***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 
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    Input: Traumatic experiences have been positively associated with both severity of attenuated psychotic symptoms in individuals at high risk ( HR ) for psychosis and transitions into psychotic disorders . Our aim was to determine what characteristics of the trauma history are more likely to be associated with individuals at HR . The Trauma History Screen ( THS ) was used to enable emphasis on number and perceived intensity of adverse life events and age at trauma exposure . Sixty help-seeking individuals who met HR criteria were compared to a r and om sample of 60 healthy volunteers . Both groups were aged 16–35 and resided in the same geographical location . HR participants experienced their first trauma at an earlier age , continued to experience trauma at younger developmental stages , especially during early/mid adolescence and were exposed to a high number of traumas . They were more depressed and anxious , but did not experience more distress in relation to trauma . Both incidences of trauma and age at which trauma occurred were the most likely predictors of becoming HR . This work emphasises the importance of assessing trauma characteristics in HR individuals to enable differentiation between psychotic-like experiences that may reflect dissociative responses to trauma and genuine prodromal psychotic presentations Summary Background Provision of early intervention services has increased the rate of social recovery in patients with first-episode psychosis ; however , many individuals have continuing severe and persistent problems with social functioning . We aim ed to assess the efficacy of early intervention services augmented with social recovery therapy in patients with first-episode psychosis . The primary hypothesis was that social recovery therapy plus early intervention services would lead to improvements in social recovery . Methods We did this single-blind , phase 2 , r and omised controlled trial ( SUPEREDEN3 ) at four specialist early intervention services in the UK . We included participants who were aged 16–35 years , had non-affective psychosis , had been clients of early intervention services for 12–30 months , and had persistent and severe social disability , defined as engagement in less than 30 h per week of structured activity . Participants were r and omly assigned ( 1:1 ) , via computer-generated r and omisation with permuted blocks ( sizes of four to six ) , to receive social recovery therapy plus early intervention services or early intervention services alone . R and omisation was stratified by sex and recruitment centre ( Norfolk , Birmingham , Lancashire , and Sussex ) . By necessity , participants were not masked to group allocation , but allocation was concealed from outcome assessors . The primary outcome was time spent in structured activity at 9 months , as measured by the Time Use Survey . Analysis was by intention to treat . This trial is registered with IS RCT N , number IS RCT N61621571 . Findings Between Oct 1 , 2012 , and June 20 , 2014 , we r and omly assigned 155 participants to receive social recovery therapy plus early intervention services ( n=76 ) or early intervention services alone ( n=79 ) ; the intention-to-treat population comprised 154 patients . At 9 months , 143 ( 93 % ) participants had data for the primary outcome . Social recovery therapy plus early intervention services was associated with an increase in structured activity of 8·1 h ( 95 % CI 2·5–13·6 ; p=0·0050 ) compared with early intervention services alone . No adverse events were deemed attributable to study therapy . Interpretation Our findings show a clinical ly important benefit of enhanced social recovery on structured activity in patients with first-episode psychosis who received social recovery therapy plus early intervention services . Social recovery therapy might be useful in improving functional outcomes in people with first-episode psychosis , particularly in individuals not motivated to engage in existing psychosocial interventions targeting functioning , or who have comorbid difficulties preventing them from doing so . Funding National Institute for Health Research Objective Recent studies suggest that psychotic-like experiences may also act as markers for non-psychotic psychiatric disorders , which may indicate that the focus of research in individuals at high risk ( HR ) for psychosis needs updating . In this study we thoroughly examined the clinical and functional characteristics of a consecutive cohort of young people at HR for psychosis and compared them to a matched sample of healthy volunteers . Method Between February 2010 and September 2012 60 help-seeking HR individuals , aged 16–35 , were recruited from CAMEO Early Intervention in Psychosis Service , Cambridgeshire , UK . Forty-five age- and gender-matched healthy volunteers were r and omly recruited from the same geographical area . Sociodemographic , psychiatric morbidity , functioning and quality of life measures were compared between both groups . Results HR individuals suffered a wide range of