***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 To assess the direct cost of relapse and the predictors of relapse during the treatment of patients with schizophrenia in the United States . Methods Data were drawn from a prospect i ve , observational , noninterventional study of schizophrenia in the United States ( US-SCAP ) conducted between 7/1997 and 9/2003 . Patients with and without relapse in the prior 6 months were compared on total  direct mental health costs  and  cost  components in the following year using propensity score matching method . Baseline predictors of subsequent relapse were also assessed . Results Of 1,557 participants with eligible data , 310 ( 20 % ) relapsed during the 6 months prior to the 1-year study period .  Costs for patients with prior relapse were about 3 times the costs for patients without prior relapse . Relapse was associated with higher costs for inpatient services as well as for outpatient services and medication .  Patients with prior relapse were younger and had onset of illness at earlier ages , poorer medication adherence , more severe symptoms , a higher prevalence of substance use disorder , and worse functional status . Inpatient costs for patients with a relapse during both the prior 6 months and the follow-up year were 5 times the costs for patients with relapse during the follow-up year only . Prior relapse was a robust predictor of subsequent relapse , above and beyond information about patients ' functioning and symptom levels . Conclusions Despite the historical decline in utilization of psychiatric inpatient services , relapse remains an important predictor of subsequent relapse and treatment costs for persons with schizophrenia Brain morphology was examined using magnetic resonance imaging in 30 first-episode patients with a schizophreniclike psychosis , 15 chronic schizophrenics , and 20 neurological controls . Statistical analyses of computer-generated measurements of regions of interest were controlled for gender , age , social class , and total brain volume . Lateral ventricular size was increased in both first-episode and chronic schizophrenic patients , with greater significance on the left than on the right side . Only the chronic patients , however , had reduced temporal lobe size , which also was greater on the left side . No major correlations of regional brain morphological measurements with cognitive functioning were found , although some measurements of verbal memory were correlated with parahippocampal size . This is a report of a preliminary study that suggests that some morphological brain changes may be present at the time of first treatment for a psychotic illness , whereas others may occur later in the course of illness . Future prospect i ve studies may determine the clinical significance of these changes and whether they progress with the development of illness chronicity OBJECTIVE To compare the long-term outcome in individuals with early-onset ( before age 18 ) and adult-onset schizophrenia spectrum disorder who were initially diagnosed and treated in the same clinical center . METHOD A prospect i ve follow-up study of 723 consecutive first-episode psychosis patients ( age range 14 to 30 years ) on average 7.4 years after initial presentation to an early psychosis service , the Early Psychosis Prevention and Intervention Centre in Melbourne , Australia . The outcome measures included the Brief Psychiatric Rating Scale , the Schedule for the Assessment of Negative Symptoms , the Beck Depression Inventory , the Global Assessment of Functioning Scale , the Social and Occupational Functioning Assessment Scale , and the Quality of Life Scale .  RESULTS Follow-up interviews were conducted on 66.9 % ( 484/723 ) individuals , of whom 75.6 % ( 366/484 ) received a schizophrenia spectrum disorder diagnosis at baseline . Early-onset schizophrenia spectrum disorder was observed in 11.2 % ( 41/366 ) . At follow-up , individuals with early-onset reported significantly fewer positive symptoms and were characterised by significantly superior functioning on measures assessing global functioning , social-occupational functioning , and community functioning than individuals with adult-onset . The early-onset group also achieved significantly better vocational outcomes and had a more favourable course of illness with fewer psychotic episodes over the last two years prior to follow-up . Finally , when investigated as a continuous variable , younger age at onset significantly correlated with better symptomatic and functional outcomes . CONCLUSIONS These results question the assumption that early-onset schizophrenia typically has a poor outcome . Early detection and specialised treatment for the first psychotic episode appear to be more effective at improving long-term functional outcomes in people with early-onset schizophrenia as in those with adult-onset schizophrenia . This possibility and the reasons for it need further investigation This study examined the longitudinal course of competitive employment  in patients with schizophrenia following treatment for an acute exacerbation , and prospect ively predicts work approximately 2 years later from sociodemographic and clinical characteristics . A sample of 528 patients was assessed at baseline , and 313 were followed up 1 and 2 years later . Assessment s included sociodemographic characteristics , premorbid functioning , work history , symptoms , social functioning , recent efforts to find work , and interest in work . Analyses examined changes in competitive work from baseline to the followups , the correlates of work history , the prospect i ve prediction of work at the 1- and 2-year followup assessment s , and correlates of competitive work . Competitive employment increased significantly from 10 percent at baseline to 23 percent and 21 percent at the 1- and 2-year followups , respectively . At baseline , among patients who were not competitively working , 61 percent reported interest in working . Patients who were not competitively employed at baseline but reported making recent efforts to find work were more likely to be working at the followups than other not