***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 Numerous early intervention services targeting young people with psychosis have been established , based on the premise that reducing treatment delay and providing intensive treatment in the initial phase of psychosis can improve long-term outcome . AIMS To establish the effect of extending a specialised early intervention treatment for first-episode psychosis by 1 year . METHOD A r and omised , single-blind controlled trial ( NCT01202357 ) compared a 1-year extension of specialised early intervention with step-down care in patients who had all received a 2-year intensive early intervention programme for first-episode psychosis . RESULTS Patients receiving an additional year of specialised intervention  had better outcomes in functioning , negative and depressive symptoms and treatment default rate than those managed by step-down psychiatric care . CONCLUSIONS Extending the period of specialised early intervention is clinical ly desirable but may not be feasible in lower-income countries Abstract Objectives To evaluate the effects of integrated treatment for patients with a first episode of psychotic illness . Table 2 Clinical outcomes and user satisfaction of patients with a first episode of psychotic illness who received integrated treatment or st and ard treatment . Values are means ( SD ) unless stated otherwise 1 year follow-up ( n=419 ) 2 year follow-up ( n=369 ) Integrated treatment ( n=227 ) St and ard treatment ( n=192 ) Estimated mean difference ( 95 % CI ) P value of difference Integrated treatment ( n=205 ) St and ard treatment ( n=164 ) Estimated mean difference ( 95 % CI ) P value of difference Psychopathology * : Psychotic dimension 1.09 ( 1.27 ) 1.35 ( 1.39 ) -0.31 ( −0.55 to −0.07 ) 0.02 1.06 ( 1.26 ) 1.27 ( 1.40 ) -0.32 ( −0.58 to −0.06 ) 0.02 Negative dimension 1.68 ( 1.10 ) 2.02 ( 1.12 ) -0.36 ( −0.54 to −0.17 ) < 0.001 1.41 ( 1.15 ) 1.82 ( 1.23 -0.45 ( −0.67 to −0.22 < 0.001 Disorganised dimension 0.40 ( 0.59 ) 0.42 ( 0.56 ) -0.04 ( −0.14 to 0.07 ) 0.5 0.37 ( 0.56 ) 0.50 ( 0.73 ) -0.12 ( −0.25 to 0.00 ) 0.06 GAF , symptom 48.2 ( 14.9 ) 44.9 ( 16.0 ) 3.00 ( 0.37 to 5.63 ) 0.03 51.18 ( 15.01 ) 48.67 ( 15.92 ) 2.45 ( −0.32 to 5.22 ) 0.08 GAF , function 51.7 ( 15.1 ) 49.4 ( 14.6 ) 2.61 ( 0.11 to 5.15 ) 0.04 55.16 ( 15.15 ) 51.13 ( 15.92 ) 3.12 ( 0.37 to 5.88 ) 0.03 User satisfaction† 24.9 ( 4.5 ) 23.0 ( 7.2 ) 1.88 ( 0.73 to 3.02 ) 0.001 26.1 ( 3.7 ) 22.9 ( 5.2 ) 3.09 ( 2.10 to 4.04 ) < 0.001 GAF = global assessment of functioning . * Estimated mean differences are based on a repeated measurements model with treatment site , sex , substance misuse , diagnosis at baseline , and baseline values of the scale included as covariates ( see text for details ) . † Based on client satisfaction question naire score . Estimated mean differences calculated by analysis of variance with treatment site as covariate . Design R and omised clinical trial . Setting Copenhagen Hospital Corporation and Psychiatric Hospital Aarhus , Denmark . Participants 547 patients with first episode of schizophrenia spectrum disorder . Interventions Integrated treatment and st and ard treatment . The integrated treatment lasted for two years and consisted of assertive community treatment with programmes for family involvement and social skills training . St and ard treatment offered contact with a community mental health centre . Main outcome measures Psychotic and negative symptoms ( each scored from 0 to a maximum of 5 ) at one and two years ' follow-up . Results At one year 's follow-up , psychotic symptoms changed favourably to a mean of 1.09 ( st and ard deviation 1.27 ) with an estimated mean difference between groups of −0.31 ( 95 % confidence interval −0.55 to −0.07 , P = 0.02 ) in favour of integrated treatment . Negative symptoms changed favourably with an estimated difference between groups of −0.36 ( −0.54 to −0.17 , P < 0.001 ) in favour of integrated treatment . At two years ' follow-up the estimated mean difference between groups in psychotic symptoms was −0.32 ( −0.58 to −0.06 , P = 0.02 ) and in negative symptoms was −0.45 ( −0.67 to −0.22 , P < 