DSM-IV psychiatric disorders , mainly within the affective and anxiety diagnostic spectra . In comparison to healthy volunteers , young people at HR reported more suicidal ideation/intention , depressive and anxiety symptoms and presented with remarkably poor functioning and quality of life . Conclusion The presence of co-morbid moderate or severe depressive and anxiety symptoms was common in our sample of young people at enhanced risk for psychosis . A HR mental state may be associated not only with an increased risk for psychosis , but also other psychiatric disorders . Our findings may have implication s for the future implementation of therapeutic interventions that this population could benefit from Objective To determine whether cognitive therapy is effective in preventing the worsening of emerging psychotic symptoms experienced by help seeking young people deemed to be at risk for serious conditions such as schizophrenia . Design Multisite single blind r and omised controlled trial . Setting Diverse services at five UK sites . Participants 288 participants aged 14 - 35 years ( mean 20.74 , SD 4.34 years ) at high risk of psychosis : 144 were assigned to cognitive therapy plus monitoring of mental state and 144 to monitoring of mental state only . Participants were followed-up for a minimum of 12 months and a maximum of 24 months . Intervention Cognitive therapy ( up to 26 ( mean 9.1 ) sessions over six months ) plus monitoring of mental state compared with monitoring of mental state only . Main outcome measures Primary outcome was scores on the comprehensive assessment of at risk mental states ( CAARMS ) , which provides a dichotomous transition to psychosis score and ordinal scores for severity of psychotic symptoms and distress . Secondary outcomes included emotional dysfunction and quality of life . Results Transition to psychosis based on intention to treat was analysed using discrete time survival models . Overall , the prevalence of transition was lower than expected ( 23/288 ; 8 % ) , with no significant difference between the two groups ( proportional odds ratio 0.73 , 95 % confidence interval 0.32 to 1.68 ) . Changes in severity of symptoms and distress , as well as secondary outcomes , were analysed using r and om effects regression ( analysis of covariance ) adjusted for site and baseline symptoms . Distress from psychotic symptoms did not differ ( estimated difference at 12 months −3.00 , 95 % confidence interval −6.95 to 0.94 ) but their severity was significantly reduced in the group assigned to cognitive therapy ( estimated between group effect size at 12 months −3.67 , −6.71 to −0.64 , P=0.018 ) . Conclusions Cognitive therapy plus monitoring did not significantly reduce transition to psychosis or symptom related distress but reduced the severity of psychotic symptoms  in young people at high risk . Most participants in both groups improved over time . The results have important implication s for the at risk mental state concept . Trial registration Current Controlled Trials IS RCT N56283883 BACKGROUND There have been recent advances in the identification of people at high risk of psychosis and psychological treatments have shown promise for prevention . AIMS To compare the longitudinal course of psychotic experiences and emotional dysfunction in high-risk participants receiving cognitive therapy with those receiving treatment as usual .  METHOD Data from a recent r and omised controlled trial of cognitive therapy for people at risk of developing psychosis were utilised to examine three different statistical models that were based on 432 measurements of  psychotic experiences and 421 of  emotional dysfunction ( anxiety-depression )  contributed by 57 participants across the 13 measurement occasions ( monthly monitoring for a year ) . RESULTS Psychotic experiences and emotional dysfunction were correlated and decreased significantly over the course of the study , with most improvement in the early months . The reduction in positive symptoms , but not emotional dysfunction , was enhanced by allocation to cognitive therapy . CONCLUSIONS Psychotic experiences and emotional dysfunction appear to interact in people at risk of developing psychosis . There appears to be a specific benefit of cognitive therapy BACKGROUND Not all persons identified in the early stages to be at risk for psychosis eventually cross the threshold for a psychotic illness . However , sub- clinical symptoms may not only indicate a specific risk but also suggest a more general , underlying psychopathology that predisposes one to various common mental disorders . METHODS Analyzing data from the prospect i ve Zurich Cohort Study , we used two psychosis subscales - " schizotypal signs " and " schizophrenia nuclear symptoms " - derived from the SCL-90-R checklist that measured sub- clinical psychosis symptoms in 1979 . We also assessed 10 different diagnoses of common mental disorders through seven interview waves between 1979 and 2008 . This 30-year span , covering participant ages of 19/20 to 49/50 , encompasses the period of highest risk for the occurrence of such disorders . RESULTS Both psychosis scales from 1979 , but especially " schizotypal signs " , were significantly correlated with most mental disorders over the subsequent test period . Higher values on both subscales were associated with an increasing number of co-occurring disorders . CONCLUSIONS Our data demonstrate that sub- clinical psychosis generally represents a risk factor for the development of common mental disorders and a liability for co-occurring disorders . This refers in particular to dysthymia , bipolar disorder , social phobia , and obsessive-compulsive disorder . Proneness to psychosis could signal a fundamental tendency toward common mental disorders OBJECTIVES To explore participants ' experiences of ' enhanced monitoring ' and cognitive behaviour therapy ( CBT ) within a r and omized controlled trial evaluating early detection and prevention of psychosis ( ' early detection and intervention evaluation [ EDIE ] 2 ' ) . DESIGN Semi-structured qualitative interviews were conducted with a sample of participants at the end of their involvement with the trial . METHODS Ten young people were interviewed ; six males and four females , with a mean age of 27.5 . Nine participants identified themselves as White British and one Black British . All participants had received ' enhanced monitoring ' during the trial , and 8 of 10 also received CBT . Interviews were transcribed verbatim and analysed using thematic analysis to identify central themes within and among participants ' accounts . RESULTS Three super-ordinate thematic areas were identified : ' a chance to talk ' , monitoring-specific themes , and  CBT-specific themes . The central theme ( ' a chance to talk ' ) was drawn from across all participants ' accounts and represents the most consistently valued attribute of participants ' experiences of the EDIE 2 trial . Sub-themes of this topic were identified as follows : interpersonal engagement , informality and normalization , and ' opening up ' . Sub-themes related to monitoring include the following : clarity and reassurance , ' a therapeutic process ' , and challenges .  CBT experience was most consistently conceptualized as ' rethinking things ' , and two additional CBT-specific sub-themes were identified : hard work and moving forward . CONCLUSIONS Our findings suggest that for young people at risk of psychosis , a normalizing psychosocially oriented assessment and monitoring process may have benefits for many , while CBT may help to reduce the negative impact of unusual psychological experiences for both the short- and long term . PRACTITIONER POINTS Young people considered at risk of psychosis highly value normalizing , collaborative , and flexible approaches when engaging with research or clinical staff . All of our participants highlighted the primary value of their engagement with staff members as having a ' chance to talk ' about their experiences and difficulties . CBT seems to be widely acceptable among ' at-risk ' participants , though further research is required to establish the ' key ingredients ' of effective CBT for ' at-risk ' individuals . Valued CBT-related outcomes highlighted by participants included improved psychosocial underst and ing of their difficulties , improved coping ability , and greater optimism for the future CONTEXT It has been suggested that patients with major depressive disorder ( MDD ) who display pretreatment features suggestive of bipolar disorder or bipolar spectrum features might have poorer treatment outcomes . OBJECTIVE To assess the association between bipolar spectrum features and antidepressant treatment outcome in MDD . DESIGN Open treatment followed by sequential r and omized controlled trials . SETTING Primary and specialty psychiatric outpatient centers in the United States . PARTICIPANTS Male and female out patients aged 18 to 75 years with a DSM-IV diagnosis of nonpsychotic MDD who participated in the Sequenced Treatment Alternatives to Relieve Depression ( STAR*D ) study . INTERVENTIONS Open treatment with citalopram followed by up to 3 sequential next-step treatments . MAIN OUTCOME MEASURES Number of treatment levels required to reach protocol -defined remission , as well as failure to return for the postbaseline visit , loss to follow-up , and psychiatric adverse events . For this secondary analysis , putative bipolar spectrum features , including items on the mania and psychosis subscales of the Psychiatric Diagnosis Screening Question naire , were examined for association with treatment outcomes . RESULTS Of the 4041 subjects who entered the study , 1198 ( 30.0 % ) endorsed at least 1 item on the psychosis scale and 1524 ( 38.1 % ) described at least 1 recent maniclike/hypomaniclike symptom . Irritability and psychoticlike symptoms at entry were significantly associated with 
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Discussion The identification of effective psychological interventions and of specific components associated with intervention effectiveness will augment existing evidence that can inform the development of a new , tailored intervention to improve outcomes related to psychotic symptoms , anxiety and depression , distress , functioning , and quality of life .