***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: New psychiatric out- patients with depressive , phobic , and anxiety neurosis were r and omly allocated to out-patient care or to one of two types of day hospital treatment , one specialising in psychotherapy and the other offering all forms of day care .  Of 106 patients who entered the study , 78 had assessment s of psychiatric symptomatology and social adjustment both before treatment and after 4 , 8 and 24 months . There was no significant difference in outcome between depressive , phobic , and anxiety neurosis , and no overall difference in response to treatment between the three types of care . Suicidal symptoms were significantly less common in out- patients . In many respects , neurotic disorder can be regarded as a single syndrome A one-year cohort of patients from a defined catchment area with acute functional disorders were allocated at r and om to brief care ( experimental group ) or st and ard care ( control group ) in hospital to examine the effect of shortening hospital stay on the clinical and social functioning of patients and the distress abnormal functioning caused to others . A total of 127 patients were interviewed on entry to the study , and 106 were followed up . The brief care group had significantly shorter mean and median lengths of stay than the control group , but there was no difference between the groups in the number of days spent in hospital during subsequent admissions . The groups were well matched for clinical and social variables . Rates of improvement over 13 weeks were essentially the same by all measures of outcome , including the Present State Examination and Patient 's Behaviour Assessment Scale , which was developed for the study to measure deterioration in behaviour and social functioning and adverse effects and distress on others . There was no difference between the two groups in burden to the community supporting services , social security requirements , or GP attendances . Improvement rates were nearly identical on all measures within and across diagnostic subgroups . Brief care result ed in a 33 % reduction in average length of stay compared with the year before but was associated with a corresponding increase in day hospital use . The short-stay policy continued the year after the study finished . The findings confirm the value of shortening hospital stay and improving day care facilities for most localities The effects of day care therapy for a period of 6 months upon patients with schizophrenia were studied through comparison with schizophrenia out patients at four facilities in Japan . The clinical features of the 31 day care patients and 30 out patients were evaluated by the hospital staff using the Positive and Negative Syndrome Scale ( PANSS ) and Global Assessment Scale ( GAS ) , and by the patients ' close relatives using the Katz Adjustment Scale ( KAS ) before and after 6 months of treatment . Day care patients showed a significant decrease in the general pathological score of PANSS and GAS , but out patients did not show any comparable improvement . As for KAS scores , similar improvement was observed for both the day care patients and out patients After 6 months , 43 % of the day care patients improved on the post-/pre- PANSS total scores ratio , as against only 13 % of the out patients . In addition , 13 % of the out patients were readmitted due to an exacerbation of their symptoms , whereas all day care patients were able to remain at home for 6 months . This study clearly demonstrated that day care therapy for patients with schizophrenia was more effective than the usual out patients treatment setting . Further therapeutic efforts ( e.g. psycho-education ) in day care therapy are needed in order to improve family member 's evaluation of the patient Ninety-one patients admitted as emergencies , suffering from neurosis , personality disorder , or adjustment reaction , were r and omly allocated to day hospital or to continued in-patient care . Follow-up was for up to one year . Clinical outcome was similar in the day care and in-patient groups , but patient satisfaction was significantly greater in day patients . Day hospital care was only about two-thirds of the cost of the cheaper of the two in-patient regimes , even though contact with it was on average twice as long as for in- patients Emerging models of cognitive-behavioral treatment ( CBT ) offer promising new intervention strategies in the psychotherapy of schizophrenia . These models , however , have not been integrated into community support programs and evaluated in comparison to st and ard community treatments . This study examined differences in outcomes of clients who received long-term day treatment program services ( DTP ) compared to clients who received individual CBT that was included as part of their DTP treatment . Twenty-four clients were r and omly assigned to DTP treatment or CBT/DTP treatment .  