***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: OBJECTIVES Poor treatment response is an important factor contributing to lack of treatment adherence . The goals of this research were to determine whether improvements in Positive and Negative Syndrome Scale ( PANSS ) symptom domains predict the likelihood of staying on treatment and whether differential responses to treatment with various atypical antipsychotics in specific symptom domains account for differences in discontinuation rates or treatment adherence . METHODS We conducted a post-hoc analysis of pooled data from 5 r and omized , double-blind , 24- to 28-week clinical trials in 1103 olanzapine-treated and 1090 risperidone- , quetiapine- , ziprasidone- , or aripiprazole-treated adult patients with schizophrenia . The 5 PANSS factors were tested as potential predictors of treatment adherence for all treatment groups combined . Treatment differences in the 5 PANSS factors and individual items were assessed between olanzapine and the other atypical antipsychotics combined . Secondary analyses repeated for the 21 Heinrichs Quality of Life Scale ( QLS ) items . RESULTS Improvement in PANSS positive factor was the strongest predictor of treatment adherence , irrespective of medication ( based on st and ardized scores , hazard ratio [ HR ] , 1.58 ; 95 % confidence interval [ CI ] , + 1.40 to + 1.79 ; P < .001 ) . Improvement in PANSS hostility ( HR , 1.23 ; 95 % CI , + 1.11 to + 1.37 ; P < .001 ) and depressive ( HR , 1.15 ; 95 % CI , + 1.05 to + 1.27 ; P = .002 ) factors was also a significant predictor ; negative and disorganized thoughts factors were not . All QLS items had significant predictive effects . Olanzapine-treated patients showed significantly greater improvements than all other groups at week 24 on all 5 PANSS factors ( P = .028 for negative ; P < .001 for all others ) and on 3 QLS items . CONCLUSION Significant improvement in positive symptoms , regardless of treatment , followed by significant improvement in hostility and depressive symptoms , may best predict treatment adherence . Olanzapine-treated patients experienced significantly greater improvements in these specific symptoms than patients treated with the other atypical antipsychotics examined . These findings may further explain why olanzapine-treated patients continue treatment more often BACKGROUND Cognitive predictors of relapse have been extensively explored only in few long term longitudinal studies of first-episode schizophrenia . METHOD This study prospect ively followed 93 patients with first-episode schizophrenia , schizophreniform disorder , and schizoaffective disorder for 3 years after their first-episode illness .  Cognitive domains including  verbal intelligence , verbal and visual memory , verbal fluency , and Wisconsin Card Sorting Test performance  were investigated as potential predictors of relapse . RESULTS We found that by the first year 21 % patients had relapsed , by the second year 33 % had relapsed , and by the third year 40 % had relapsed . There was a significant difference in the relapse rate between patients with good adherence and patients with poor adherence to medication regimes . A multiple logistic regression analysis revealed that after controlling for medication adherence , perseverative error in the Wisconsin Card Sorting Test was the only cognitive function that significantly predict relapse with an odds ratio of 2.4 . CONCLUSIONS Cognitive flexibility in set shifting is related to tendency towards relapse in first-episode schizophrenic patients . Other cognitive factors appear not to be related to relapse . Possible mechanisms included the link between prefrontal dysfunction and sub-cortical dopamine system stability , as well as the effects of executive dysfunction on insight impairment and adherence behavior BACKGROUND Relatively little is known about the relationships between medication adherence and long-term functional outcomes in the treatment of schizophrenia . To extend previous research , we prospect ively examined the relationships between adherence with any antipsychotic medication and functional outcomes among schizophrenia patients treated over a 3-year period , assessed the stability of adherence over time , and examined whether adherence in the first year predicts changes in functional outcomes over the following 2 years . METHOD Analyses included 1906 participants with DSM-IV diagnoses of schizophrenia or schizoaffective or schizophreniform disorder in a multi-site , 3-year , prospect i ve , naturalistic study conducted in the United States between July 1997 and September 2003 . Outcome measures were assessed at 6-month intervals using systematic medical record abstract ion and structured interview of patients . Adherence with antipsychotic regimen was assessed using patient-reported adherence and