***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 Because wide variations in mental health care utilization exist throughout the world , determining long-term effectiveness of psychotropic medications in a real-world setting would be beneficial to physicians and patients . The purpose of this analysis was to describe the effectiveness of injectable risperidone long-acting therapy ( RLAT ) for schizophrenia across countries . Methods This was a pragmatic analysis of data from two prospect i ve observational studies conducted in the US ( Schizophrenia Outcomes Utilization Relapse and Clinical Evaluation [ SOURCE ] ; Clinical Trials.gov registration number for the SOURCE study : NCT00246194 ) and Spain , Australia , and Belgium ( electronic Schizophrenia Treatment Adherence Registry [ eSTAR ] ) . Two separate analyses were performed to assess clinical improvement during the study and estimate psychiatric hospitalization rates before and after RLAT initiation . Clinical improvement was evaluated using the Clinical Global Impressions-Severity ( CGI-S ) and Global Assessment of Functioning ( GAF ) scales , and change from baseline was evaluated using paired t tests . Psychiatric hospitalization rates were analyzed using incidence densities , and the bootstrap resampling method was used to examine differences between the pre-baseline and post-baseline periods . Results The initial sample comprised 3,069 patients ( US , n = 532 ; Spain , n = 1,345 ; Australia , n = 784 ; and Belgium , n = 408 ) . In all , 24 months of study participation , completed by 39.3 % ( n = 209 ) , 62.7 % ( n = 843 ) , 45.8 % ( n = 359 ) , and 64.2 % ( n = 262 ) of patients from the US , Spain , Australia , and Belgium , respectively , were included in the clinical analysis . Improvements compared with baseline were observed on both clinical assessment s across countries ( P < 0.001 at all post-baseline visits ) . The mean improvement was approximately 1 point on the CGI-S and 15 points on the GAF . A total of 435 ( 81.8 % ) , 1,339 ( 99.6 % ) , 734 ( 93.6 % ) , and 393 ( 96.3 % ) patients from the US , Spain , Australia , and Belgium , respectively , had ≥1 post-baseline visit and were included in the analysis of psychiatric hospitalization rates . Hospitalization rates decreased significantly in all countries regardless of hospitalization status at RLAT initiation ( P < 0.0001 ) and decreased significantly in the US and Spain ( P < 0.0001 ) when the analysis was limited to out patients only . Conclusions RLAT in patients with schizophrenia was associated with improvements in clinical and functional outcomes and decreased hospitalization rates in the US , Spain , Australia , and Belgium , despite differences in health care delivery systems Paliperidone palmitate is a long-acting injectable antipsychotic agent . This 13-week , multicenter , r and omized ( 1 : 1 : 1 : 1 ) , double-blind , parallel-group study evaluated the efficacy , safety , and tolerability of fixed 25 , 50 , and 100 milligram equivalent ( mg equiv . ) doses of paliperidone palmitate vs placebo administered as gluteal injections on days 1 and 8 , then every 4 weeks ( days 36 and 64 ) in 518 adult patients with schizophrenia . The intent-to-treat analysis set ( N=514 ) was 67 % men and 67 % White , with a mean age of 41 years . All paliperidone palmitate dose groups showed significant improvement vs placebo in the Positive and Negative Syndrome Scale ( PANSS ) total score ( primary efficacy measure ; 25 and 50 mg equiv . , p=0.02 ; 100 mg equiv . , p<0.001 ) , as well as Clinical Global Impression Severity scores ( p⩽0.006 ) and PANSS negative and positive symptom Marder factor scores ( p⩽0.04 ) . The Personal and Social Performance scale showed no significant difference between treatment groups . The overall incidence of treatment-emergent adverse events was similar between groups . Parkinsonism , the most frequently reported extrapyramidal symptom , was reported at similar rates for placebo ( 5 % ) and paliperidone palmitate ( 5–6 % across doses ) . The mean body mass index and mean weight showed relatively small dose-related increases during paliperidone palmitate treatment . Investigator-evaluated injection-site pain , swelling , redness , and in duration were similar across treatment groups ; scores for patient-evaluated injection-site pain ( visual analog scale ) were similar across groups