***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: BACKGROUND Relapse is one of the most costly aspects of schizophrenia . AIMS To compare costs , clinical outcomes and quality of life for patients who experienced relapse in schizophrenia with a control group who did not relapse . METHOD Patients were r and omly selected from current psychiatric case-loads drawn from urban and suburban areas of Leicester . Differences in costs and outcomes by relapse status in the previous 6 months were examined using parametric and non-parametric tests , and multivariate analysis was used to examine factors associated with relapse and costs . RESULTS Costs for the patients who relapsed were over four times higher than those for the non-relapse group . There were few statistically significant differences in clinical and quality of life measures by relapse status . Multivariate analyses suggested some significant correlates of relapse and costs . CONCLUSIONS The higher costs associated with relapse will be of interest to policy-makers who face difficult choices concerning new but more expensive treatments for patients with schizophrenia While weight-management interventions are effective in attenuating antipsychotic-induced weight , there is no available evidence on their long-term effectiveness . This study sought to investigate the 2-year effects of an early behavioural intervention ( EBI ) design ed to prevent antipsychotic-induced weight gain in first-episode psychosis ( FEP ) patients . Sixty-one FEP patients were r and omized to receive either EBI or treatment-as-usual .  Intention-to-treat and observed-cases analysis showed that patients in the EBI group gained significantly less weight than those allocated to routine care at intervention completion ( 3-month follow-up ) with treatment effects maintained over 3months . Differences between groups were no longer significant by 12months . Weight-management interventions may need to be offered for longer periods to maintain preventative effects . Alternatively , booster sessions may need to be regularly delivered after intervention completion BACKGROUND Recently , the " Remission in Schizophrenia Working Group " proposed remission criteria consisting of a reduction to mild levels on key symptoms for at least 6 months . AIMS This study applied these remission criteria to a large first-episode psychosis sample in order to ( 1 ) determine the rates of remission ; ( 2 ) explore predictors of remission ; and ( 3 ) test the external validity of these criteria . METHODS We analyzed data from 462 subjects with a first-episode of psychosis who participated in a long-term , multinational , r and omized , double-blinded trial of risperidone and haloperidol over 2 to 4 years . RESULTS At some time point in the study 323 ( 70 % ) of the 462 subjects had a reduction to mild levels on the key symptoms as measured by the PANSS although only 109 ( 23.6 % ) maintained this level for at least 6 months thereby meeting remission criteria . The two strongest predictors of remission were shorter duration of untreated psychosis ( p=0.01 ) and treatment response at 6 weeks ( p=0.001 ) . Compared to non-remitted patients , those in remission experienced greater improvement on all PANSS subscales ( p<.0001 ) , CGI-S ( p<.0001 ) , better quality of life ( p=0.006 ) , fewer relapses ( p<.0001 ) , displayed a more favorable attitude towards their medication ( p=.002 ) , had lower EPS levels according to the ESRS ( p=<.0001 ) and received lower doses of antipsychotic medication ( p=0.003 ) . The remission and non-remission groups did not differ significantly regarding composite cognitive scores , suicidality and body mass index . CONCLUSIONS The results suggest that the remission criteria , although based solely on core symptom improvement , can effectively identify patients who have a more favorable overall outcome To add to the open question whether cognitive impairments predict clinical outcome in schizophrenia , a sample of 125 first episode patients was assessed at the onset and over one year of controlled long-term treatment within a study of the German Research Network on Schizophrenia . No relapse according to predefined criteria occurred within the first year , but a total of 29 patients fulfilled post-hoc criteria of “ clinical deterioration ” . Impairments in cognitive functioning assessed by the Trail-Making Test B at the onset of long-term treatment differentiated between patients with vs. without later clinical deterioration and proved to be a significant predictor of the clinical course in a regression analysis outperforming initial clinical status as predictor . However , low sensitivity ( 72 % ) and specificity ( 51 % ) limit possibilities of a transfer to individual predictions . As a linear combination of neuropsychological and psychopathological variables obtained highest predictive validity , such a combination may improve the prediction of the course of schizophrenic disorders and may ultimately lead to a more efficient and comprehensive treatment planning BACKGROUND Well- design ed prospect i ve studies of substance misuse in first-episode psychosis can improve our underst and ing of the risks associated with comorbid substance misuse and psychosis . AIMS To examine the potential effects of substance misuse on in-patient admission and remission and relapse of positive symptoms in first-episode psychosis . METHOD The study was a prospect i ve 15-month follow-up investigation of 103 patients with first-episode psychosis recruited from three mental health services . RESULTS Substance misuse was independently associated with increased risk of in-patient admission , relapse of positive symptoms and shorter time to relapse of positive symptoms after controlling for potential confounding factors . Substance misuse was not associated with remission or time to remission of positive symptoms . Heavy substance misuse was associated with increased risk of in-patient admission , relapse and shorter time to relapse . CONCLUSIONS Substance misuse is an independent risk factor for a problematic recovery from first-episode psychosis 96 first episode schizophrenic patients were included for a prospect i ve follow-up study on factors affecting course and outcome of  schizophrenia .  