***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: OBJECTIVE Despite the frequent use of the Positive and Negative Syndrome Scale ( PANSS ) for rating the symptoms of schizophrenia , the clinical meaning of its total score and of the cut-offs that are used to define treatment response ( e.g. at least 20 % or 50 % reduction of the baseline score ) are as yet unclear . We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions ( CGI ) . METHOD PANSS and CGI ratings at baseline ( n = 4091 ) , and after one , two , four and six weeks of treatment taken from a pooled data base of seven pivotal , multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking . RESULTS Being considered " mildly ill " according to the CGI approximately corresponded to a PANSS total score of 58 , " moderately ill " to a PANSS of 75 , " markedly ill " to a PANSS of 95 and severely ill to a PANSS of 116 . To be " minimally improved " according to the CGI score was associated with a mean percentage PANSS reduction of 19 % , 23 % , 26 % and 28 % at weeks 1 , 2 , 4 and 6 , respectively . The corresponding figures for a CGI rating " much improved " were 40 % , 45 % , 51 % and 53 % . CONCLUSIONS The results provide a better framework for underst and ing the clinical meaning of the PANSS total score in drug trials of schizophrenia patients with acute exacerbations . Such studies may ideally use at least a 50 % reduction from baseline cut-off to define response rather than lower thresholds . In treatment resistant population s , however , even a small improvement can be important , so that a 25 % cut-off might be appropriate CONTEXT Second-generation ( atypical ) antipsychotics ( SGAs ) are more expensive than first-generation ( typical ) antipsychotics ( FGAs ) but are perceived to be more effective , with fewer adverse effects , and preferable to patients . Most evidence comes from short-term efficacy trials of symptoms . OBJECTIVE To test the hypothesis that in people with schizophrenia requiring a change in treatment , SGAs other than clozapine are associated with improved quality of life across 1 year compared with FGAs . DESIGN A noncommercially funded , pragmatic , multisite , r and omized controlled trial of antipsychotic drug classes , with blind assessment s at 12 , 26 , and 56 weeks using intention-to-treat analysis . SETTING Fourteen community psychiatric services in the English National Health Service . PARTICIPANTS Two hundred twenty-seven people aged 18 to 65 years with DSM-IV schizophrenia and related disorders assessed for medication review because of inadequate response or adverse effects . INTERVENTIONS R and omized prescription of either FGAs or SGAs ( other than clozapine ) , with the choice of individual drug made by the managing psychiatrist . MAIN OUTCOME MEASURES Quality of Life Scale scores , symptoms , adverse effects , participant satisfaction , and costs of care . RESULTS The primary hypothesis of significant improvement in Quality of Life Scale scores during the year after commencement of SGAs vs FGAs was excluded . Participants in the FGA arm showed a trend toward greater improvements in Quality of Life Scale and symptom scores . Participants reported no clear preference for either drug group ; costs were similar . CONCLUSIONS In people with schizophrenia whose medication is changed for clinical reasons , there is no disadvantage across 1 year in terms of quality of life , symptoms , or associated costs of care in using FGAs rather than nonclozapine SGAs . Neither inadequate power nor patterns of drug discontinuation accounted for the result Schizophrenia is a devastating psychiatric disorder . Clozapine has long been the gold st and ard for treatment of patients with treatment-resistant schizophrenia ;  however , some patients are only partially responsive to clozapine treatment . Augmentation of clozapine treatment might enhance its effectiveness in partial responders , but only a few studies have investigated possible augmentation strategies . This study compared the effectiveness and tolerability of the combination of amisulpride and clozapine with the combination of quetiapine and clozapine in patients who were only partially responsive to clozapine monotherapy . Fifty-six treatment-resistant patients who were partially responsive to clozapine  were r and omly assigned to receive amisulpride or quetiapine along with an ongoing stable dose of clozapine .  