and diminished with time . All doses of once-monthly paliperidone palmitate were efficacious and generally tolerated , both locally and systemically . Paliperidone palmitate offers the potential to improve outcomes in adults with symptomatic schizophrenia This study assessed the efficacy and the safety of a dosing regimen that was revised from earlier studies for the investigational injectable atypical antipsychotic paliperidone palmitate ( approved in the USA , August 2009 ) for adult patients with acutely exacerbated schizophrenia . The patients ( N = 652 ) were r and omly assigned ( 1:1:1:1 ) to paliperidone palmitate at 25 , 100 , or 150 mg eq. or placebo in this 13-week double-blind study . The patients received an injection of paliperidone palmitate at 150 mg eq. or placebo in the deltoid muscle on day 1 and the assigned fixed dose or placebo in the deltoid or muscle on day 8 and then once monthly ( days 36 and 64 ) . No oral supplementation was used . Target plasma levels were achieved by day 8 in all paliperidone palmitate groups . The mean change in Positive and Negative Syndrome Scale total score from baseline to end point improved significantly ( P ≤ 0.034 ) in all the paliperidone palmitate dose-groups versus placebo . Paliperidone palmitate treatment with this revised dosing regimen led to the achievement of rapid and consistent therapeutically effective plasma levels that were maintained by once-monthly dosing in either the deltoid or gluteal muscle . Common treatment-emergent adverse events ( ≥2 % of patients in any of the treatment groups ) that occurred more frequently in the total paliperidone palmitate group versus the placebo group ( with ≥1 % difference ) were injection-site pain ( 7.6 % vs 3.7 % ) , dizziness ( 2.5 % vs 1.2 % ) , sedation ( 2.3 % vs 0.6 % ) , pain in the extremity ( 1.6 % vs 0.0 % ) , and myalgia ( 1.0 % vs 0.0 % ) . The paliperidone palmitate treatment was efficacious and generally tolerated across the dose range ( 25 , 100 , or 150 mg eq. ) in adult patients with acutely exacerbated schizophrenia . Abbreviations : BMI - body mass index , CGI-S - Clinical Global Impression-Severity , EPS - extrapyramidal symptoms , ER - extended release , ITT - intent-to-treat , LAI - long-acting injectable , PANSS - Positive and Negative Syndrome Scale , PK - pharmacokinetic , PSP - Personal and Social Performance Scale , TEAE - treatment-emergent adverse events , VAS - Visual Analogue OBJECTIVE The authors assessed the efficacy and safety of the first long-acting atypical antipsychotic ( long-acting injectable risperidone ) in patients with schizophrenia . METHOD In a 12-week , multicenter , double-blind , r and omized study , patients received intramuscular injections every 2 weeks of placebo or long-acting risperidone ( 25 mg , 50 mg , or 75 mg ) . The primary measure of efficacy was the change in total score on the Positive and Negative Syndrome Scale . RESULTS Of the 554 patients who were enrolled , 400 entered the double-blind study , and 370 received at least one postbaseline assessment .  Mean changes in score of -6.2 , -8.5 , and -7.4 on the Positive and Negative Syndrome Scale were seen at endpoint for the 25- , 50- , and 75-mg risperidone groups , respectively ; all three change scores were significantly different from that seen with placebo ( + 2.6 ) . Improvements in positive and negative symptoms were also significantly greater in patients receiving risperidone . Long-acting risperidone was well tolerated . Adverse events related to extrapyramidal symptoms were spontaneously reported by 13 % of patients receiving placebo and 10 % of patients in the 25-mg risperidone group , with higher rates in the 50-mg and 75-mg groups . Severity of extrapyramidal symptoms was mild at baseline and throughout the trial in each treatment group . Mean weight changes were small in the 25- , 50- , and 75-mg risperidone groups ( 0.5 kg , 1.2 kg , and 1.9 kg , respectively ) . Injection site pain was rated as low by the patients , consistent with the investigators ' pain ratings . CONCLUSIONS Long-acting injectable risperidone was efficacious and well tolerated and provides both clinicians and patients with a new mode of treatment that can improve the outcome of long-term therapy The maintained antipsychotic efficacy of risperidone long-acting injectable ( RLAI ) was investigated in patients with schizophrenia or other psychoses who were transitioned directly from their previous antipsychotic medication . Patients symptomatically stable , but considered to require a treatment change , received 25 mg of RLAI ( increased to 37.5 or 50 mg , if necessary ) every 2 weeks for 6 months . Assessment s included Positive and Negative Syndrome Scale ( PANSS ) , Clinical Global Impression – Severity ( CGI-S ) , Global Assessment of Functioning ( GAF ) , SF-36 Health-Related Quality of Life Question naire and Extrapyramidal Symptoms Rating Scale ( ESRS ) .  