the medication possession ratio ( percent days with prescription for any antipsychotic ) , dichotomized into adherence and non-adherence . Analyses employed generalized estimating equations and mixed models with repeated measures . RESULTS Nonadherence was associated with poorer functional outcomes , including greater risks of psychiatric hospitalizations , use of emergency psychiatric services , arrests , violence , victimizations , poorer mental functioning , poorer life satisfaction , greater substance use , and more alcohol-related problems ( all p < .001 ) . Adherence was relatively stable , with 77.3 % of patients maintaining the same adherence status from the first year to the second year . Nonadherence in the first year predicted significantly poorer outcomes in the following 2 years . CONCLUSIONS Findings highlight the importance of adherence with antipsychotic medication in the long-term treatment of schizophrenia and its potential beneficial impact on the mental health and criminal justice delivery systems Dropout from prophylactic neuroleptic treatment is one major reason for relapse in schizophrenia patients . There is a lack of prospect i ve studies on factors that predict medication adherence . We investigated factors suspected to predict dropout from continuous neuroleptic treatment in a 2-year prospect i ve study involving 122 out patients with a DSM-III-R diagnosis of schizophrenia . Forty-two ( 34.4 % ) were classified as patient-related dropouts . No significant difference between compliant patients and dropouts was found with regard to sociodemographic variables , except that compliant patients were significantly older . Also , no differences in psychopathology were seen at the beginning of treatment , but compliant patients had a longer duration of illness . Compliant patients had higher doses of neuroleptics in the initial stabilization phase and correspondingly showed more extrapyramidal signs . Physicians rated compliant patients from the beginning as more cooperative . These patients also showed significantly higher scores in positive treatment expectations . In a stepwise regression analysis , positive illness concepts , the global assessment of functioning ( GAF ) , and the physicians ' view of patients ' cooperation predicted 19 percent of the variance . We concluded that the prediction of dropouts is insufficient and remains largely an unsolved problem . Future research should focus more on context factors in the search for clinical ly meaningful explanations of patient dropout from treatment BACKGROUND The relative effectiveness of second-generation ( atypical ) antipsychotic drugs as compared with that of older agents has been incompletely addressed , though newer agents are currently used far more commonly . We compared a first-generation antipsychotic , perphenazine , with several newer drugs in a double-blind study . METHODS A total of 1493 patients with schizophrenia were recruited at 57 U.S. sites and r and omly assigned to receive olanzapine ( 7.5 to 30 mg per day ) , perphenazine ( 8 to 32 mg per day ) , quetiapine ( 200 to 800 mg per day ) , or risperidone ( 1.5 to 6.0 mg per day ) for up to 18 months . Ziprasidone ( 40 to 160 mg per day ) was included after its approval by the Food and Drug Administration . The primary aim was to delineate differences in the overall effectiveness of these five treatments . RESULTS Overall , 74 percent of patients discontinued the study medication before 18 months ( 1061 of the 1432 patients who received at least one dose ) : 64 percent of those assigned to olanzapine , 75 percent of those assigned to perphenazine , 82 percent of those assigned to quetiapine , 74 percent of those assigned to risperidone , and 79 percent of those assigned to ziprasidone . The time to the discontinuation of treatment for any cause was significantly longer in the olanzapine group than in the quetiapine ( P<0.001 ) or risperidone ( P=0.002 ) group , but not in the perphenazine ( P=0.021 ) or ziprasidone ( P=0.028 ) group . The times to discontinuation because of intolerable side effects were similar among the groups , but the rates differed ( P=0.04 ) ; olanzapine was associated with more discontinuation for weight gain or metabolic effects , and perphenazine was associated with more discontinuation for extrapyramidal effects . CONCLUSIONS The majority of patients in each group discontinued their assigned treatment owing to inefficacy or intolerable side effects or for other reasons . Olanzapine was the most effective in terms of the rates of discontinuation , and the efficacy of the conventional antipsychotic agent perphenazine appeared similar to that of quetiapine , risperidone , and ziprasidone . Olanzapine was associated with greater weight gain and increases in measures of glucose and lipid metabolism To assess baseline predictors