Fifty patients completed the study . Patients were evaluated at baseline and at the first , third , sixth , and eighth weeks . Efficacy measures consisted of the Brief Psychiatric Rating Scale ( BPRS ) , the Scale for the Assessment of Negative Symptoms ( SANS ) , the Scale for the Assessment of Positive Symptoms ( SAPS ) , and the Clinical Global Impression ( CGI ) scale . Tolerability and adverse effects were assessed with the Udvalg for Kliniske Undersogelser ( UKU ) Side Effect Rating Scale and the Simpson Angus Scale ( SAS ) . A substantial improvement occurred in both groups by the end of the eighth week ; however , the improvement associated with amisulpride was significantly greater than that seen with quetiapine . This difference was noted as early as the third week of follow-up in terms of CGI scores , and by the sixth week with regard to BPRS , SANS , and SAPS scores . Both drugs were well tolerated , as measured by UKU and SAS . Improvement favoring clozapine+amisulpride could be attributed to the selective D2/D3 binding property of amisulpride , which had an additional effect in improving symptoms of schizophrenia . The authors concluded that amisulpride seems to be effective and well tolerated for augmentation purpose s in clozapine-resistant patients Combined serotonin-2A ( 5-HT2A ) and dopamine-2 ( D2 ) receptor blockade has been proposed as a c and i date mechanism by which second-generation antipsychotics ( SGAs ) improve both cognition and negative symptoms in schizophrenic patients , in contrast to antipsychotics of the first generation . The SGA amisulpride , however , only binds to D2/D3 receptors , which makes it an interesting tool to test this assumption . In a r and omized controlled trial , 52 schizophrenic patients were allocated to treatment with either olanzapine ( 10–20 mg/day ) or amisulpride ( 400–800 mg/day ) . A comprehensive neuropsychological test battery and clinical ratings were used to assess participants at inclusion and after 4 and 8 weeks . Cognitive improvements of moderate size were observed , with effect sizes similar to those obtained in previous studies on the cognitive effects of SGAs . Importantly , amisulpride was not inferior to olanzapine for any cognitive domain . Combined 5-HT2A/D2 receptor blockade is probably not necessary for cognitive improvement by SGAs This multicenter , double-blind , r and omized study evaluated the efficacy , safety and functional effects of two atypical antipsychotics , amisulpride and risperidone , in patients with chronic schizophrenia ( DSM IV ) with a recent worsening of symptoms . It was planned as a non-inferiority trial . 309 patients received amisulpride ( 400–1000 mg/day ) or risperidone ( 4–10 mg/day ) for six months . Amisulpride was demonstrated to be not inferior to risperidone with respect to the decrease in Positive and Negative Syndrome Scale ( PANSS ) total score from baseline ( 90 % 2-sided confidence interval ( −5.6 ; 4.0 ) ) . Symptomatic improvement measured with the Brief Psychiatry Rating Scale ( BPRS ) , the PANSS positive subscale , and the Bech Rafaelsen Melancholia Scale was similar in both groups . Amisulpride was significantly ( p < .05 ) superior to risperidone in terms of response ( ⩾50 % improvement in PANSS and BPRS total scores or “ very much/much improved ” on the Clinical Global Impression Scale ) and also demonstrated better functional effects and subjective response . Both treatments were well tolerated and had a similar low incidence of extrapyramidal symptoms ;  however , amisulpride was associated with less weight gain and endocrine/sexual symptoms The impact of antipsychotic drug treatment on sexual function was investigated during a r and omised trial comparing first generation antipsychotics ( FGAs ) to ( nonclozapine ) second generation antipsychotics ( SGAs ) .  Sexual function and quality of life were ( rater-blind ) assessed in 42 patients with DSM-IV schizophrenia ( aged 18–65 ) using the self-report version of the Derogatis Interview for Sexual Function ( DISF-SR ) and the Heinrichs Quality of Life Scale ( QLS ) , prior to , and 12 weeks following , a change in medication from an FGA drug to either an FGA or SGA drug . SGAs significantly improved sexual function compared to FGAs . Change in sexual function was associated with change in quality of life . Where impaired sexual functioning is a distressing adverse effect of treatment with an FGA agent , consideration should be given to switching to an SGA BACKGROUND Schizophrenic patients exhibit impairments in prepulse inhibition ( PPI ) and habituation of the acoustic startle response ( ASR ) . Recent studies suggested that PPI deficits and habituation deficits are normalized after antipsychotic treatment . Despite clear evidence of gating and habituation mechanisms in animal models , it is still unknown which neurotransmitter systems are involved in schizophrenic patients . Thus , we compared the effects of a combined 5-HT2A/D2 and a pure D2/D3 antagonist on PPI and habituation of ASR in patients with schizophrenia . METHODS The ASR was measured in 37 acute schizophrenic patients who were r and omized and double-blinded as to treatment with amisulpride or olanzapine .  