***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: Background Previous family experience of psychotic illness may play an important role in whether and when a patient seeks help in first-episode psychosis . This study investigated the relationship between family experience of psychosis and the duration of untreated psychosis in a prospect i ve sample of first-episode psychosis patients in Hong Kong . We also studied the effects of pre-morbid adjustment , educational level , living alone , and mode of onset as potential determinants of the duration of untreated psychosis ( DUP ) . Methods A total of 131 first-episode psychosis patients in Hong Kong were recruited in a study of the DUP and related factors . The Interview for the Retrospective Assessment of the Onset of Schizophrenia ( IRAOS ) was used to measure the DUP and to provide a structured assessment of family history , educational level , household arrangement , and mode of onset . Results Previous family experience of psychiatric illness ( the presence of another family member who has been receiving psychiatric treatment ) and an acute mode of onset were significant predictors of a shorter DUP . Educational level had a modest effect on its own , but was not significant in the binary logistic regression model . Living alone had a moderate effect size , but was non-significant , possibly because of the small proportion of single-person households in the sample . The symptom profile , pre-morbid adjustment , and other demographic factors were not significantly related to the DUP . Conclusion In addition to the mode of onset , previous family experience plays an important role in the presentation of early psychosis . Educational efforts that target the family should be an important part of any strategy for the early detection of psychosis 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 BACKGROUND Many patients recovering from a first psychotic episode will discontinue medication against medical advice , even before a 1-year treatment course is completed . Factors associated with treatment adherence in patients with chronic schizophrenia include beliefs about severity of illness and need for treatment , treatment with typical versus atypical antipsychotic and medication side effects . METHOD In this 2-year prospect i ve study of 254 patients recovering from a first episode of schizophrenia , schizophreniform , or schizoaffective disorder we examined the relationship between antipsychotic medication non-adherence and patient beliefs about : need for treatment , antipsychotic medication benefits , and negative aspects of antipsychotic medication treatment . We also examined the relationship between medication non-adherence and treatment with either haloperidol or olanzapine , and objective measures of symptom response and side effects . RESULTS The likelihood of becoming medication non-adherent for 1 week or longer was greater in subjects whose belief in need for treatment was less ( HR=1.75 , 95 % CI 1.16 , 2.65 , p=0.0077 ) or who believed medications were of low benefit ( HR=2.88 , 95 CI 1.79 - 4.65 , p<0.0001 ) . Subjects r and omized to haloperidol were more likely to become medication non-adherent for > or=1 week than subjects r and omized to olanzapine ( HR-1.51 , 95 % CI 1.01 , 2.27 , p=0.045 ) . CONCLUSION Beliefs about need for treatment and the benefits of antipsychotic medication may be intervention targets to improve likelihood of long-term medication adherence in patients recovering from a first episode of schizophrenia , schizoaffective , or schizophreniform disorder In a Dutch treatment intervention study of patients ( n=76 ) with first psychotic episodes of schizophrenia the hypothesis tested was whether early differential treatment after an acute psychotic break improved outcome as compared with other studies . Patients had a relatively short duration of untreated psychosis . No significant effect between two treatment conditions on relapse rate was found . The 15-month intervention program kept the psychotic relapse rate as low as 15 % ; lower than comparable studies . Thus , the initial results were in support of the hypothesis . After completion of the 15 months study , patients were referred to other agencies and followed for five years . Results of the follow up study showed that the low relapse rate could not be maintained . Of the remaining 71 patients of the initial sample , 52 % had one or more psychotic relapses , 25 % developed chronic positive symptoms and 23 % did not have another psychotic episode . In addition , the level of social functioning turned out to be low : the majority of patients were dependent upon their parents , few held down a skilled or paid job and also their quality of life seemed low , results indicate that early intervention may improve short term but not long term outcome in schizophrenia . Our results also suggest that referral to other mental health agencies after intervention is not sufficient . Continuity of outpatient care , including continuity of a professional relationship , continuity of support for the family , and the continuity in management of illness , medication and stress may be a key issue in the first five years after the onset of psychosis in schizophrenia . Early recognition and intervention may not nearly be as important for outcome as continuity in care and caregivers . At present , however , it remains question able whether early intervention programs in first-episode patients with a short duration of untreated psychosis can offer the prospect of altering the course of schizophrenia without a sustained comprehensive treatment program The hypothesis that a longer duration of symptoms prior to first hospitalization is associated with a poorer treatment response was prospect ively investigated in 998 first-hospitalized schizophrenic patients . Results indicate that most indicators of outcome were worse when the duration of symptoms was long . This was also true when age , gender , as well as the acuteness of illness were controlled for in the analyses BACKGROUND There has been controversy as to whether early intervention in psychosis can improve the outcome of the disorder . AIMS To establish if there is an association between duration of untreated psychosis and the 4-year outcome of persons with a first episode of psychosis . METHOD Prospect i ve naturalistic follow-up study of the outcome of consecutive first presentations with DSM-IV psychosis attending a community-based psychiatric service . RESULTS A longer duration of untreated psychosis was associated with a significantly poorer functional and symptomatic outcome 4 years later . For schizophrenia and schizophreniform disorder , each increment in duration of untreated psychosis was associated with a 7.8 point decrease in global