***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: BACKGROUND Previously , we demonstrated that cognitive behavior therapy for ultra-high risk ( called CBTuhr ) halved the incidence of psychosis over an 18-month period . Follow-up data from the same study are used to evaluate the longer-term effects at 4 years post-baseline . METHOD The Dutch Early Detection and Intervention Evaluation study was a r and omized controlled trial of 196 UHR patients comparing CBTuhr with treatment-as-usual ( TAU ) for comorbid disorders with TAU only . Of the original 196 patients , 113 consented to a 4-year follow-up ( 57.7 % ; CBTuhr = 56 vs TAU = 57 ) . Over the study period , psychosis incidence , remission from UHR status , and the effects of transition to psychosis were evaluated . RESULTS The number of participants in the CBTuhr group making the transition to psychosis increased from 10 at 18-month follow-up to 12 at 4-year follow-up whereas it did not change in the TAU group ( n = 22 ) ; this still represents a clinical ly important ( incidence rate ratio [ IRR ] = 12/22 = 0.55 ) and significant effect ( F(1,5 ) = 8.09 , P = .03 ) , favoring CBTuhr . The odds ratio of CBTuhr compared to TAU was 0.44 ( 95 % CI : 0.24 - 0.82 ) and the number needed to treat was 8 . Moreover , significantly more patients remitted from their UHR status in the CBTuhr group ( 76.3 % ) compared with the TAU group ( 58.7 % ) [ t(120 ) = 2.08 , P = .04 ] . Importantly , transition to psychosis was associated with more severe psychopathology and social functioning at 4-year follow-up . CONCLUSIONS CBTuhr to prevent a first episode of psychosis in persons at UHR of developing psychosis is still effective at 4-year follow-up . Our data also show that individuals meeting the formal criteria of a psychotic disorder have worse functional and social outcomes compared with non-transitioned cases . TRIAL REGISTRATION The trial is registered at Current Controlled Trials as trial number IS RCT N21353122 ( http://controlled-trials.com/IS RCT N21353122/gaag ) Objective : Impaired social functioning is one of the defining features of patients with schizophrenia and subjects at ultra-high risk ( UHR ) for psychosis . This prospect i ve study aim ed to investigate the course of social dysfunction in UHR subjects and to examine its relationship with later conversion to psychosis . The effect of pharmacotherapy on the course of social dysfunction was also examined . Method : A total of 57 UHR subjects and 58 healthy controls participated in this study . The Social Functioning Scale ( SFS ) was used to assess social functioning of UHR subjects at baseline and at the 1 year follow up . The changes in social functioning of UHR subjects have been examined to compare the social functioning of those who later converted to psychosis ( ‘ converters ’ ) with those who did not ( ‘ non-converters ’ ) . The effect of  pharmacotherapy  on longitudinal change in social functioning was also evaluated . Results : Subjects at UHR for psychosis showed more impaired social functioning at baseline than did healthy controls . Moreover , the course of social dysfunction of the converter and non-converter groups differed during the 1 year follow up period . The converters showed decreases in SFS average ( F ( 1,32 ) = 7.85 , p = 0.009 ) and interpersonal behaviour ( F ( 1,32 ) = 10.43 , p = 0.003 ) scores over time , whereas the non-converters showed increased scores . Additionally , we found that pharmacological treatment was associated with increased prosocial activities score ( F ( 1,32 ) = 4.66 , p = 0.038 ) . Conclusions : We found that the social functioning of converters was impaired before the onset of the psychosis and further declined during the at-risk phase . A series of social functioning indices in the longitudinal course may be helpful in predicting conversion to psychosis in subjects at UHR .  Appropriate pharmacotherapy can offer clinical benefits by improving social functioning in UHR individuals AIM Recent research has indicated that preventative intervention is likely to benefit patients ' at-risk ' for psychosis , both in terms of symptom reduction and delay or prevention of onset of threshold psychotic disorder . The strong preliminary results for the effectiveness of omega-3 polyunsaturated fatty acids ( PUFAs ) , coupled with the falling transition rate in ultra high-risk ( UHR ) sample s , mean that further study of such benign , potentially neuroprotective interventions is clinical ly and ethically required . Employing a multicentre approach , enabling a large sample size , this study will provide important information with regard to the use