***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 The most common ways of assessing adherence to oral antipsychotic medications in research and in clinical practice are self-report and physician report . This prospect i ve study examined the agreement among measures of adherence to oral antipsychotic medications among 52 out patients with schizophrenia . METHODS Participants were assessed at baseline during a visit to their outpatient clinic and followed for 12 weeks . Adherence was assessed by using subjective measures ( self-report and physician report ) and objective measures ( pill counts conducted in the home , electronic monitoring , and blood plasma concentrations ) . Electronic monitoring was used as an imperfect st and ard against which other methods were judged . RESULTS Data from pill counts and from electronic monitoring were strongly correlated ( r(k)=.61 ) . Self-report and physicians ' ratings of compliance were weakly correlated with pill count and electronic monitoring when compliance scores were examined with rank-order correlations ( r(k)=.18-.32 ) . When the sample was dichotomized into adherent and nonadherent groups on the basis of electronic monitoring or pill count ( at least 80 % adherent ) , neither physicians nor patients identified adherent behavior ( kappa < or=20 ) . Blood plasma concentrations were not correlated with any other measures of adherence ( kappa < or=20 ) . Self-report and physician report were best correlated with clinical state ( r(k)=-.27 , r(k)=-.25 ) , suggesting that patients and treating professionals may use clinical state to estimate adherence . CONCLUSIONS Patients and physicians were not able to identify adherence . The inability of physicians to accurately identify adherent individuals is likely to have important consequences for prescribing behavior , health care costs , and patient outcomes 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 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 discontinuation because of inadequate therapeutic effect was significantly longer for clozapine than for olanzapine , quetiapine , or risperidone . At 3-month assessment s , Positive and Negative Syndrome Scale total scores had decreased more in patients treated with clozapine than in patients treated with quetiapine or risperidone but not olanzapine . One patient treated with clozapine developed agranulocytosis , and another developed eosinophilia ; both required treatment discontinuation . CONCLUSIONS For these patients with schizophrenia who prospect ively failed to improve with an atypical antipsychotic , clozapine was more effective than switching to another newer atypical antipsychotic . Safety monitoring is necessary to detect and manage clozapine 's serious side effects OBJECTIVE To evaluate predictors of treatment discontinuation against medical advice and poor medication adherence among first-episode patients treated with olanzapine , quetiapine , or risperidone .  METHOD First-episode patients with schizophrenia , schizophreniform disorder , or schizoaffective disorder ( DSM-IV ) were r and omly assigned to olanzapine ( 2.5 - 20 mg/day ) , quetiapine ( 100 - 800 mg/day ) , or risperidone ( 0.5 - 4 mg/day ) as part of a 52-week , r and omized , double-blind , flexible-dose , multicenter study . Patients were enrolled from 2002 to 2004 at one of 26 sites in the United States and Canada .  Survival analysis tested for predictors of treatment discontinuation against medical advice , while mixed models tested for predictors of poor medication adherence . Significant findings from the final models were replicated in sensitivity analyses . RESULTS Of the 400 patients r and omly assigned to treatment , 115 patients who discontinued treatment against medical advice and 119 study completers were compared in this analysis . Poor treatment response ( p < .001 ) and low medication adherence ( p = .02 ) were independent predictors of discontinuation against medical advice . Ongoing substance abuse , ongoing depression , and treatment response failure significantly predicted poor medication adherence ( p < .01 ) . Higher cognitive performance at baseline and ethnicity ( black ) were also associated with lower medication adherence ( p < .05 ) . An association between poor medication adherence and illness insight at study entry was found at trend level ( p = .059 ) . CONCLUSION This study highlights the importance of treatment response in predicting discontinuation against medical advice and poor adherence to medication in first-episode patients . These results also support interventions to improve adherence behavior , particularly by targeting substance use disorders and depressive symptoms . TRIAL REGISTRATION Clinical Trials.gov identifier NCT00034892 ( http://www . clinical trials.gov ) 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 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . Among out patients with schizophrenia , antipsychotic non-adherence is common , grossly under-detected by patients and their prescribers , and is associated with poor clinical outcomes . Using electronic monitoring ( EM ) as the reference st and ard we evaluated the reliability and validity as well as the sensitivity and specificity of a recently developed , brief , pencil-paper , clinician-administered adherence instrument [ the Brief Adherence Rating Scale ( BARS ) ] to assess the oral antipsychotic medication adherence of out patients with schizophrenia and schizoaffective disorder .  EM and BARS adherence and symptom severity ratings were gathered at baseline and prospect ively at 6 monthly visits in 61 participants ( n=35 with schizophrenia ; n=26 with schizoaffective disorder ) . A significant positive relationship was found between mean BARS and EM adherence ( beta=0.98 ; rs=0.59 , p<0.0001 ) . Cronbach 's coefficient alpha revealed very high internal reliability for the BARS ( alpha=0.92 ) . A moderate-to-strong degree of test-retest reliability was also found for the BARS ( beta ranged from 0.53 to 0.92 and rs ranged from 0.46 to 0.86 ) . Regarding concurrent validity of the BARS , greater mean  BARS adherence was significantly related to lower mean PANSS total scores ( beta=-0.40 ; rs=-0.39 , p=0.002 ) and to lower mean Positive symptom sub-scale scores ( beta=-0.08 , p=.007 ; rs=-0.28 , p=.02 ) . An initial 3-month monitoring period with the BARS also demonstrated good sensitivity ( 73 % ) and specificity ( 74 % ) in identifying non-adherent out patients ( defined as < 70 % mean EM adherence ) . Relative to EM , the BARS appears to provide valid , reliable , sensitive , and specific estimates of antipsychotic medication adherence of out patients with schizophrenia and schizoaffective disorder . The BARS appears to be a promising c and i date as a brief adherence assessment instrument for feasible use in community-based setting BACKGROUND Second-generation antipsychotic drugs were introduced over a decade ago for the treatment of schizophrenia ; however , their purported clinical effectiveness compared with first-generation antipsychotic drugs is still debated . We aim ed to compare the effectiveness of second-generation antipsychotic drugs with that of a low dose of haloperidol , in first-episode schizophrenia . METHODS We did an open r and omised controlled trial of haloperidol versus second-generation antipsychotic drugs in 50 sites , in 14 countries . Eligible patients were aged 18 - 40 years , and met diagnostic criteria for schizophrenia , schizophreniform disorder , or schizoaffective disorder . 498 patients were r and omly assigned by a web-based online system to haloperidol ( 1 - 4 mg per day ; n=103 ) , amisulpride ( 200 - 800 mg per day ; n=104 ) , olanzapine ( 5 - 20 mg per day ; n=105 ) , quetiapine ( 200 - 750 mg per day ; n 
    Output:
    
Adherence to antipsychotics improves outcome in schizophrenia .
Positive attitude to medication and illness insight were the only factors consistently associated with better adherence , while contradictory results were found for socio-demographic characteristics , symptom severity and side effects .
Only distinct aspects of the therapeutic relationship and social support in younger patients were related to good adherence .
Antipsychotic type or formulation and neurocognitive functioning did not appear to impact medication adherence .