and consequences of antipsychotic adherence during the long-term treatment of schizophrenia out patients , data were taken from the 3-year , prospect i ve , observational , European Schizophrenia Out patients Health Outcomes ( SOHO ) study , in which out patients  starting  or  changing antipsychotics were assessed every 6 months . Physician-rated adherence was dichotomized as adherence/non-adherence . Regression models tested for predictors of adherence during follow-up , and associations between adherence and outcome measures . Of the 6731 patients analysed , 71.2 % were adherent and 28.8 % were non-adherent over 3 years . The strongest predictor of adherence was adherence in the month before baseline assessment . Other baseline predictors of adherence included initial treatment for schizophrenia and greater social activities . Baseline predictors of non-adherence were alcohol dependence and substance abuse in the previous month , hospitalization in the previous 6 months , independent housing and the presence of hostility . Non-adherence was significantly associated with an increased risk of relapse , hospitalization and suicide attempts . In conclusion , non-adherence is common but can partly be predicted . This may allow strategies to improve adherence to be targeted to high-risk patients . Also , reversal of some risk factors may improve adherence . Non-adherence is associated with a range of poorer long-term outcomes , with clinical and economic implication OBJECTIVES This study aim ed to prospect ively identify the best single predictor and the best set of predictors of risk for nonadherence with anti-psychotic medication in the treatment of patients with schizophrenia . METHOD We used data from 1579 patients in a 3-year , prospect i ve , naturalistic , nonr and omized , multisite study of schizophrenia patients conducted from July 1997 to September 2003 ( U.S. Schizophrenia Care and Assessment Program ) . Adherence with any oral antipsychotic medication was assessed using  patient-reported medication adherence and an indirect adherence measure  based on medical record prescription information . Patients who reported poor medication adherence or had a medication possession ratio < or = 80 % ( percentage of days with prescriptions for any oral antipsychotic ) during the first year after enrollment were defined as nonadherent ( N = 296 , 18.8 % ) . Thirty-nine previously reported potential risk factors of nonadherence with antipsychotic medication were assessed at enrollment with valid and reliable measures . Risk factors represented patient- , environment- , and treatment-related domains , including sociodemographics , symptom severity , substance use , threat to safety of self and others , other illness-related factors , need for supervision , medication-related adverse events , and prior medication-utilization patterns . RESULTS The best single predictor of future nonadherence was nonadherence during the 6 months prior to enrollment ( odds ratio = 4.1 , 95 % confidence interval = 3.1 to 5.6 , p < .001 ) . The best set of predictors of nonadherence , ordered by strength of association , included prior non-adherence , recent illicit drug use , recent alcohol use , prior treatment with antidepressants , and greater patient-reported , medication-related cognitive impairment . CONCLUSION Nonadherence with antipsychotic medication is associated with a well-defined set of risk factors that can be used to identify patients who are predisposed to poor adherence OBJECTIVE Nonadherence to antipsychotic regimens is considered to be one of the main reasons for hospital readmission . This study assessed the extent of nonadherence in the month before inpatient treatment . METHODS Ninety-five consecutive patients with an ICD-10 diagnosis of a psychotic disorder ( F20 ) were surveyed about adherence at admission to psychiatric inpatient treatment at a hospital in Linz , Austria .  Adherence was assessed on the basis of self-report and by interviewing multiple informants . Episodes of inpatient treatment during the year after discharge were assessed prospect ively . RESULTS Fifty-four patients ( 57 percent ) were rated as 
    Output:
    
Results : Key drivers of nonadherence included lack of insight , medication beliefs and substance abuse .
Key consequences of nonadherence included greater risk of relapse , hospitalization and suicide .
Factors positively related to adherence were a good therapeutic relationship with physician and perception of benefits of medication .
The most frequently reported driver and consequence were lack of insight and greater risk of hospitalization respectively .
Conclusions : Improving adherence in schizophrenia may have a considerable positive impact on patients and society .
This can be achieved by focusing on the identified multitude of factors driving nonadherence