employed patients . Work at the 1- and 2-year followups was predicted by prior work experience , patient and mother 's educational level , cognitive impairment , and social functioning . Similar correlates of current work status were found . Interventions may need to target educational level , cognitive impairment , and social competence and functioning in order to improve the competitive employment outcomes of persons with schizophrenia The present study is an empirical contribution to the controversy over whether the poor social performance and lower social class of schizophrenic patients are consequences of the illness , consequences of changes in the individuals predisposed to develop schizophrenia or are due to the adverse social conditions that lead to schizophrenia . The study focuses on the socioeconomic status at onset , on the performance of social roles in the early course of schizophrenia by taking age , gender and the individual level of social development into account . In a representative sample of 232 first episodes of schizophrenia age and type of onset , type and accumulation of symptoms and social functioning in the prodromal and the psychotic prephase and at first admission were assessed and analysed for their predictive power concerning social disability 2 years after first admission . In a case-control study expected and observed social functioning from onset until first admission were compared . The subsequent course was followed up prospect ively in five cross sections until 2 years after first admission . In women the age at onset was significantly higher than in men , whereas symptomatology and type of onset showed no gender differences . In 73 % of the sample the prodromal phase covered 5 years on average , and the psychotic prephase ( until the maximum of positive symptoms ) 1.1 years . Deficits in social functioning occurred predominantly during the prodromal and the psychotic prephase . The course over 14 years showed stable group trends in social and symptom measures . By the end of the prodromal phase it was possible to predict social disability 2 years after first admission with a correct classification of 81 % . The main factor determing social outcome appeared to the the acquired social status during the prodromal phase of the disorder . The unfavourable early course in men was due mainly to their significantly lower age at onset . These results raise questions concerning an earlier therapeutic and rehabilitative intervention The classical prognostic indicators of Vaillant and Stephens , the acute onset of psychotic symptoms , and key demographic factors were investigated as predictors of outcome in a prospect i ve study of 153 schizophrenic patients defined using broad ( DSM-II ) and narrow ( DSM-III ) concepts of schizophrenia . Findings indicate : Several established prognostic items did not show strong predictive utility in DSM-II or DSM-III schizophrenia when young , nonchronic patients were studied . For both DSM-II and DSM-III schizophrenic patients , longitudinal assessment s of psychotic symptoms , work history , and social functioning predicted their respective assessment s at followup . However , the predictive utility of some key prognostic indicators shifted for narrow vs. broad concepts of schizophrenia . Most importantly , sex , which was the most powerful predictor of overall outcome among patients with DSM-II schizophrenia , failed to predict outcome among patients with DSM-III schizophrenia , primarily because many women with favorable outcome did not meet the DSM-III criteria for schizophrenia . DSM-III schizophrenia comprises a more homogeneous group of poor prognosis patients in comparison to DSM-II schizophrenia . Educational level , age at first hospitalization , and work history were successful predictors of outcome ( p less than .01 ) when a new , narrow concept of schizophrenia was used Remission and relapse are clinical outcomes of increasing interest in schizophrenia . We analyzed remission and relapse , and the sociodemographic and clinical factors associated with these outcomes , in the usual care of schizophrenia using the 3-year , follow-up data from a large cohort of out patients with schizophrenia taking part in the prospect i ve , observational , European Schizophrenia Outpatient Health Outcomes study . Of the 6516 patients analyzed for remission , 4206 ( 64.6 % ) achieved remission during the 3-year , follow-up period . Logistic regression analysis revealed that being female , having a good level of social functioning at study entry , and a shorter duration of illness were factors significantly associated with achieving remission . Treatment with olanzapine was also associated with a higher frequency of remission compared with other antipsychotic agents . A Kaplan-Meier survival curve estimated that relapse occurred in approximately 25 % of the patients who achieved remission , with the risk of relapse remaining constant during the follow-up period . Shorter duration of illness , having hostile behaviors , and substance abuse were factors associated with a higher risk of relapse , whereas good level of social functioning and the use of olanzapine and clozapine were associated with a lower risk of relapse . In conclusion , the 3-year results of the Schizophrenia Outpatient Health Outcomes study indicate that the likelihood of remission decreases over the longitudinal course of schizophrenia , but risk of relapse is maintained even after 3 years of achieving remission severity levels . Results suggest that treatment with olanzapine is associated with a better chance of achieving remission than other antipsychotics . Moreover , the use of olanzapine and clozapine is associated with a lower risk of relapse compared with risperidone , quetiapine , and typical antipsychotics . The results should be interpreted conservatively because of the observational , nonr and omized study design 
    Output:
    
This was the first systematic review of the effects of age at onset on the long-term outcomes of schizophrenia .
The results show that age at onset has a small , but significant impact on some of the outcomes of schizophrenia