***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: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results The Soteria project ( 1971–1983 ) compared residential treatment in the community and minimal use of antipsychotic medication with “ usual ” hospital treatment for patients with early episode schizophrenia spectrum psychosis . Newly diagnosed DSM-II schizophrenia subjects were assigned consecutively ( 1971 to 1976 , N = 79 ) or r and omly ( 1976 to 1979 , N = 100 ) to the hospital or Soteria and followed for 2 years . Admission diagnoses were subsequently converted to DSM-IV schizophrenia and schizophreniform disorder . Multivariate analyses evaluated hypotheses of equal or better outcomes in Soteria on eight individual outcome measures and a composite outcome scale in three ways : for endpoint subjects ( N = 160 ) , for completing subjects ( N = 129 ) , and for completing subjects corrected for differential attrition ( N = 129 ) . Endpoint subjects exhibited small to medium effect size trends favoring experimental treatment . Completing subjects had significantly better composite outcomes of a medium effect size at Soteria ( + .47 SD , p = .03 ) . Completing subjects with schizophrenia exhibited a large effect size benefit with Soteria treatment ( + .81 SD , p = .02 ) , particularly in domains of psychopathology , work , and social functioning .  Soteria treatment result ed in better 2-year outcomes for patients with newly diagnosed schizophrenia spectrum psychoses , particularly for completing subjects and for those with schizophrenia . In addition , only 58 % of Soteria subjects received antipsychotic medications during the follow-up period , and only 19 % were continuously maintained on antipsychotic medications A double-blind withdrawal trial in 41 chronic schizophrenic out patients was carried out during 6 months . Depot neuroleptics ( fluphenazine decanoate or flupenthixol decanoate ) were compared with placebo to evaluate clinical and neurological effects during continued therapy and during withdrawal . The drugs were significantly more effective than placebo in preventing relapse and rehospitalization . In the placebo group 62 % relapsed compared to 27 % in the drug group . There was a weak and nonsignificant tendency to a higher relapse frequency in the flupenthixol group compared to the fluphenazine group . After withdrawal for 6 months , plasma levels for fluphenazine were detectable . Plasma levels for flupenthixol  were not detectable after 9 weeks of withdrawal . The differences in the plasma levels may possibly explain the difference in relapse rate between the two depot neuroleptics . Furthermore , it was found that the patients who relapsed during fluphenazine treatment had a significantly lower plasma level of the drug than patients who did not relapse during treatment . The results from this study provide some information on the therapeutic levels of fluphenazine and flupenthixol in schizophrenic patients A six-month evaluation of penfluridol , a long-acting oral preparation , was conducted with 50 severely ill schizophrenic patients . After an initial three-month stabiization period , the patients were divided into two equal groups and a double-blind evaluation of penfluridol versus placebo was conducted . The results of this study indicate that weekly administration of penfluridol ( one oral dose ) provides relatively safe and adequate control of severely ill schizophrenic patients  and displays efficacy similar to that of the shorter-acting antipsychotic agents . If these results are confirmed by other clinical investigators , this medication may prove to be of invaluable help in maintaining the schizophrenic patient in his community Out of 253 patients fulfilling criteria for a first episode of schizophrenic illness , 120 entered a r and omised placebo-controlled trial of maintenance neuroleptic medication on discharge ; they were followed to relapse or loss to follow-up , for two years or to the end of the study . Of those on active medication , 46 % relapsed , as did 62 % of those on placebo ; the most important determinant of relapse was duration of illness prior to starting neuroleptic medication . This finding might be because extended duration of symptoms before admission is more likely to be present in illnesses which in any case will have poor prognosis , or because susceptibility to relapse is reduced by early institution of treatment . The study provides no data on which a decision between these alternative explanations can be based BACKGROUND Amisulpride is a substituted benzamide with high selectivity for dopamine D2 and D3 receptors . The purpose of the study was to evaluate the effect of 100 mg amisulpride in patients with predominantly negative symptoms of schizophrenia . METHOD This was a multi-centre , r and omised , parallel-group , double-blind study . Patients received either amisulpride ( 100 mg/day ) or placebo over a six-month treatment period . RESULTS A total of 141 patients were included , 69 received amisulpride , 72 placebo .  