Of 1876 patients enrolled , 74 % completed the 6-month study . The most frequent reasons for treatment change were non-compliance ( 38 % ) , insufficient efficacy ( 33 % ) and side-effects ( 26 % ) . There was a significant reduction from baseline to endpoint in mean total PANSS score and in the scores on all PANSS subscales and symptom factors ( P<0.001 ) . CGI-S improved significantly , as did mean GAF score , all factors on the SF-36 and patient satisfaction with treatment . Scores on ESRS showed significant , sustained improvements throughout the study period . Direct initiation of RLAI was effective and well tolerated . RLAI provides an advancement in the treatment options available for a wide range of patients requiring long-term antipsychotic therapy Abstract Objective To study the association between prescribed antipsychotic drugs and outcome in schizophrenia or schizoaffective disorder in the community . Design Prospect i ve cohort study using national central registers . Setting Community care in Finl and . Participants Nationwide cohort of 2230 consecutive adults hospitalised in Finl and for the first time because of schizophrenia or schizoaffective disorder , January 1995 to December 2001 . Main outcome measures Rates of discontinuation of drugs ( all causes ) , rates of rehospitalisation , and mortality associated with monotherapy with the 10 most commonly used antipsychotic drugs . Multivariate models and propensity score methods were used to adjust estimates of effectiveness . Results Initial use of clozapine ( adjusted relative risk 0.17 , 95 % confidence interval 0.10 to 0.29 ) , perphenazine depot ( 0.24 , 0.13 to 0.47 ) , and olanzapine ( 0.35 , 0.18 to 0.71 ) were associated with the lowest rates of discontinuation for any reason when compared with oral haloperidol . During an average follow-up of 3.6 years , 4640 cases of rehospitalisation were recorded . Current use of perphenazine depot ( 0.32 , 0.22 to 0.49 ) , olanzapine ( 0.54 , 0.41 to 0.71 ) , and clozapine ( 0.64 , 0.48 to 0.85 ) were associated with the lowest risk of rehospitalisation . Use of haloperidol was associated with a poor outcome  among women .  Mortality was markedly raised in patients not taking antipsychotics ( 12.3 , 6.0 to 24.1 ) and the risk of suicide was high ( 37.4 , 5.1 to 276 ) . Conclusions The effectiveness of first and second generation antipsychotics varies greatly in the community . Patients treated with perphenazine depot , clozapine , or olanzapine have a substantially lower risk of rehospitalisation or discontinuation ( for any reason ) of their initial treatment than do patients treated with haloperidol . Excess mortality is seen mostly in patients not using antipsychotic drugs BACKGROUND Recently , the " Remission in Schizophrenia Working Group " proposed remission criteria consisting of a reduction to mild levels on key symptoms for at least 6 months . AIMS This study applied these remission criteria to a large first-episode psychosis sample in order to ( 1 ) determine the rates of remission ; 
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Results While the efficacy of LAIs , compared with placebo , is well established , the evidence from RCTs is equivocal for any specific advantage for SGA LAIs , compared with oral medications , probably owing to challenges in conducting such RCTs .
Evidence from method ologically less rigorous studies and from clinical practice suggests some advantages in achieving and maintaining remission , risk of relapse , and hospitalization .
However , there is a relatively high rate of use in specific early psychosis programs and in conjunction with community treatment orders in Canada .
Conclusions LAIs are at least as effective as oral APs  in the treatment of psychotic disorders  .
The former may have specific advantages for patients who demonstrate covert nonadherence .