of omega-3 PUFAs in the UHR group . METHODS This trial is a 6-month , double-blind , r and omized placebo-controlled trial of 1.4 g day-1 omega-3 PUFAs in UHR patients aged between 13 and 40 years . The primary hypothesis is that UHR patients receiving omega-3 PUFAs plus cognitive-behavioural case management ( CBCM )  will be less likely to transition to psychosis over a 6-month period compared to treatment with placebo plus CBCM . Secondary outcomes will examine symptomatic and functional changes , as well as examine if c and i date risk factors predict response to omega-3 PUFA treatment in the UHR group . CONCLUSION This is the protocol of the NeuraproE study . Utilizing a large sample , results from this study will be important in informing indicated prevention strategies for schizophrenia and other psychotic disorders , which may be the strongest avenue for reducing the burden , stigmatization , disability and economic consequences of these disorders Despite increased efforts over the last decade to prospect ively identify individuals at ultra-high risk of developing a  psychotic illness  , limited attention has been specifically directed towards adolescent population s ( < 18 years ) . In order to evaluate how those under 18 fulfilling the operationalised criteria for an At-Risk Mental State ( ARMS ) present and fare over time , we conducted an observational study . Participants ( N = 30 ) generally reported a high degree of functional disability and frequent and distressing perceptual disturbance , mainly in the form of auditory hallucinations . Seventy percent ( 21/30 ) were found to fulfil the criteria for a co-morbid ICD-10 listed mental health disorder , with mood ( affective ; 13/30 ) disorders being most prevalent . Overall transition rates to psychosis were low at 24 months follow-up ( 2/28 ; 7.1 % ) whilst many participants demonstrated a significant reduction in psychotic-like symptoms . The generalisation of these findings may be limited due to the small sample size and require replication in a larger sample BACKGROUND Although there is evidence for the effectiveness of interventions for psychosis among ultra-high-risk ( UHR ) groups , health economic evaluations are lacking . This study aim ed to determine the cost effectiveness and cost-utility of cognitive-behavioural therapy ( CBT ) to prevent first-episode psychosis . METHOD The Dutch Early Detection and Intervention Evaluation study was a r and omized controlled trial of 196 UHR patients with an 18-month follow-up . All participants were treated with routine care ( RC ) for non-psychotic disorders . The experimental group ( n = 95 ) received add-on CBT to prevent first-episode psychosis . We report the intervention , medical and travel costs , as well as costs arising from loss of productivity . Treatment response was defined as psychosis-free survival and quality -adjusted life years ( QALYs ) gained . RESULTS In the cost-effectiveness analysis , the proportion of averted psychoses was significantly higher in the CBT condition ( 89.5 % v. 76.2 % ) . CBT showed a 63.7 % probability of being more cost effective , because it was less costly than RC by US$ 844 ( £ 551 ) per prevented psychosis . In the cost-utility analysis , QALY health gains were slightly higher for CBT than for RC ( 0.60 v. 0.57 ) and the CBT intervention had a 52.3 % probability of being the superior treatment because , for equal or better QALY gains , the costs of CBT were lower than those of RC . CONCLUSIONS Add-on preventive CBT for UHR result ed in a significant reduction in the incidence of first psychosis . QALY gains show little difference between the two conditions . The CBT intervention proved to be cost saving BACKGROUND Cannabis use is associated with an increased risk of developing a psychotic disorder but the temporal relationship between cannabis use and onset of illness is unclear . The objective of this study was to assess prospect ively the influence of cannabis use on transition to psychosis in people at ultra-high risk ( UHR ) for the disorder . METHOD Lifetime and continued cannabis use was assessed in a consecutively ascertained sample of 182 people ( 104 male , 78 female ) at UHR for psychosis . Individuals were then followed clinical ly for 2 years to determine their clinical outcomes . RESULTS Lifetime cannabis use was reported by 134 individuals ( 73.6 % ) . However , most of these individuals had stopped using cannabis before clinical presentation ( n=98 , 73.1 % ) , usually because of adverse effects . Among lifetime users , frequent use , early-onset use and continued use after presentation were all associated with an increase in