***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 
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    Input: There is an ongoing debate as to whether psychosis is a progressively deteriorating illness or one of progressive amelioration . This paper aims at investigating the rate of recovery and institutionalization  and predicting a continuous illness course in a descriptive prospect i ve study of a sub- sample of the OPUS trial of 265 first-episode psychotic patients after five years . Recovery , defined as no psychotic or negative symptoms , living independently , GAF (f)>59 , working or study ing , was reached for 18 % after five years , whereas 13 % were institutionalized either at hospital or supported housing after five years . Male gender ( OR 1.9 , 95 % CI 1.06 to 3.23 ) , premorbid social functioning ( OR 1.2 , 95 % CI 1.01 to 1.33 ) , psychotic symptoms ( OR 1.3 , 95 % CI 1.07 to 1.66 ) , and negative symptoms ( OR 1.3 , 95 % CI 1.01 to 1.67 ) were found to predict a continuous illness course at five-year follow-up . Rates of recovery and institutionalization  contradict the assumption that the illness deteriorates progressively , since no changes in the rates are seen from two to five years Aim : To determine the 25 year follow-up of subjects originally enrolled in the Study of factors associated with course and outcome of schizophrenia ( SOFACOS ) at Chennai . Material s and Methods : All subjects who were followed up were administered the same research tools which were done at inclusion , namely the PSE & PPHS . Results : At the end of 25 years , 47 of the original ninety subjects were assessed completely . Twenty five ( 26 % ) had died and 18 ( 20 % ) were lost to follow-up during the 25 year period . 32 of the 47 followed up were in partial or total remission . Outcome was good in 27.7 % , intermediate in 52 % and poor in 19 % . More men were single and more women were either married or separated  . Gender differences were not marked . Conclusions : This is one of the few prospect i ve , long term follow up studies from India . Although outcome was good in those followed up , the numbers who died and could not be followed up causes concern BACKGROUND First episode mania ( FEM ) cohorts provide an opportunity to identify windows for intervention to potentially alter the course of bipolar disorder ( BD ) . Despite several efforts to prospect ively characterize first episode patients , follow-up of such cohorts has seldom exceeded 1 year . We present 4-year outcomes from the STOP-EM FEM cohort . METHOD Of 101 identified FEM patients , 81 had longitudinal follow-up . Clinical evaluations including substance misuse , sociodemographics and family history were characterized using semi-structured instruments . Clinical re assessment s occurred every 6 months . RESULTS Within one year , all patients had remitted and 95 % recovered . Recurrence following remission occurred in 58 % of patients by 1 year and 74 % by 4 years ( 60 % depressive , 28 % manic and 12 % hypomanic ) . Recurrence within one year was associated with a higher rate of recurrence thereafter . Older age was associated with a shorter time to remission . Substance misuse was associated with delayed recovery and earlier recurrence . LIMITATIONS This prospect i ve multiwave longitudinal design employed may be limited by the assessment schedule and associated recall bias . The influences of attrition of this sample should be considered when attempting to generalize our findings . CONCLUSIONS Best practice s in FEM result in remission and recovery . While recurrence is common , minimizing recurrence within the first year through risk factor modification may alter the course of the BD BACKGROUND Duration of untreated psychosis ( DUP ) may contribute to the observed heterogeneity of the treatment response in first-episode schizophrenia . AIMS To examine the relationship of DUP and premorbid function with clinical outcomes following up to 2 years of antipsychotic treatment . METHOD For a sub sample ( n=191 ) of subjects participating in a clinical trial , DUP and premorbid function were prospect ively compared with clinical response to olanzapine or haloperidol . RESULTS Shorter DUP and good premorbid function each independently are associated with better clinical response , including improvement in overall psychopathology and negative symptoms . Premorbid function also is associated with positive symptom , social and vocational outcomes . CONCLUSIONS Earlier antipsychotic treatment is associated with better outcomes in first-episode schizophrenia .  Poor premorbid function could indicate an illness subtype less likely to respond to antipsychotic treatment regardless of when it is instituted Background There were few studies on the outcome of schizophrenia in developing countries . Whether the outcome is similar to or different from developed world is still a point for research . The main aim of the current study was to know if patients with early onset non affective psychosis can behave and function properly after few years from start of the illness or not . Other aims included investigation of possible predictors and associated factors with remission and outcome . Method The study prospect ively investigated a group of 56 patients with onset of psychosis during childhood or adolescence . Diagnosis made according to DSM-IV criteria and included ; schizophrenia , psychotic disorder not otherwise specified and acute psychosis . Severity of psychosis was measured by PANSS . Measures of the outcome included ; remission criteria of And reasen et al 2005 , the  children 's global assessment scale and educational level . Results Analysis of data was done for only 37 patients . Thirty patients diagnosed as schizophrenia and 7 with Psychotic disorder not otherwise specified . Mean duration of follow up was 38.4 + /- 16.9 months . At the end of the study , 6 patients ( 16.2 % ) had one episode , 23(62.1 % ) had multiple episodes and 8 ( 21.6 % ) continuous course . Nineteen patients ( 51.4 % ) achieved full remission , and only 11(29.7 % ) achieved their average educational level for their age . Twenty seven percent of the sample had good outcome and 24.3 % had poor outcome . Factors associated with non remission and poor outcome included gradual onset , low IQ , poor premorbid adjustment , negative symptoms at onset of the illness