Fifty-eight patients ( 41 % ) had received neuroleptic treatment prior to inclusion . The percentage of amisulpride patients completing the study ( 55 % ) was significantly higher than that with placebo ( 32 % ) , and drop-out rates due to lack of efficacy were 27 % with amisulpride and 47 % with placebo . All efficacy assessment s were statistically in favour of amisulpride compared with placebo . The overall incidence of extrapyramidal symptoms was comparable in both groups ; only five patients started anti-Parkinsonian treatment during the study ( one in the placebo and four in the amisulpride group ) . CONCLUSION Amisulpride is effective in the medium-term treatment schizophrenic patients with predominantly negative symptoms 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 A double-blind , placebo-controlled trial was carried out to determine the value of maintenance therapy with phenothiazines in a population of out patients who had recently recovered from an acute episode of schizophrenia . The drug was shown to be significantly more effective than the placebo in preventing relapse . The relationship of the trial patients to the population from which they were selected was defined in terms of clinical , historical , and social data . Maintenance therapy seems of little value in patients with a good prognosis and in the severely ill , but it is of value in the indeterminate group between these two extremes Twenty‐seven long‐term psychiatric in patients maintained on neuroleptics with concomitant antiparkinsonian medication were entered into a study in which anticholinergic medication was gradually withdrawn in a r and omized double‐blind within‐subjects design . The extrapyramidal symptoms of each patient were compared when taking their usual anticholinergic medication , when taking placebo and when taking no antiparkinsonian drug . The relapse rate on no medication was 14 % , and if patients relapsed on no medication they also relapsed on placebo . The relapse rate was not significantly different on active medication . Nor were there significant differences in ratings of parkinsonism or dyskinesia . The lack of difference between double‐blind and overt withdrawal does not mean that studies that find a much higher relapse rate are necessarily unaffected by nonspecific factors , as significant unblinding may occur in clinical trials The plasma prolactin ( PRL ) levels of 35 chronic schizophrenic patients undergoing long‐term maintenance treatment with neuroleptic drugs  were measured before and after either neuroleptic withdrawal or a switch to a fixed dose of chlorpromazine 900 mg/ day . In both men and women there tended to be a significant correlation between the initial log plasma PRL level while on neuroleptic maintenance treatment and the dosage received converted to chlorpromazine equivalents . Neuroleptic withdrawal in each of 19 cases was followed by a decline in PRL plasma levels . Switching to chlorpromazine 900 mg/day ( 16 cases ) produced either increases or decreases in PRL plasma levels that were significantly correlated with the change in neuroleptic dosage converted to chlorpromazine equivalents . Thus there was no evidence of tolerance to the PRL‐elevating effect of neuroleptics in these patients who had been treated for many years with neuroleptics An earlier study ( Study 1 : 14 months duration ) showed that the PAT ( an auditory attention task ) is sensitive to changes of clinical state in chronic schizophrenia and is able to predict hospital discharge . The newly presented study ( Study 2 : 12 months duration ) investigated the effects of increasing the dose of chlorpromazine ( CPZ ) stepwise ( double-blind ) to between 900 mg and 1800 mg per day , in 10 of the original 20 patients . Measurements were made fortnightly throughout both studies and the data were depicted continuously for each patient . Study 2 showed that a 300 % increase of CPZ dose neither improved nor impaired PAT performance . Also , the addition of orphenadrine 300 mg per day had no significant effect on performance . Four types of relapse were detected . The first was induced by placebo substitution for CPZ and recovered when the drug was reinstated . The remaining types of relapse were all resistant to CPZ and comprised : a long-period pattern with a spontaneous reversal ; unremitting deterioration ; and a short-period pattern of labile relapse and recovery The postulated deficiency of prostagl and in E1 series ( PGE1 ) in schizophrenia has been investigated in a controlled therapeutic trial . Twenty-one in patients with a schizophrenic illness resistant to neuroleptic drug treatments were r and omly assigned to one of three treatment conditions in a blind controlled trial of dihomo-gammalinolenic acid ( DHLA ) , a PGE1 precursor . Patients received depot neuroleptic medication and DHLA capsules , placebo depot medication and DHLA capsules , or placebo depot medication and placebo capsules .  No marked treatment effects were noticed on ratings of the patients ' behaviour or symptomatology , though some clinical effects were noted in dyskinetic patients . Abnormalities in red blood cell lipids were observed in the patients entering the trial , suggesting that further investigation of an EFA/prostagl and in deficiency hypothesis in schizophrenia is worth pursuing The dopamine hypothesis of schizophrenia cl aims that increased dopamine activity underlies psychotic behavior . This hypothesis gets major support from the reported d-amphetamine-induced worsening of psychosis , because amphetamine increases dopamine activity in the brain . Dopamine receptor supersensitivity has been shown to be present in animals during the postneuroleptic period . In this study the postulated relationships between psychotic decompensation as observed after d-amphetamine infusion and the dopamine receptor supersensitivity expected to be present during the neuroleptic withdrawal period were examined . Tw 
    Output:
    
Although this and other potential sources of bias limited the overall quality , the efficacy of antipsychotic drugs for maintenance treatment in schizophrenia was clear .
The results clearly demonstrate the superiority of antipsychotic drugs compared to placebo in preventing relapse .
This effect must be weighed against the side effects of antipsychotic drugs .