0.001 ) , both in favour of integrated treatment . Patients who received integrated treatment  had significantly less comorbid substance misuse , better adherence to treatment , and more satisfaction with treatment . Conclusion Integrated treatment improved clinical outcome and adherence to treatment . The improvement in clinical outcome was consistent at one year and two year follow-ups Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objective To compare the effects of five years of specialised early intervention ( SEI ) treatment for first episode schizophrenia spectrum disorder with the st and ard two years of SEI plus three years of treatment as usual . Design R and omised , superiority , parallel group trial with blinded outcome assessment . R and omisation was central ised and computerised with concealed r and omisation sequence carried out at an external site . Setting Participants were recruited from six OPUS teams in Denmark between 2009 and 2012 . OPUS teams provide SEI treatment to all patients diagnosed with a schizophrenia spectrum disorder in Denmark . Participants 400 participants ( 51 % women ) with a mean age of 25.6 ( st and ard deviation 4.3 ) were r and omised to five years of SEI ( experimental intervention ; n=197 ) or to two years of SEI plus three years of treatment as usual  ( control ; n=203 ) . Interventions OPUS treatment consists of three core elements — modified assertive community treatment , family involvement , and social skill training — with a patient-case manager ratio of no more than 12:1 . For participants r and omised to five years of OPUS treatment , the treatment was largely unchanged . Participants r and omised to the control group were mostly referred to community health centres after two years of SEI treatment . Main outcomes Follow-up assessment s were conducted five years after start of OPUS treatment . Primary outcome was negative symptoms measured on the scale for assessment of negative symptoms ( avolition-apathy , anhedonia , alogia , and affective blunting ) . Secondary outcomes were remission of both negative and psychotic symptoms , psychotic symptoms , suicidal ideation , substance abuse , compliance with medical treatment , adherence with treatment , client satisfaction , days in hospital care , and labour market affiliation . Results Levels of negative symptoms did not differ between the intervention group and control group ( 1.72 v 1.81 points ; estimated mean difference −0.10 ( 95 % confidence interval 0.33 to 0.13 ) , P=0.39 ) . Participants receiving five years of OPUS treatment were more likely to remain in contact with specialised mental health services ( 90.4 % v 55.6 % , P<0.001 ) , had higher client satisfaction ( estimated mean difference 2.57 points ( 95 % confidence interval 1.36 to 3.79 ) , P<0.001 ) , and had a stronger working alliance ( estimated mean difference 5.56 points ( 95 % confidence interval 2.30 to 8.82 ) , P=0.001 ) than the control group . Conclusions This trial tests SEI treatment for up to five years for patients with first episode schizophrenia spectrum disorder ; previous trials have found treatment effects for programmes lasting from one to three years . The prolonged SEI treatment had few effects , which could be due to the high level of treatment provided to control participants and the late start of specialised treatment . Trial registration Clinical trial.gov NCT00914238 Abstract Objective To evaluate the effectiveness of a service for early psychosis . Design R and omised controlled clinical trial . Setting Community mental health teams in one London borough . Participants 144 people aged 16 - 40 years presenting to mental health services for the first or second time with non-organic , non-affective psychosis . Interventions Assertive outreach with evidence based biopsychosocial interventions ( specialised care group ) and st and ard care ( control group ) delivered by community mental health teams . Primary outcome measures Rates of relapse and readmission to hospital . Results Compared with patients in the st and ard care group , those in the specialised care group were less likely to relapse ( odds ratio 