psychosis services in Melbourne , Australia . A sample of 124 carers were r and omized to problem‐solving bibliotherapy or treatment as usual .  Participants were assessed at baseline , 6‐ and 16‐week follow‐up . Results Intent‐to‐treat analyses were used and showed that recipients of bibliotherapy had greater social problem‐solving abilities than those receiving treatment as usual , and these effects were maintained at both follow‐up time points . Conclusions Our findings affirm that bibliotherapy , as a low‐cost complement to treatment as usual for carers , had some effects in improving their problem‐solving skills when addressing problems related to the care and support of young people with first‐episode psychosis Family interventions for first-episode psychosis ( FEP ) are an integral component of treatment , with positive effects mainly on patients ’ mental state and relapse rate . However , comparatively little attention has been paid to the effects of family interventions on caregivers ’ stress coping and well-being , especially in non-Western countries . We aim ed to test the effects of a 5-month clinician-supported problem-solving bibliotherapy ( CSPSB ) for Chinese family caregivers of people with FEP in improving family burden and carers ’ problem-solving and caregiving experience , and in reducing psychotic symptoms and duration of re-hospitalizations , compared with those only received usual outpatient family support ( UOFS ) . A r and omized controlled trial was conducted across 2 early psychosis clinics in Hong Kong , where there might be inadequate usual family support services for FEP patients . A total of 116 caregivers were r and omly selected , and after baseline measurement , r and omly assigned to the CSPSB or UOFS . They were also assessed at 1-week and 6- and 12-month post-intervention . Intention-to-treat analyses were applied and indicated that the CSPSB group reported significantly greater improvements in family burden and caregiving experience , and reductions in severity of psychotic symptoms and duration of re-hospitalizations , than the UOFS group at 6- and 12-month follow-up . CSPSB produces moderate long-term benefits to caregivers and FEP patients , and is a low-cost adjunct to UOFS This r and omized controlled trial examined the effectiveness of a 12-session mutual support group conducted over 3-months for Chinese family caregivers of a relative with schizophrenia compared with routine family support services in Hong Kong . Forty-eight family caregivers from two psychiatric outpatient clinics were allocated r and omly to an experimental ( mutual support and usual outpatient care ) group  ( n = 24 ) or a  control ( usual outpatient care only ) group  ( n = 24 ) . Data were collected prior to , 1 week and 3 months after the intervention . Families allocated to the mutual support group experienced decreased levels of family burden and increased family functioning and these changes were significantly greater than those of the controls at both post-intervention time points . The experimental group also showed a significant decrease in the duration of patient re-hospitalization ( the total number of days of psychiatric hospitalization ) at 3 months compared with the control group . This suggests that the mutual support group provided a more responsive service for patients than st and ard care . However , there was no significant difference in family service utilization between the two groups . The findings indicate that a mutual support group can provide benefits for family caregivers of people with schizophrenia that go beyond those provided by routine family support OBJECTIVE To investigate whether the beneficial effects of a structured , psychoeducational , parallel-group program for adolescents with early-onset psychosis and their families observed immediately after the intervention were maintained 2 years later . METHOD The present study examines the longitudinal efficacy of a r and omized controlled trial based on a psychoeducational , problem-solving , structured group intervention for adolescents with early-onset psychosis and their families ( PE ) and compares it with that of a nonstructured group intervention ( NS ) after a 2-year follow-up . We analyzed whether the differences between PE and NS found after the intervention persisted 2 years later . Intergroup differences in number and duration of hospitalizations , symptoms , and functioning were also assessed . RESULTS After 2 years of follow-up , we were able to reassess 89 % of patients . In the PE group , 13 % of patients had visited the emergency department , compared with 50 % in the NS group ( p = .019 ) . However , no statistically significant differences were found between the groups for negative symptoms or number and duration of hospitalizations . A significant improvement in Positive and Negative Syndrome Scale ( PANSS ) general symptoms was observed in the PE group . CONCLUSION Our psychoeducational group intervention showed sustained effects by diminishing the number of visits to emergency departments 2 years after the intervention . Our findings indicate that this psychoeducational intervention could provide patients with long-lasting re sources to manage crises more effectively . Clinical trial registration information-Intervention Module AGES ( AGES-CM ) ; http:// clinical trials.gov/ ; NCT02101372 OBJECTIVE This study was conducted to test the effects of a nine-month family-led peer support group for Chinese people with schizophrenia in Hong Kong over a three-year follow-up and to compare outcomes with those of psychoeducation and st and ard psychiatric outpatient care . METHODS A r and omized controlled trial of 106 Chinese families of patients with schizophrenia was conducted between August 2007 and January 2011 in three psychiatric outpatient clinics 
    Output:
    
Compared with usual psychiatric care , family intervention was more effective in reducing care burden over all follow-up periods .
Family intervention was also superior to  usual care  with regards to caregiving experience in the short term and improved utilization of formal support and family functioning over longer-term follow up .
Mutual support is more effective than  psychoeducation  in improving family functioning when measured 1 to 2 years after the intervention but had equivalent effects on utilization of formal support services .
CONCLUSIONS This review provides evidence that family intervention is effective for caregivers of recent-onset psychosis , especially for care burden where the positive effects are enhanced over time