***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: A controlled longitudinal treatment study was carried out to investigate the effect of a behavioral family treatment on Expressed Emotion ( EE ) and to examine the correspondence between EE changes and relapse rates .  Subjects were 52 patients with recent onset schizophrenia or related disorders and their parents . After completion of inpatient treatment they were r and omly allocated to individual treatment or individual treatment plus family treatment . The family treatment consisted of education and training in communication and problem-solving skills .  Expressed Emotion was measured with the Five-Minute Speech Sample ( FMSS ) . The findings show that family treatment did not have a significant positive effect on EE level . The dichotomous FMSS/EE did not systematic ally change and these findings were comparable with the results of prior EE research . A scoring system that included all subscores of the FMSS was somewhat more sensitive to changes . In the individual treatment condition relapse rates tended to co-occur with a change in FMSS/EE level , irrespective of the direction of this change OBJECTIVE To compare outcomes in psychoeducational multiple-family group treatment vs psychoeducational single-family treatment . METHOD A total of 172 acutely psychotic patients , aged 18 to 45 years , with DSM-III-R schizophrenic disorders were r and omly assigned to single- or multiple-family psychoeducational treatment  at six public hospitals in the state of New York .  Psychotic relapse , symptom status , medication compliance , rehospitalization , and employment were assessed independently during 2 years of supervised treatment . RESULTS The multiple-family groups yielded significantly lower 2-year cumulative relapse rates than did the single-family modality ( 16 % vs 27 % ) and achieved markedly lower rates in patients whose conditions had not remitted at index hospital discharge ( 13 % vs 33 % ) . The relapse hazard ratio between treatments was 1:3 . The relapse rate for both modalities was less than half the expected rate ( 65 % to 80 % for 2 years ) for patients receiving individual treatment and medication . Rehospitalization rates and psychotic symptoms decreased significantly , and medication compliance was high , to an equal degree in both modalities . CONCLUSION Psychoeducational multiple-family groups were more effective than single-family treatment in extending remission , especially in patients at higher risk for relapse , with a cost-benefit ratio of up to 1:34 OBJECTIVE The present study aims to assess the efficacy of a structured psychoeducational group intervention for adolescents with early-onset psychosis and their families . The intervention was implemented in parallel in 2 separate groups by focusing specifically on problem-solving strategies and structured psychosis-related information to manage daily life difficulties associated with the disease , to mitigate crises , and to prevent relapses . METHOD We performed a 9-month , r and omized , rater-blinded clinical trial involving 55 adolescent patients with early-onset psychosis and either or both of their parents . A psychoeducational problem-solving group intervention ( n = 27 ) was compared with a nonstructured group intervention ( n = 28 ) . The primary outcomes were number of hospitalizations , days of hospitalization , and visits to the emergency department . The secondary outcome measures were clinical variables and family environment . RESULTS Assessment s were performed before and after the intervention . At the end of the group intervention , 15 % of patients in the psychoeducational group and 39 % patients in the nonstructured group had visited the emergency department ( χ² = 3.62 , df = 1 , p = .039 ) . The improvement in negative symptoms was more pronounced in the psychoeducational group ( 12.84 [ 7.87 ] ) than in the nonstructured group ( 15.81 [ 6.37 ] ) ( p = .039 ) . CONCLUSION A parallel psychoeducational group intervention providing written instructions in a structured manner could help adolescents with early-onset psychosis and their parents to manage crises by implementing problem-solving strategies within the family , thus reducing the number of visits to the emergency department . Negative symptoms improved in adolescents in the psychoeducational group . Clinical trial registration information -- Intervention Module AGES ( AGES-CM ) ; http:// clinical trials.gov/ ; NCT02101372 . [ corrected ] Duration of untreated psychosis ( DUP ) has emerged as a reliable predictor of outcome but continues to remain under scientific scrutiny . The present study examines the effect of differential periods of DUP on long-term outcome of first episode schizophrenia at Mumbai , India . This research was a prospect i ve , 10-year follow-up naturalistic study . Hospitalized patients of first episode schizophrenia were selected and followed up . Results showed that the mean DUP was higher for a group which showed clinical recovery on Clinical Global Impression Scale [ 14.0 months ( SD=8.0 ) in recovered and 10.8 months ( SD=5.7 ) in non-recovered group ( P=0.091 ) ] . DUP was not found to be significantly associated with any of the end point parameters of good clinical or social outcome . Thus , this study found that DUP alone does not determine outcome status confirming the role of psychopathological heterogeneity OBJECTIVE Longitudinal studies have begun to clarify the phenotypic characteristics of adolescents and young adults at clinical high risk for psychosis . This 8-site r and omized trial examined whether a 6-month program of family psychoeducation was effective in reducing the severity of attenuated positive and negative psychotic symptoms and enhancing functioning among individuals at high risk . METHOD Adolescents and young adults ( mean age 17.4 ± 4.1 years ) with attenuated positive psychotic symptoms , brief and intermittent psychosis , or genetic risk with functional deterioration were r and omly assigned to 18 sessions of family-focused therapy for individuals at clinical high risk ( FFT-CHR ) in 6 months or 3 sessions of family psychoeducation ( enhanced care [ EC ] ) . FFT-CHR included psychoeducation about early signs of psychosis , stress management , communication training , and problem-solving skills training , whereas EC focused on symptom prevention . Independent evaluators assessed participants at baseline and 6 months on positive and negative symptoms and social-role functioning . RESULTS Of 129 participants , 102 ( 79.1 % ) were followed up at 6 months . Participants in FFT-CHR showed greater improvements in attenuated positive symptoms over 6 months than participants in EC ( F1,97 = 5.49 , p = .02 ) . Negative symptoms improved independently of psychosocial treatments . Changes in psychosocial functioning depended on age : participants more than 19 years of age showed more role improvement in FFT-CHR , whereas participants between 16 and 19 years of age showed more role improvement in EC . The results were independent of concurrent pharmacotherapy . CONCLUSION Interventions that focus on improving family relationships may have prophylactic efficacy in individuals at high risk for psychosis . Future studies should examine the specificity of effects of family intervention compared to individual therapy of the same duration and frequency . Clinical trial registration information-Prevention Trial of Family Focused Treatment in Youth at Risk for Psychosis ; http:// clinical trials.gov/ ; NCT01907282 Aims . Occupational functioning is severely impaired in people with psychosis . Social cognition has recently been found to be a stronger predictor of functioning than neurocognition . This study is the first to investigate if externalizing attributional biases that are typically associated with psychosis play a role in the vocational pathways of people with early psychosis . Methods . A cross-sectional design was used . Fifty participants with early psychosis were recruited from a cohort of 144 participants of the Lambeth Early Onset r and omized control trial at 18-month follow-up . Information on occupational functioning was obtained using case notes and interview .  Severity of symptoms was assessed and participants completed measures on  attributional style and executive functioning .  Results . Although executive functioning and positive symptoms were associated with poor occupational functioning , an externalizing attributional style for failures and reduced engagement in occupational activities during the previous 18 months emerged as the only predictors of poor occupational functioning at 18-month follow-up . Conclusions . An externalizing attributional bias is associated with poor occupational functioning . Further research is needed to investigate the direction of this relationship and whether attributional biases mediate the impact of symptoms and cognitive impairment on functioning The effect of in-patient and individual orientated psychosocial intervention ( IPI ) and in-patient and individual and family orientated intervention ( IPFI ) across levels of expressed emotion ( EE ) on relapse was compared in a group of patients with recent onset schizophrenic disorders . Patients were r and omly assigned to an individual orientated psychosocial intervention programme or to an identical psychosocial programme plus a behavioural family intervention .  Seventy-six patients were studied during a 12 month out-patient treatment period after an in-patient treatment programme  in which parents followed a psychoeducational programme .  Overall relapse rates during the out-patient interventions were low ( 16 % ) . Adding family intervention to the psychosocial intervention did not affect the relapse rate .  