***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: Abstract Objective : To examine the additional effect of cognitive behavioural therapy for patients with medically unexplained physical symptoms in comparison with optimised medical care . Design : R and omised controlled trial with follow up assessment s six and 12 months after the baseline evaluation . Setting : General medical outpatient clinic in a university hospital . Subjects : An intervention group of 39 patients and a control group of 40 patients . Interventions : The intervention group received between six and 16 sessions of cognitive behavioural therapy . Therapeutic techniques used included identification and modification of dysfunctional automatic thoughts and behavioural experiments aim ed at breaking the vicious cycles of the symptoms and their consequences . The control group received optimised medical care . Main outcome measures : The degree of change , frequency and intensity of the presenting symptoms , psychological distress , functional impairment , hypochondriacal beliefs and attitudes , and ( at 12 months of follow up ) number of visits to the general practitioner . Results : At six months of follow up the intervention group reported a higher recovery rate ( odds ratio 0.40 ; 95 % confidence interval 0.16 to 1.00 ) , a lower mean intensity of the physical symptoms ( difference −1.2 ; −2.0 to −0.3 ) , and less impairment of sleep ( odds ratio 0.38 ; 0.15 to 0.94 ) than the controls . After adjustment for coincidental baseline differences the intervention and control groups also differed with regard to frequency of the symptoms ( 0.32 ; 0.13 to 0.77 ) , limitations in social ( 0.35 ; 0.14 to 0.85 ) and leisure ( 0.36 ; 0.14 to 0.93 ) activities , and illness behaviour ( difference −2.5 ; −4.6 to −0.5 ) . At 12 months of follow up the differences between the groups were largely maintained . Conclusion : Cognitive behavioural therapy seems to be a feasible and effective treatment in general medical patients with unexplained physical symptoms We performed a prospect i ve study to describe the broad spectrum of causes of chest pain in patients presenting to the emergency department and to compare the diagnoses in  referred patients , self-referred patients and patients rushed in by ambulance .  The final diagnosis in a consecutive case series of 578 chest pain patients was established after discharge from the hospital . The underlying disorders were grouped into cardiac , respiratory , gastro-oesophageal disorders , musculoskeletal pathology , somatization disorders , other diseases and unknown . For comparison of the frequencies of the disease categories the Chi-squared test was used . Out of 578 patients , 161 ( 27.9 % ) were self-referred , 369 ( 63.8 % ) were referred by the general practitioner  and 48 ( 8.3 % ) were rushed in by ambulance . Cardiac diseases represented 51.7 % of the cases , myocardial infa rct ion and unstable angina 19 % and 12.8 % respectively . Cardiac diseases were statistically significantly less common in self-referred patients ( p < 0.0005 ) . Pulmonary diseases encompassed 14.2 % of the population , followed by somatization disorders ( 9.2 % ) , musculoskeletal pathology ( 7.1 % ) and other causes ( 4.3 % ) . In 11.1 % of the cases no definite final diagnosis could be established . Somatization disorders were significantly more frequent in self-referred and ambulance patients . Cardiac and pulmonary problems are the most frequent underlying disorders in acute chest pain patients in the emergency department . Somatization disorders and musculoskeletal pathology represented respectively 19.1 % and 14.8 % of the non-cardiac causes . The referral pattern influenced significantly the distribution of the disease categories with more cardiac and less psychiatric disorders in referred patients Three methods of breathing retraining ( guided breathing retraining , guided breathing retraining with physiologic monitoring of thoracic and abdominal movement plus peripheral temperature , and guided breathing retraining with physiologic monitoring of thoracic and abdominal movement , peripheral temperature and end-tidal carbon dioxide ) were compared with a no-treatment control group to determine the effectiveness of breathing retraining on modifying respiratory physiology and reducing functional cardiac symptoms in subjects with signs associated with hyperventilation syndrome . Of 41 subjects studied , 16 were diagnosed with mitral valve prolapse . Results demonstrated that all 3 methods of breathing retraining were equally effective in modifying respiratory physiology and reducing the frequency of functional cardiac symptoms . Results determined that respiratory rate and subject 's perception that training had generalized were the best predictors of treatment success . Furthermore , it was found that subjects with mitral valve prolapse  responded as well to treatment as did those without prolapse Personality and life events were measured in 69 consecutive patients ( 36 men and 33 women ) below age 40 attending the emergency care unit because of chest pain without obvious organic cause ( 91 % participation rate ) . The results were compared with 32 r and omly sample d healthy subjects matched with regard to age and sex ( 86 % participation rate ) . The patient group had significantly higher scores for " neuroticism ' , ' Type A behaviour ' and ' vital exhaustion ' . Further more the patients had experienced significantly more life events , in particular uncontrollable ones , during the last year . We conclude that ' Type A behaviour ' , ' neuroticism ' , ' vital exhaustion ' and critical recent life events are linked with emergency consultation for chest pain of non-cardiac origin . Possible explanations of the link between the psychological reaction and the chest pain are enhanced tension in the thoracic muscles producing chest pain and oesophageal disorders . This study stresses the importance of careful medical and psychosocial examination of each case of unexplained chest pain at the emergency care unit One hundred four clients completed a mailed follow-up 1 year after completing 8 of 16 sessions of treatment , either cognitive-behavioral ( CB ) or psychodynamic-interpersonal ( PI ) psychotherapy . Although mean scores on outcome measures at 1 year suggested that gains were , in general , well maintained , only 29 % of clients were asymptomatic on all 3 occasions of testing ( end of treatment , 3 months and 1 year later ) without recourse to further treatment . However , only 11 % of those asymptomatic at end of treatment experienced relapse or recurrence of depression , albeit on the limited evidence of just two follow-up assessment s. The results of comparisons among treatment conditions at 1 year differed substantially from those obtained earlier : Eight-session PI treatment now appeared less efficacious than the other 3 treatment conditions , and there was now no measurable benefit of 16-session over 8-session CB , irrespective of initial severity of depression . These findings confirm the importance of follow-up in evaluation of psychotherapies for depression 
    Output:
    
Review suggested a modest to moderate benefit for psychological interventions , particularly those using a cognitive-behavioural framework , which was largely restricted to the first three months after the intervention .
The evidence for brief interventions was less clear .