***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 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 Some studies in first-episode schizophrenia correlate shorter duration of untreated psychosis ( DUP )  with better prognosis , suggesting that timing of treatment may be important . A three-site prospect i ve clinical trial in Norway and Denmark is underway to investigate the effect of the timing of treatment in first-episode psychosis . One health care sector ( Rogal and , Norway ) is experimental and has developed an early detection ( ED ) system to reduce DUP . Two other sectors ( Ullevål , Norway , and Roskilde , Denmark ) are comparison sectors and rely on existing detection and referral systems for first-episode cases . The study ultimately will compare early detected with usual detected patients . This paper describes the study 's major independent intervention variable , i.e. a comprehensive education and detection system to change DUP in first onset psychosis . System variables and first results from the four-year inclusion period ( 1997 - 2000 ) are described . It includes targeted information towards the general public , health professionals and schools , and ED teams to recruit appropriate patients into treatment as soon as possible . This plus easy access to psychiatric services via ED teams systematic ally changed referral patterns of first-episode schizophrenia . DUP was reduced by 1.5 years ( mean ) from before the time the ED system was instituted ( to 0.5 years ) . The ED strategies appear to be effective and to influence directly the community 's help-seeking behaviour 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 With the emerging global focus on early psychosis , indicated prevention in schizophrenia has increasingly become a focus of psychiatric research interests . It has been argued that CBT may have some advantages compared with antipsychotics regarding this issue . According to MEDLINE , EMBASE and Psycinfo two completed r and omised controlled trials ( RCTs ; PACE , Melbourne , Australia ; EDIE , Manchester , United Kingdom ) and one ongoing RCT with only preliminary results published so far ( FETZ , Cologne/Bonn , Germany ) on indicated prevention in schizophrenia including manualised and st and ardised psychological treatment can be identified . The aims of the present paper are to present and discuss the three approaches with regard to ( I ) inclusion , exclusion and exit criteria , ( II ) characteristics of interventions and ( III ) evaluations . All interventions use intake , exclusion and exit criteria , which have been evaluated in prospect i ve follow-along studies . The approaches are based on the general structure and principles of cognitive behavioural therapy which have been developed , applied and evaluated in a wide range of mental health problems . Despite several method ological limitations , the first evaluations indicate some effects with regard to three possible aims of early intervention : ( 1 ) improvement of present possible pre-psychotic symptoms , ( 2 ) prevention of social decline/stagnation and ( 3 ) prevention or delay of progression to psychosis . Even though the first results are promising , we conclude that several ethical issues have to be taken into consideration and further predictive and therapeutic research is needed to judge whether psychological intervention is a realistic option for the treatment of people at risk of psychosis Abstract . Background : Despite considerable interest in early intervention in psychosis , the evidence base for its effectiveness is sparse . We aim ed to evaluate a new service in South London , UK , Croydon Outreach and Assertive Support Team ( COAST ) using a r and omised controlled trial ( RCT ) during its first year . Method : Referrals were taken from local adult community mental health teams of those with documented first service contact in the last 5 years and a diagnosis of any functional psychosis . Those who consented ( N = 59 ) were r and omised to COAST or treatment as usual ( TAU ) .  COAST offered a range of interventions , including optimum atypical medication , psychological interventions ( individual cognitive behavioural therapy and family intervention if appropriate ) and a range of vocational and welfare help according to need . Whole team training was used to be able to offer these kinds of interventions . Results : Outcomes were evaluated at baseline , 6 months and 9 months on a range of st and ardised clinical and social measures . Overall both COAST and TAU clients improved over time , but there were no significant improvements for COAST clients ; a lack of significant results in the time x treatment interaction . There was a trend for COAST carers ’ quality of life to increase . Bed days were also less in COAST , but not significantly so . Conclusions : The lack of clearly demonstrated improvements for COAST is consistent with the published literature so far . The fact that both groups improved in symptoms and functioning over the year suggests that while access to early intervention is helpful , community adult mental health teams should aim to offer high quality input at any stage of psychosis in order to meet client and carer needs BACKGROUND Little is known about the early phases of bipolar disorders ( BPAD ) and most of current knowledge derives from putative " high-risk " studies conducted in population s of bipolar off-spring ; such information may therefore be relevant only to a sub-group of at-risk subjects . METHODS Retrospective assessment of the phase preceding the emergence of mania and of premorbid characteristics of patients treated for a first episode of psychotic mania . The collected data was used mainly to generate hypotheses . RESULTS Before onset of a first episode of psychotic mania , patients go through a phase of change from previous mental state where they present mood symptoms , sleep disruption and general functional decline . These clinical manifestations are however likely to have low specificity . However , their occurrence in patients presenting certain risk factors or markers of vulnerability that were identified at a relatively high prevalence in our sample , may be an indicator of impending first episode mania . LIMITATIONS This is a retrospective study , in a small sample of patients presenting with psychotic mania . Criteria identified need therefore to be vali date d in larger prospect i ve studies . CONCLUSIONS Early identification of patients at risk to develop a first episode of psychotic mania is unlikely to be possible on the basis of symptoms alone . However , the occurrence of certain clinical characteristics in patients who have risk factors or markers of vulnerability to BPAD could be a sign of impending first episode mania 
    Output:
    
Specific interventions require further research but there is emerging evidence that specialised intervention for people in the early phase of psychotic illness is achievable and possibly essential .
It is within the scope of practice of mental health nurse-practitioners to ensure patient and carer education and support , adherence to medication and other treatments , promotion of social inclusion and social connectedness .