transition to psychosis . Transition to psychosis was highest among those who started using cannabis before the age of 15 years and went on to use frequently ( frequent early-onset use : 25 % ; infrequent or late-onset use : 5 % ; χ(2)1=10.971 , p=0.001 ) . However , within the whole sample , cannabis users were no more likely to develop psychosis than those who had never used cannabis ( cannabis use : 12.7 % ; no use : 18.8 % ; χ(2)1=1.061 , p=0.303 ) . CONCLUSIONS In people at UHR for psychosis , lifetime cannabis use was common but not related to outcome . Among cannabis users , frequent use , early-onset use and continued use after clinical presentation were associated with transition to psychosis Social amotivation and diminished expression have been reported to underlie negative symptomatology in schizophrenia . In the current study we sought to establish and vali date these negative symptom domains in a large cohort of schizophrenia subjects ( n=887 ) and individuals who are deemed to be Ultra-High Risk ( UHR ) for psychosis . Confirmatory factor analysis conducted on PANSS item domains demonstrate that the dual negative symptom domains exist in schizophrenia and UHR subjects . We further sought to examine if these negative symptom domains were associated with functioning in UHR subjects . Linear regression analyses confirmed that social amotivation predicted functioning in UHR subjects prospect ively at 1 year follow up . Results suggest that the association between social amotivation and functioning is generalisable beyond schizophrenia population s to those who are at-risk of developing psychosis . Social amotivation may be an important dimensional clinical construct to be studied across a range of psychiatric conditions Background Psychotic disorders are a serious mental health problem . Intervention before the onset of psychosis might result in delaying the onset , reducing the impact or even preventing the first episode of psychosis . This study explores the effectiveness of cognitive behavioural therapy ( CBT ) in targeting cognitive biases that are involved in the formation of delusions in persons with an ultra-high risk for developing psychosis . A single blind r and omised controlled trial compares CBT with treatment as usual in preventing or delaying the onset of psychosis . Method / design All help seeking patients aged 14 to 35 years referred to the mental health services in three regions in the Netherl and s are pre-screened with the Prodromal Question naire during a period of two years . Patients with a score of 18 or more on the sub- clinical positive symptoms items ( 45 items in total ) will be assessed with the Comprehensive Assessment of At Risk Mental State ( CAARMS ) . In a different pathway to care model all referrals from the mental health services in Amsterdam to the specialized psychosis clinic of the Academic Medical Centre in Amsterdam are also assessed with the CAARMS . The primary outcome is the transition rate to psychosis according to the CAARMS- criteria . Group differences will be analysed with chi-square tests and survival analyses . Discussion CBT is a highly tolerated treatment . The psycho-educational CBT approach may prove to be a successful strategy since most people with an At Risk Mental State ( ARMS ) are distressed by odd disturbing experiences . Giving explanations for and normalising these experiences may reduce the arousal ( distress ) and therefore may prevent people from developing a catastrophic delusional explanation for their odd experiences and thus prevent them from developing psychosis . Screening the entire help-seeking population referred to community mental health services with a two-stage strategy , as compared with traditional referral to a specialist clinical psychosis centre , might detect more ultra-high-risk ( UHR ) patients . This type of screening could be implemented in mental health care as routine screening . The trial is registered at Current Controlled trials as trial number IS RCT N21353122 AIM Based on previous reports of second-generation antipsychotic agents having a beneficial effect on prodromal symptoms , we investigated the effectiveness and tolerability of atypical antipsychotic therapies in individuals at high risk for developing psychosis . METHODS We examined prodromal symptoms and functioning in individuals at 
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When they are included , the  CAARMS scores differ between some minorities and the native-born majority group .
This selection bias may result in lower validity for the CAARMS among these population s and thus in inadequate intervention programmes .