Feighner 's diagnostic criteria were used for inclusion and a yearly assessment was made using the Present State Examination and the Personal and Psychiatric History Schedule . At the end of 3 years , 64 patients had been followed up . Of these , 38 patients had one or more relapses . A comparison of the relapsing group with the non-relapsers revealed certain variables to be significantly associated with relapses . Some of these were regularity of follow-up , presence of affective symptoms and self-neglect and lack of social contacts . The importance of recognising these factors in order to prevent relapses in schizophrenia is discussed "  Expressed emotion " ( EE )  is considered a marker of dysfunctional family interaction in patients with schizophrenia . An alternative hypothesis , however , is that at least some of the different elements of EE really represent attempts on the part of carers to cope with and care for a relative with a psychiatric disorder .  EE ( criticism and emotional overinvolvement )  was measured in relatives ( n = 31 ) of patients with psychotic illness using the Five-Minute Speech Sample ( FMSS ) . Level of EE was examined in relation to ( 1 )  patient-reported family involvement in care over the previous 2 years as indicated by medication monitoring , involvement in treatment decisions , and providing a substitute for  institutional care ; and ( 2 ) symptom severity and number of psychotic episodes . Presence of EE in the relative was strongly associated with the degree of family involvement in care ( odds ratio [ OR ] over three levels : 3.2 ; 95 % confidence interval [ CI ] , 1.1 to 9.0 ) . In addition , presence of high EE was associated with number of psychotic episodes in the previous 5 years in the prob and ( OR over 0 , 1 , or 2 episodes : 6.2 ; 95 % CI , 1.2 to 31.9 ) . The association with family involvement was confined to emotional overinvolvement ( OR = 9.1 ; 95 % CI , 2.0 to 42.2 ) , whereas the association with previous psychotic episodes was confined to criticism ( OR = 20.6 ; 95 % CI , 2.8 to 149.3 ) . Emotional overinvolvement may be a state marker for attempts on the part of relatives to be partners in the care for patients with psychotic illness . High level of criticism may be a trait marker in relatives associated with poor prognosis , but could also develop in reaction to a frequently relapsing illness Background Transcultural studies have found lack of insight to be an almost invariable feature of acute and chronic schizophrenia , but its influence on prognosis is unclear . Aims To investigate the relationship between insight , psychopathology and outcome of first-episode schizophrenia in Vellore , India . Method Patients with a DSM – IV diagnosis of schizophrenia ( n = 131 ) were assessed prospect ively at baseline and at 6-month and 12-month follow-up . Demographic and clinical measures included  insight , psychopathology , duration of untreated psychosis ( DUP ) and social functioning . Linear and logistic regression was used to measure predictors of outcome . Results Follow-up data were available for 115 patients at 1 year . All achieved remission , half of them with and half without residual symptoms . Changes in psychopathology and insight during the first 6 months and DUP strongly predicted outcome ( relapse or functional impairment ) , controlling for baseline measures . Conclusions Outcome of schizophrenia in this setting is driven by early symptomatic improvement and is relatively favourable , in line with other studies from low- and middle-income countries . Early improvement in insight might be a useful clinical guide to future outcome . Reduction of DUP should be a target for intervention A tentative model for conceptualizing the interplay of vulnerability factors , stressors , and protective factors in the course of schizophrenia is discussed . A study of the initial years after a first schizophrenic episode is testing the predictive role of key factors . During an initial 1‐year period of depot antipsychotic medication , independent life events and expressed emotion were found to predict the likelihood of psychotic relapse . Initial analyses indicate that independent life events play less of a role in relapse prediction during a medication‐free period . These results suggest that maintenance antipsychotic medication raises the threshold for return of psychotic symptoms , such that relapses are less likely unless major environmental stressors occur . A low expressed emotion environment may be a protective factor Cross-sectional investigations , using the five-factor model of personality have evinced relationships among neuroticism , agreeableness , and psychotic symptoms . The current study examined these relationships via a prospect i ve follow-up study with remitted first-episode psychosis patients . Baseline five-factor model personality profiles , diagnoses , symptom ratings , and premorbid adjustment ratings were followed by nine monthly ratings on Brief Psychiatric Rating Scale psychosis items in 60 first-episode patients . Valid baseline personality profiles were completed by 40 patients . Patients who had a return of symptoms scored higher on baseline neuroticism and agreeableness than those who remained in remission . Premorbid adjustment also predicted return of symptoms . After premorbid adjustment was controlled for , the agreeableness differences remained significant , but the neuroticism scores were no longer significantly different . It is concluded that lower agreeableness acts as a mediating variable in relapse . Further studies should clarify whether agreeableness is associated with specific biases in processing interpersonal information , and interpersonal behaviors 
    Output:
    
Clinical variables and general demographic variables have little impact on relapse rates .
Conversely , non-adherence with medication , persistent substance use disorder , carers ' criticism and poorer premorbid adjustment significantly increase the risk for relapse in FEP .