functioning and an increase in positive symptoms scores by 1.9 points . CONCLUSIONS This study extends the findings of short-term follow-up studies by confirming an association between duration of untreated psychosis and ' mid-term ' outcome BACKGROUND Urban and rural population s have different rates of psychotic illness . If psychosis exists as a continuous phenotype in nature , urban-rural population differences in the rate of psychotic disorder should be accompanied by similar differences in the rate of abnormal mental states characterized by psychotic or psychosislike symptoms . METHODS A r and om sample of 7076 individuals aged 18 to 64 years were interviewed by trained lay interviewers with the Composite International Diagnostic Interview . Approximately half of those with evidence of psychosis according to the Composite International Diagnostic Interview were additionally interviewed by clinicians . We investigated associations between a 5-level urbanicity rating and ( 1 ) any DSM-III-R diagnosis of psychotic disorder ( sample prevalence , 1.5 % ) , ( 2 ) any rating of hallucinations and /or delusions ( sample prevalence , 4.2 % ) , and ( 3 ) any rating of psychotic or psychosislike symptoms ( sample prevalence , 17.5 % ) . RESULTS Level of urbanicity was associated not only with DSM-III-R psychotic disorder ( adjusted odds ratio [ OR ] over 5 levels , 1.47 ; 95 % confidence interval [ CI ] , 1.25 - 1.72 ) , but also , independently , with any rating of delusion and /or hallucination ( adjusted OR , 1.28 ; 95 % CI , 1.17 - 1.40 ; clinician-assessed psychotic symptoms only : OR , 1.30 ; 95 % CI , 1.03 - 1.64 ) and any rating of psychosislike symptom ( adjusted OR , 1.18 ; 95 % CI , 1.13 - 1.24 ) . Psychotic symptoms were strongly and independently associated with psychotic disorder , regardless of the level of urbanization . CONCLUSIONS Community level of psychotic and psychosislike symptoms may be inextricably linked to the prevalence of psychotic disorder . The prevalence of abnormal mental states that facilitate development to overt psychotic illness increases progressively with level of urbanization CONTEXT Most studies on first-episode psychosis show an association between a long duration of untreated psychosis ( DUP ) and poorer short-term outcome , but the mechanisms of this relationship are poorly understood . OBJECTIVE To determine whether it is possible to reduce the DUP for first-episode patients in a defined health care area through the introduction of an early detection ( ED ) program , compared with parallel health care areas without an ED program ( No-ED ) . SETTING AND PATIENTS We included consecutive patients with a DSM-IV diagnosis of nonorganic , nonaffective psychosis coming to their first treatment in the study health care areas between January 1 , 1997 , and December 31 , 2000 . A total of 281 patients ( 76 % of the total ) gave informed consent . INTERVENTIONS The ED and No-ED health care areas offered an equivalent assessment and treatment program for first-episode psychosis . The ED area also carried out an intensive ED program . RESULTS The DUP was significantly shorter for the group of patients coming from the ED area , compared with patients from the No-ED areas ( median , 5 weeks [ range , 0 - 1196 weeks ] vs 16 weeks [ range , 0 - 966 weeks ] ) . Clinical status measured by the Positive and Negative Syndrome Scale and the Global Assessment of Functioning Scale was significantly better for patients from the ED area at start of treatment and , with the exception of Positive and Negative Syndrome Scale positive subscale , at 3 months . Multiple linear regression analyses gave no indication that confounders were responsible for these differences . CONCLUSIONS It is possible to reduce the DUP through an ED program . The reduction in DUP is associated with better clinical status at baseline that is maintained after 3 months There is overwhelming evidence that the outcome for people with schizophrenia in Western industrialised countries is inferior to that of those living in the Third World . Extended family structures , greater opportunities for social reintegration , and more positive constructions of mental illness have been offered as possible explanations for this effect . The Asian community in the UK retains many of these features as well as strong links with native cultures of origin . The issue arises as to whether similar differences in outcome may be observed in the UK . An exploratory study was undertaken , examining the early progress of  schizophrenia in a first-episode sample ( n = 137 ) , and based on systematic examination of case-note data . A lower rate of relapse/readmission in the first 12 months after discharge was found in the Asian ( 16 % ) as compared with white ( 30 % ) and Afro-Caribbean ( 49 % ) patients . Available evidence suggested that speed of access to care , living with a family , and employment may account for this effect . Medication compliance may have contributed to differences in relapse between white and Afro-Caribbeans but was not a factor influencing the low rate among Asians . The limitations and strengths of case-note studies are discussed at length , and it is concluded that a prospect i ve study is warranted and would be highly instructive Objective : We describe a system of outcome evaluation for early psychosis programmes and present preliminary data . The Early Psychosis Outcome Evaluation System ( EPOES ) was design ed for use in a naturalistic , prospect i ve study of a cohort of early-episode psychosis patients . We describe patients in terms of symptoms , substance use , social functioning and family burden , and examine the effectiveness of treatment programmes . Method : Four sites in Perth , Western Australia , participated . Outcome was evaluated from three sources : case manager ( CM ) , patient ( P ) and family member ( FM ) . Seven clinical outcome measures were used : the Brief Psychiatric Rating Scale ( CM ) , Brief Symptom Inventory ( P ) , Substance Use ( CM ) ; Social Functioning Scale ( P ) ; Global Assessment Scale ( CM ) ; Burden Assessment Scale ( FM ) , and the General Health Question naire-12 ( FM ) .  Measures were collected at intake ( baseline ) into a specialist early psychosis service and thereafter every 6 months until discharge from the service . Results : After the first year of data capture , 84 baseline assessment s have been completed , and 23 patients have 
    Output:
    
Sex , age , and the methods of measuring the onset and end-point of DUP and the type of service in which the studies were performed did not contribute to the heterogeneity of the mean or median DUP values .
Mean DUP is significantly prolonged by a small number of patients , and the median DUP is a poor indicator of the rate at which patients present .