***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: Negative symptoms are considered the most debilitating and refractory aspect of schizophrenia , being associated with poor social , occupational and global outcomes . Conventional antipsychotics have limited efficacy against these symptoms and poor tolerability profiles . Atypical antipsychotics are an alternative treatment , and this 12‐week , r and omised , flexibly dosed study compared the efficacy , safety and tolerability of quetiapine and olanzapine in this regard . Of the 40 patients who entered the study ( 32 male ; 8 female ) , 19 were r and omised to quetiapine  ( mean dose 637 mg/day , mean treatment duration 80 days ) and 21 to  olanzapine  ( mean dose 16 mg/day , mean treatment duration 78 days ) . Quetiapine and olanzapine were similarly effective : in each treatment group significant improvements at Week 12 were observed for negative symptom scores on the SANS and the PANSS , and for subscale scores of affective flattening and alogia on the SANS . Both treatments were well tolerated in this patient population , with no worsening of extrapyramidal symptoms in either case . Anxiety and insomnia were the most common adverse events ( ≥7 % of patients in each group ) , but were not drug‐related . Although this is a small study with limited power , the results support the effectiveness of quetiapine and olanzapine in treating the negative symptoms of schizophrenia . Copyright © 2006 John Wiley & Sons , Suicidal  behavior in patients with psychotic disorders represents a seriously undertreated life-threatening condition . The International Suicide Prevention Trial ( InterSePT ) is the first large-scale , prospect i ve study design ed to evaluate the potential of antipsychotic medications to reduce suicidal behaviors in patients with schizophrenia or schizoaffective disorder who are known to be at high risk for suicide . The unique challenges to study design and the solutions identified for the InterSePT study are described . These challenges included defining suicidal behavior in patients with psychosis , endpoint selection , determination of analytic strategy , and development of scales to assess suicidal behavior . Given the life-threatening nature of suicidal behavior , ethical considerations required that the design minimize suicide attempts and deaths . While the study focused primarily on treatment of suicide , opportunities were used to collect data in related areas of interest , including suicide risk factors , other efficacy measures ( e.g. , Positive and Negative Syndrome Scale , Covi Anxiety Scale , Calgary Depression Scale ) , adverse events , pharmacoeconomics , and pharmacogenetics . Because of the complexity of the design issues , a steering committee , suicide monitoring board , and publication committee were established to assist with their management Positive psychotic symptoms , such as threat/"control-override " delusions or comm and hallucinations , have been related to aggression in patients with schizophrenia . However , retrospective data collection has hampered evaluation of the direct influence of psychopathology on aggressive behavior . In this study , we monitored aggressive behavior and psychopathology prospect ively and in close temporal proximity in 157 treatment-resistant in patients diagnosed with chronic schizophrenia or schizoaffective disorder participating in a 14-week double-blind clinical trial . Aggressive behavior was rated with the overt aggression scale ( OAS ) . Psychopathology was assessed using the positive and negative syndrome scale ( PANSS ) . At baseline , subjects who would be aggressive during the study had higher scores on only two PANSS items : hostility and poor impulse control . During the study PANSS positive subscale scores were significantly higher in aggressive subjects . Total PANSS scores were higher within 3 days of an aggressive incident , as were positive and general psychopathology subscale scores . However , in a smaller sub sample for whom PANSS ratings were available within 3 days before aggressive incidents , only scores on the PANSS positive subscale were significantly higher . These findings in chronic , treatment resistant in patients support the view that positive symptoms may lead to aggression 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 We examined the potential risks and benefits of switching from olanzapine to quetiapine in mentally stable , obese , or overweight patients with schizophrenia or schizoaffective disorder . Patients receiving olanzapine were r and omized to continuing olanzapine treatment ( N = 68 ; 7.5–20 mg/day ) or switching to  quetiapine ( N = 65 ; 300–800 mg/day ) . Time to relapse was the primary study objective ; secondary objectives included changes in weight , metabolic parameters , and psychiatric symptoms , and discontinuation rates . No significant difference in time to relapse was observed ( p = 0.293 ) , but significantly more patients remained on treatment in the olanzapine group compared with the quetiapine group ( 70.6 % vs 43.1 % ; p = 0.002 ) . Olanzapine-treated patients had significantly lower rates of study discontinuation for lack of efficacy and psychiatric adverse events ( AEs ) compared to quetiapine ( 2.94 % vs 15.38 % , p = 0.015 ) . Significantly more patients in the olanzapine group experienced an increase in BMI ≥1 kg/m2 . Olanzapine-treated patients experienced significantly greater increases in weight from Weeks 2 through 13 . Switching patients with stable disease from olanzapine to quetiapine did not significantly shorten time to relapse , but produced more frequent study discontinuations due to lack of efficacy or psychiatric AEs with moderate but variable improvement in weight and no significant between-group differences in mean changes in metabolic laboratory parameters BACKGROUND The purpose of this investigation was to test the efficacy of novel antipsychotic medications in the treatment of  cognitive impairment in early phase schizophrenia . METHODS Sixty-five patients in this multicenter double-blind study were r and omly assigned to olanzapine ( 5 - 20 mg ) , risperidone ( 4 - 10 mg ) , or haloperidol ( 5 - 20 mg ) . St and ard measures of clinical and motor syndromes were administered , as well as a comprehensive battery of tests to assess ( 1 ) motor skills , ( 2 ) attention span , ( 3 ) verbal fluency and reasoning , ( 4 ) nonverbal fluency and construction , ( 5 ) executive skills , and ( 6 ) immediate recall at baseline and after 6 , 30 , and 54 weeks of treatment . RESULTS The general cognitive index derived from the 6 domain scores revealed a significantly greater benefit from treatment with olanzapine relative to haloperidol and olanzapine relative to risperidone , but no significant difference was shown between risperidone and haloperidol . The improvement related to olanzapine was apparent after 6 weeks and enhanced after 30 and 54 weeks of treatment . Exploratory within-group analyses of the 6 cognitive domains after a conservative Bonferroni adjustment revealed a significant improvement with olanzapine only on the immediate recall domain , and similar analyses of the 17 individual tests revealed a significant improvement with olanzapine only on the Hooper Visual Organization Test . CONCLUSIONS These data suggest that olanzapine has some superior cognitive benefits relative to haloperidol and risperidone . A larger sample replication study is necessary to confirm and generalize the observations of this study and begin evaluation of the implication s of this change to cerebral function and quality of life for people with schizophrenia 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 The present study examined sexual functioning among first-time treated schizophrenia patients at the time that they initiated antipsychotic treatment  , and again 3 and 6 months later . These first-time treated patients comprise a subgroup of 570 schizophrenia patients who were part of a cohort of 7655 patients enrolled in the Intercontinental Schizophrenia Outpatient-Health Outcomes observational study ( IC-SOHO ) . As part of a brief clinical assessment conducted at entry to the study , and after 3 and 6 months of antipsychotic medication , patients were asked to rate their sexual functioning , and the investigator was asked to rate the extent to which the patient had neuroleptic-related loss of libido and sexual dysfunction . After being treated , patients treated with olanzapine showed the lowest prevalence of neuroleptic-induced sexual difficulties . At 3 months , there were significant differences between the treatment groups on neuroleptic-related loss of libido , neuroleptic-related sexual dysfunction and change in patient-rated sexual dysfunction . At 6 months , the difference between the groups on neuroleptic-related loss of libido was statistically significant . There were no significant differences between males and females . Many recent onset patients appear to suffer from problems of sexual functioning .  Olanzapine may offer an advantage in this area OBJECTIVE When a schizophrenia patient has an inadequate response to treatment with an antipsychotic drug  , it is unclear what other antipsychotic to switch to and when to use clozapine . In this study , the authors compared switching to clozapine with switching to another atypical antipsychotic in patients who had discontinued treatment with a newer atypical antipsychotic in the context of the Clinical Antipsychotic Trials for Interventions Effectiveness ( CATIE ) investigation . METHOD Ninety-nine patients who discontinued treatment with olanzapine , quetiapine , risperidone , or ziprasidone in phase 1 or 1B of the trials , primarily because of inadequate efficacy , were r and omly assigned to open-label treatment with clozapine ( N=49 ) or blinded treatment with another newer atypical antipsychotic not previously received in the trial ( olanzapine [ N=19 ] , quetiapine [ N=15 ] , or risperidone [ N=16 ] ) . RESULTS Time until treatment discontinuation for any reason was significantly longer for clozapine ( median=10.5 months ) than for quetiapine ( median=3.3 ) , or risperidone ( median=2.8 ) , but not for olanzapine ( median=2.7 ) . Time to discontinu 
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Associated problems such as glucose and cholesterol increase were usually also more frequent in the olanzapine group .
Other differences in adverse effects were less well documented .
Olanzapine may be a somewhat more efficacious drug than some other second generation antipsychotic drugs .
This small superiority in efficacy needs to be weighed against a larger weight gain and associated metabolic problems than most other second generation antipsychotic drugs , except clozapine .