Data on st and ardized measures of psychosocial functioning , symptomatology and rehospitalizations were collected over the course of three years of treatment . Analysis of variance with repeated measures was conducted to evaluate the effects of type of treatment ( CBT/DTP and DTP ) and time ( dependent variable scores taken at the end of treatment years one , two and three ) on the three outcome variables . Results indicate significant improvement for the CBT/DTP group compared to the DTP group in the patterns of change over time for psychosocial functioning and symptomology . In addition to this significant group/time interaction the time factor was also significant for both variables . For rehospitalizations the time factor was significant and the group/time factor was nonsignificant . Implication s for service delivery to persons with schizophrenia and suggestions for future research are discussed BACKGROUND Postnatal depression affects one in ten women within 6 months of childbirth . The most effective treatment strategy for postnatal depression is not clear . METHODS This prospect i ve , naturalistic study of the treatment of postnatal depression compared 30 women treated at a specialised psychiatric day hospital with 30 women treated using routine primary care ( RPC ) .  Clinical , marital and social adjustment were assessed on three occasions over 6 months using : the Edinburgh Postnatal Depression Question naire ( EPDS ) ; the Clinical Interview schedule ( CIS ) ; the Anxiety Subscale of the Hospital Anxiety and Depression Scale ; the Dyadic Adjustment Scale ( DAS ) ; and the Work Leisure and Family Life Question naire-Modified ( WLFLQ-M ) .  RESULTS There were no significant differences between the two groups at baseline . However , there were significant differences in outcome at 3 and 6 months follow-up for all outcome measures except the DAS . At 6 month follow-up 21 of the PBDU group were no longer depressed compared with 7 of the RPC group . CONCLUSIONS A specialised day hospital is a more effective treatment setting for postnatal depression than routine primary care . LIMITATIONS OF THE STUDY The study is not an RCT , so systematic bias is possible . The sample size is relatively small and the duration of follow-up relatively short The authors r and omly assigned 79 in patients with nonchronic schizophrenia or affective disorder to either an intensive experimental day program called " transitional treatment " or a control treatment -- weekly clinical ly believed to require intensive posthospital treatment to make the transition to the community . Although initially there was a significantly higher dropout rate from the control condition , at the point of discharge from the two programs as well as at 6- and 12-month follow-up there was no difference in outcome . Direct costs for the transitional treatment , however , were much higher A prospect i ve r and omized comparative study on the effectiveness of  psychiatric day treatment and inpatient treatment is described . The target population consisted of patients who would normally have been admitted to an open inpatient unit . Outcome indicators were psychopathology , social functioning , interpersonal functioning , social network and social support . No differences in effectiveness were found between the two forms of treatment , although more patients accepted and completed day treatment , and day patients were more satisfied . Although a uniform treatment programme for both departments was established , distinct differences did arise in the actual treatment programme offered to the patients . The duration of treatment for the day patients was considerably longer , and the intensity of treatment was more low‐key . No striking differences in the amount of medication prescribed and in the occurrence of crisis situations ( including suicide ) were found . Day treatment turns out to be a realistic alternative for 33 % of all patients admitted for inpatient treatment . It was not possible to predict which type of patient in particular is suitable for day treatment The authors compared treatment results for 141 schizophrenic patients r and omly assigned to short-term or long-term hospitalization .  Test results indicated that the long-term group was functioning significantly better one year after admission according to global measures only . The authors caution that the differences between the two groups , although statistically reliable , were modest and may have been confounded by the amount of psychotherapy the patients received after hospitalization . Although there appears to be a general advantage to the long-term approach , further work will be needed to identify patient subgroups for whom this more expensive treatment is cost effective The feasibility of  day treatment with community care for  schizophrenic patients was tested by means of a longitudinal r and omized experiment with 34 experimentals and 16 controls : 38 percent could be treated satisfactorily in a day program that included a very active ambulatory service . The new approach did not improve prognosis with respect to psychiatric symptomatology , social role disabilities , or number of readmissions during the first year of followup . Total cost of treatment was less for day-treatment patients than for ordinary clinical patients A controlled , prospect i ve , two-year follow-up study examined the relative effectiveness of short-term vs long-term psychiatric hospitalization . Results of the inpatient phase for a sample of 74 nonschizophrenic patients are reported here . About four weeks after admission the patients hospitalized for a short stay were discharged , and at that time were functioning better than the patients in the long-stay group . When the patients hospitalized for a long stay were discharged , three to fur months after admission , they were then functioning as well as , but not noticeably better than , the patients in the short-stay