0.46 , 95 % confidence interval 0.22 to 0.97 ) , were readmitted fewer times ( β 0.39 , 0.10 to 0.68 ) , and were less likely to drop out of the study ( odds ratio 0.35 , 0.15 to 0.81 ) . When rates were adjusted for sex , previous psychotic episode , and ethnicity , the difference in relapse was no longer significant ( odds ratio 0.55 , 0.24 to 1.26 ) ; only total number of readmissions ( β 0.36 , 0.04 to 0.66 ) and dropout rates ( β 0.28 , 0.12 to 0.73 ) remained significant . Conclusions Limited evidence shows that a team delivering specialised care for patients with early psychosis is superior to st and ard care for maintaining contact with professionals and for reducing readmissions to hospital . No firm conclusions can , however , be drawn owing to the modest sample size This study describes an integrated treatment approach that was implemented to enhance functional recovery in first-episode psychotic patients . Patients were r and omized to two treatment conditions : either to an integrated treatment approach : pharmacotherapy , psychosocial treatment , and psychoeducation ( experimental group : N = 39 ) or to medication alone ( control group : N = 34 ) . Patients were evaluated at baseline and after one year of treatment . Functional recovery was assessed according to symptomatic and functional remission . At the end of treatment , experimental patients showed a 94.9 % of symptomatic remission compared to 58.8 % of the control group . Functional remission was 56.4 % for the experimental group and 3.6 % for the control group , while 56.4 % of the experimental group met both symptomatic and functional remission criteria and were considered recovered compared to 2.9 % of the control group Objective : This r and om‐controlled study evaluated benefits derived from continued integrated biomedical and psychosocial treatment for recent‐onset schizophrenia OBJECTIVE The primary aim of this study was to compare the impact of NAVIGATE , a comprehensive , multidisciplinary , team-based treatment approach for first-episode psychosis design ed for implementation in the U.S. health care system , with community care on quality of life . METHOD Thirty-four clinics in 21 states were r and omly assigned to NAVIGATE or community care . Diagnosis , duration of untreated psychosis , and clinical outcomes were assessed via live , two-way video by remote , central ized raters masked to study design and treatment . Participants ( mean age , 23 ) with schizophrenia and related disorders and ≤6 months of antipsychotic treatment ( N=404 ) were enrolled and followed for ≥2 years . The primary outcome was the total score of the Heinrichs-Carpenter Quality of Life Scale , a measure that includes sense of purpose , motivation , emotional and social interactions , role functioning , and engagement in regular activities . RESULTS The 223 recipients  of NAVIGATE  remained in treatment longer , experienced greater improvement in quality of life and psychopathology , and experienced greater involvement in work and school compared with 181 participants in community care . The median duration of untreated psychosis was 74 weeks . NAVIGATE participants with duration of untreated psychosis of < 74 weeks had greater improvement in quality of life and psychopathology compared with those with longer duration of untreated psychosis and those in community care . Rates of hospitalization were relatively low compared with other first-episode psychosis clinical trials and did not differ between groups . CONCLUSIONS Comprehensive care for first-episode psychosis can be implemented in U.S. community clinics and improves functional and clinical outcomes . Effects are more pronounced for those with shorter duration of untreated psychosis BACKGROUND Measurement of the global burden of disease with disability-adjusted life-years ( DALYs ) requires disability weights that quantify health losses for all non-fatal consequences of disease and injury . There has been extensive debate about a range of conceptual and method 
    Output:
    
Conclusions and Relevance In early-phase psychosis , EIS are superior to TAU across all meta-analyzable outcomes .