Patients in low EE families  relapsed slightly more often during the psychosocial plus family intervention . In-patient treatment with psychoeducation for parents , followed by an out-patient psychosocial intervention programme , has a favourable impact on relapse . Additional family intervention may increase stress in low EE families , thus affecting relapse in their children At the time of discharge from their first stay in psychiatric hospital , 78 male schizophrenic patients were r and omly assigned to a family intervention ( experimental ) group or a ' st and ard care ' control group and were followed for the next 18 months . The family intervention consisted of both group and individual counselling sessions every 1 - 3 months that focused on education about the illness and on methods of dealing with the patient . There was a significantly lower rate of hospital readmission in the family intervention group than in the control group ( 15.4 % versus 53.8 % , chi 2 = 12.75 , P < 0.01 ) , and the mean hospital-free period for those who were readmitted was significantly longer in the experimental group than in the control group ( 245 days versus 130 days , t = 2.91 , P < 0.01 ) . Moreover , the clinical status and overall level of functioning in patients who were not readmitted were significantly better in experimental subjects than in control subjects . Stratified analysis showed that family intervention and regular use of medication had independent and additive effects on the outcome . During the 18 months after the index discharge patients who did not take medication regularly and who did not receive family intervention were 7.9 times as likely to be readmitted to hospital as patients who took medication regularly and received family intervention BACKGROUND Empirical evidence of the efficacy and effectiveness of psychosocial family intervention and of the specificity of its effects on the course of schizophrenia is limited . The aim was to study the efficacy and effectiveness of psychosocial family intervention with regard to clinical and social functioning and family burden after controlling for compliance and several prognostic factors . METHOD A 2-year r and omized controlled trial with blind assessment s. Fifty patients with DSM-IV schizophrenia and persistent positive symptoms and /or previous clinical relapse were allocated to psychosocial family intervention , individual counselling and st and ard treatment versus individual counselling and st and ard treatment . RESULTS Family intervention was associated with fewer clinical relapses , hospitalizations and major incidents , and an improvement in positive and negative symptoms , social role performance , social relations , employment and family burden . The reduction in hospitalizations in the family intervention group was significantly greater than that observed in the group of patients who refused to participate but this was not the case for the control group . The effects of family intervention were independent of compliance and prognostic factors . CONCLUSIONS Family intervention is effective in severe schizophrenia independently of compliance and prognostic factors BACKGROUND It is unclear if the impact of psychoeducational family intervention for patients with schizophrenia can be sustained over 10 years . In this study , we explored the 14-year effect of psychoeducational family intervention for patients with schizophrenia in a Chinese rural area . METHOD The data from a cluster r and omized control trial ( C RCT ) study of psychoeducational family intervention in a 14-year follow-up was analyzed . All patients with schizophrenia ( n = 326 ) who participated in the C RCT drawn from six townships in Xinjin County of Chengdu in 1994 , of whom 238 ( 73.0 % ) who were still alive , and their informants were followed up in 2008 . The Patients Follow-up Scale , the Positive and Negative Syndrome Scale ( PANSS ) and the Global Assessment of Functioning were used in the follow-up study . RESULTS There were no significant differences of marital status , mean scores of PANSS positive symptoms , negative symptoms , general mental health , and total scores among the psychoeducational family intervention , medication , and control groups in 2008 . The psychoeducational family intervention group had a significantly higher rate of antipsychotic medication and a higher level of work ability than other two groups . The control group had a significantly higher rate of never-treated ( 26.0 % ) than psychoeducational family intervention group ( 6.5 % ) . CONCLUSION Psychoeducational family intervention might be still effective in the 14-year follow-up , especially in patients ' treatment adherence/compliance and social functioning .  Psychoeducational family intervention might be more effective in places where family members frequently participated in patients ' care and had a 
    Output:
    
Meta-analytic synthesis showed that FIp  improved service user functioning and reduced the likelihood of relapse by the end of treatment .
Psychotic symptoms were significantly reduced in the FIp group at follow up , but this was not evident at end of treatment .
In terms of FIp target mechanisms , carers receiving FIp were more likely to shift from high to low expressed emotion and less likely to report patient focused criticism or engage in conflict communication than carers r and omized to st and ard care .
Carer burden and well-being were improved by the end of treatment but gains were not sustained at follow up .
FIp had no impact on carer emotional over-involvement .
The findings indicate that FIp is an effective intervention for early psychosis service users and their relatives .