and poor adherence to drugs . Moreover , there was tendency of negative symptoms at illness start to predict poor outcome . ConclusionS ome patients with early onset non affective psychosis can behave and function properly after few years from the start of the illness . Although remission is a difficult target in childhood psychosis , it is still achievable 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 ; ( 2 ) explore predictors of remission ; and ( 3 ) test the external validity of these criteria . METHODS We analyzed data from 462 subjects with a first-episode of psychosis who participated in a long-term , multinational , r and omized , double-blinded trial of risperidone and haloperidol over 2 to 4 years . RESULTS At some time point in the study 323 ( 70 % ) of the 462 subjects had a reduction to mild levels on the key symptoms as measured by the PANSS although only 109 ( 23.6 % ) maintained this level for at least 6 months thereby meeting remission criteria . The two strongest predictors of remission were shorter duration of untreated psychosis ( p=0.01 ) and treatment response at 6 weeks ( p=0.001 ) . Compared to non-remitted patients , those in remission experienced greater improvement on all PANSS subscales ( p<.0001 ) , CGI-S ( p<.0001 ) , better quality of life ( p=0.006 ) , fewer relapses ( p<.0001 ) , displayed a more favorable attitude towards their medication ( p=.002 ) , had lower EPS levels according to the ESRS ( p=<.0001 ) and received lower doses of antipsychotic medication ( p=0.003 ) . The remission and non-remission groups did not differ significantly regarding composite cognitive scores , suicidality and body mass index . CONCLUSIONS The results suggest that the remission criteria , although based solely on core symptom improvement , can effectively identify patients who have a more favorable overall outcome 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 We examine the relationship between achieving remission of positive symptoms within 3 months in first episode psychosis and outcomes 5 years later . Time to remission of positive symptoms , other early characteristics and 5 year outcomes were assessed in a prospect i ve study of 132 patients being treated for the first time for a psychotic disorder . Just under 60 % of patients showed remission of positive symptoms within 3 months . In comparison to later remitters , they showed lower levels of positive symptoms , greater likelihood of competitive employment and less likelihood of collecting a disability pension at 5 years . Earlier remission of positive symptoms may have prognostic significance for longer term outcomes Fifty first-episode patients with schizophrenia were followed for 5 years subsequent to their first hospitalization . The course of illness was charted prospect ively and premorbid childhood histories were obtained retrospectively at the initial evaluation , and MRI scans were obtained initially and at each follow-up . Fifteen different life-time patterns of illness course emerged , although none were specifically associated with structural brain change . A deterioration in premorbid scores was positively correlated with larger ventricular volume at the first hospitalization , and the larger the ventricles , the less the subsequent change in ventricular size thereafter . An analysis to see whether initial hemispheric and ventricular size could predict different course types only revealed that patients with an acute onset and complete recovery had significantly smaller ventricles than all others . No differences emerged for initial hemispheric size . Thirty-four percent of patients individually showed some association of brain ventricular size and 28 % hemisphere volume reductions with fluctuation in psychotic symptoms . Paradoxically , most showed larger ventricles and smaller hemispheres to be associated with clinical improvement , rather than the predicted reverse . These latter data question the notion that the structural brain changes seen over time in some patients are related to poor outcome , although small ventricular size in those patients with acute onset may be predictive of recovery . Thus , brain structural change is occurring early in the course of illness and may be a consequence of the process leading to resolution BACKGROUND Recovery , the optimal goal in treatment , is the attainment of both symptomatic and functional remission over a sustained period of time . Identification of factors that promote recovery can help develop interventions that facilitate good outcomes for people with first episode psychosis . AIM To examine long-term outcomes within a cohort of people with first episode psychosis in relation to symptom remission , functioning and recovery , 10 years after diagnosis . METHOD The study had a prospect i ve design . Participants from the OPUS trial ( 1998 - 2000 ) ( n=496 ) completed a series of interviews and question naires to measure current levels of psychopathology and social/vocational functioning , ten years after diagnosis . Predictors of recovery were identified using socio-demographic and clinical characteristics collected at baseline . RESULTS A total of 304 participants were interviewed , giving a follow-up rate of 61 % . A total of 42 people ( 14 % ) met the criteria for symptomatic and psychosocial recovery at 10 years . A multivariable binary logistic regression analysis indicated that baseline predictors accounted for 22 % of the variance of full recovery . Lower severity of negative symptoms at baseline ( Odds Ratio ( OR ) 0.53 , 95 % confidence interval CI 0.36 - 0.78 , p<0.001 ) and earlier age of diagnosis ( OR 0.92 , 95 % CI 0.86 - 0.99 , p<0.05 ) predicted better rates of recovery at 10 years . CONCLUSION Results of this study indicated that negative symptoms could play a central role in the process of recovery from schizophrenia . A challenge for clinicians and research ers is to underst and the mechanisms behind negative symptoms 
    Output:
    
Conclusions Remission and recovery rates in FEP may be more favourable than previously thought .
We observed stability of recovery rates after the first 2 years , suggesting that a progressive deteriorating course of illness is not typical .
Although remission rates have improved over time recovery rates have not , raising questions about the effectiveness of services in achieving improved recovery