Patients were assessed during the first week and after four and eight weeks of treatment . Twenty healthy matched control subjects were examined likewise . RESULTS Schizophrenic patients showed a significant PPI deficit and significantly decreased startle amplitude at baseline . The gating deficit disappeared after antipsychotic treatment in both treatment groups . Amisulpride sensitized the startle amplitude , whereas startle amplitude was not changed by olanzapine . After correcting for startle amplitude , patients did not show a habituation deficit ; however , amisulpride accelerated habituation , whereas olanzapine had no effect . CONCLUSIONS Our findings suggest that the PPI-restoring effect of antipsychotics is probably attributed to a dopamine D2 receptor blockade Objective : Atypical antipsychotics are increasingly drugs of first choice in schizophrenia . Amisulpride , a new atypical antipsychotic , is reported to be effective for both positive and negative symptoms of schizophrenia in Western countries but Indian experience is limited . The aim of the present study was therefore to conduct a trial of amisulpride versus olanzapine in Indian schizophrenia patients . Methods : Eighty adult patients of either sex were r and omized to receive st and ard doses of the two drugs orally , in a single blind manner , for 12 weeks , with follow up at 4 and 8 weeks . Effectiveness was assessed by changes in scores on the Brief Psychiatric Rating Scale ( BPRS ) , Scale for Assessment of Positive Symptoms ( SAPS ) , Scale for Assessment of Negative Symptoms ( SANS ) , and physician-administered Clinical Global Impression ( CGI ) scale . Tolerability was assessed by treatment-emergent adverse drug reactions ( ADRs ) . Results : Evaluable were 39 patients on amisulpride and 38 on olanzapine . The groups were comparable at baseline with respect to demographics , illness duration and rating scores . Final BPRS score was lower for olanzapine ( 33.2 ± 9.44 ) than for amisulpride ( 37.7 ± 9.67 ) . SAPS and SANS scores and CGI rating improved individually in both arms but remained comparable between groups throughout the study period , but olanzapine reduced SAPS score to a greater extent . ADRs were encountered in 67.5 % and 47.5 % of patients ( p = 0.113 ) on amisulpride and olanzapine , respectively . Tremor and insomnia were more frequent with amisulpride , while olanzapine caused more weight gain and sedation . No serious ADRs occurred . Conclusions : Amisulpride , although comparable to olanzapine on some measures , did not match the improvement seen with the latter drug in BPRS and SAPS scores . Despite differences in ADR profiles , overall tolerability was satisfactory for both drugs . In Indian patients , amisulpride should therefore be an alternative to olanzapine to a limited extent , such as when weight gain and sedation are undesirable The authors estimated components of variance and intraclass correlation coefficients ( ICCs ) to aid in the design of complex surveys and community intervention studies by analyzing data from the Health Survey for Engl and 1994 . This cross-sectional survey of English adults included data on a range of lifestyle risk factors and health outcomes . For the survey , households were sample d in 720 postal code sectors nested within 177 district health authorities and 14 regional health authorities . Study subjects were adults aged 16 years or more .  ICCs and components of variance were estimated from a nested r and om-effects analysis of variance . Results are presented at the district health authority , postal code sector , and household levels . Between-cluster variation was evident at 
    Output:
    
We found amisulpride may be somewhat more effective than ziprasidone , and more tolerable in terms of weight gain and other associated problems than olanzapine and risperidone .