group had been at their earlier time of discharge . Patients with affective disorders  were more impaired at admission and improved more than patients with other diagnoses , regardless of length of stay OBJECTIVE The authors investigated the clinical feasibility and the outcome for patients of a program design ed as an alternative to acute hospitalization . METHOD This was a r and om- design study comparing a conventional inpatient program for urban , poor , severely ill voluntary patients who usually require hospitalization to an alternative experimental program consisting of a day hospital linked to a crisis residence . Patients were assessed with st and ardized measures of symptoms , functioning , social adjustment , quality of life , and satisfaction with clinical services upon admission to the study , at discharge from the index admission , and at follow-ups 2 , 5 , and 10 months after discharge . RESULTS One hundred ninety-seven patients were enrolled in the 2-year research program and followed for 10 months . Of the voluntary patients who would have been admitted to the hospital , 83 % were appropriate for the experimental program . The clinical , functional , social adjustment , quality of life , and satisfaction outcome measures were not statistically different for the patients in the two treatment conditions ; however , there was a slightly more positive effect of the experimental program on measures of symptoms , overall functioning , and social functioning . CONCLUSIONS The experimental condition , a combined day hospital/crisis respite community residence , seems to have had the same treatment effectiveness as acute hospital care for urban , poor , acutely ill voluntary patients with severe mental illness Previous attempts at program evaluation of partial hospitalization programs have consisted largely of descriptive and anecdotal reports of programs and patient characteristics . There have been no comparative or experimental studies of the effectiveness of differing day treatment programs . In the current study , Goal Attainment Scaling , a goal -oriented program evaluation system , was used with 56 r and omly selected partial hospitalization patients who attended two day hospitals : one program was based on behavioral-educational methods , and the other was an eclectic program based on the concepts of a therapeutic community . Patients attending the behavioral-educational program showed greater attainment of their therapeutic goals than did the patients involved in the eclectic program . The greater effectiveness of the behavioral-educational day program  increased from the 3-month follow-up to the 2-year follow-up The effect of a treatment program ( E ) providing inpatient care , a day hospital , community housing , and sheltered work are compared with a program ( C ) emphasizing rapid discharge .  A group of 94 male general psychiatric patients were r and omized to the two units . Outcome data collected at 18 months from admission revealed small but significant differences between the total sample s in employment , maintenance of treatment contact , use of medication , and social adjustment . More C than E patients were in the hospital after the 14th month . Program effects varied considerably with patient type . Patients with less social disability had somewhat better employment outcomes with the E program , but no differences in use of services . Patients with a better prognosis by measure of psychopathology ( Minnesota Multiphasic Personality Inventory cluster and diagnosis of schizophrenia ) spent less inpatient time in the E program , but were not helped to better employment outcomes . Patients with greater social h and icap were not differentially affected . More E patients than C with a poorer prognosis stayed in outpatient treatment and used antipsychotic medications . Patients in the E group with better previous employment and more social isolation used the E day hospital and community housing more heavily than other E subgroups OBJECTIVE The authors compared service utilization and costs for acutely ill psychiatric patients treated in a day hospital/crisis respite program or in a hospital inpatient program .  METHOD The patients ( N = 197 ) were r and omly assigned to one of the two programs and followed for 10 months after discharge . Both programs were provided by a community mental health center ( CMHC ) in a poor urban community . Data were collected for developing service utilization profiles and estimates of per-unit costs of the inpatient , day hospital , and outpatient services provided by the CMHC . RESULTS On average , the day hospital/crisis respite program  cost less than inpatient hospitalization . The average saving per patient was + 7,100 , or roughly 20 % of the total direct costs . There were no significant differences between programs in service utilization or costs during the follow-up phase . Cost savings accrued in the index episode because per-unit costs were lower for day hospital/crisis respite and the average stay was shorter . Significant differences in cost were found among patient groups with psychosis , affective disorders , and dual diagnoses ; psychotic patients had the highest costs in both programs . 
    Output:
    
REVIEW ER 'S CONCLUSIONS There is only limited evidence to justify the provision of day treatment programmes and transitional day hospital care , and no evidence to support the provision of day care centres