***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 The sole focus of models of insight on bio-medical perspectives to the complete exclusion of local , non-medical and cultural constructs m and ates review . This study attempted to investigate the impact of  insight , psychopathology , explanatory models of illness on outcome of first episode schizophrenia . Method Patients diagnosed to have DSM IV schizophrenia ( n = 131 ) were assessed prospect ively for  insight , psychopathology , explanatory models of illness at baseline , 6 , 12 and 60 months using st and ard instruments . Multiple linear and logistic regression and generalized estimating equations ( GEE ) were employed to assess predictors of outcome . Results We could follow up 95 ( 72.5 % ) patients . Sixty-five of these patients ( 68.4 % ) achieved remission . There was a negative relationship between psychosis rating and insight scores . Urban residence , fluctuating course of the initial illness , and improvement in global functioning at 6 months and lower psychosis rating at 12 months were significantly related to remission at 5 years . Insight scores , number of non-medical explanatory models  and individual explanatory models held during the later course of the illness were significantly associated with outcome . Analysis of longitudinal data using GEE showed that women , rural residence , insight scores and number of non-medical explanatory models of illness held were significantly associated with BPRS scores during the study period . Conclusions Insight , the disease model and the number of non-medical model positively correlated with improvement in psychosis arguing for a complex interaction between the culture , context and illness variables . These finding argue that insight and explanatory models are secondary to psychopathology , course and outcome of the illness . The awareness of mental illness is a narrative act in which people make personal sense of the many challenges they face . The course and outcome of the illness , cultural context , acceptable cultural explanations and the prevalent social stigma interact to produce a complex and multifaceted underst and ing of the issues . This complexity calls for a nuanced framing of insight OBJECTIVES The authors used nationwide survey data to characterize current public conceptions related to recognition of mental illness and perceived causes , dangerousness , and desired social distance . METHODS Data were derived from a vignette experiment included in the 1996 General Social Survey .  Respondents ( n = 1444 ) were r and omly assigned to 1 of 5 vignette conditions . Four vignettes described psychiatric disorders meeting diagnostic criteria , and the fifth depicted a " troubled person " with sub clinical problems and worries . RESULTS Results indicate that the majority of the public identifies schizophrenia ( 88 % ) and major depression ( 69 % ) as mental illnesses and that most report multicausal explanations combining stressful circumstances with biologic and genetic factors . Results also show , however , that smaller proportions associate alcohol ( 49 % ) or drug ( 44 % ) abuse with mental illness and that symptoms of mental illness remain strongly connected with public fears about potential violence and with a desire for limited social interaction . CONCLUSIONS While there is reason for optimism in the public 's recognition of mental illness and causal attributions , a strong stereotype of dangerousness and desire for social distance persist . These latter conceptions are likely to negatively affect people with mental illness Objective This study was design ed to examine whether a brief hospital intervention design ed to alter patients ’ perceptions about their myocardial infa rct ion ( MI ) would result in a better recovery and reduced disability . Design In a prospect i ve r and omized study , 65 consecutive patients with their first MI aged were assigned to receive an intervention design ed to alter their perceptions about their MI or usual care from rehabilitation nurses . Patients were assessed in hospital before and after the intervention and at 3 months after discharge from hospital . Results The intervention caused significant positive changes in patients ’ views of their MI . Patients in the intervention group also reported they were better prepared for leaving hospital ( p < .05 ) and subsequently returned to work at a significantly faster rate than the control group ( p < .05 ) . At the 3-month follow-up , patients in the intervention group reported a significantly lower rate of angina symptoms than control subjects ( 14.3 vs. 39.3 , p < .03 ) . There was no significant differences in rehabilitation attendance between the two groups . Conclusions An in-hospital intervention design ed to change patients ’ illness perceptions can result in improved functional outcome after MI Background Based on experiences and empirical evidence gained in studies using the Lancashire Quality of Life Profile ( LQLP ) , the Manchester Short Assessment of Quality of Life ( MANSA ) has been developed as a condensed and slightly modified instrument for assessing quality of life . Its properties have been tested in a sample of community care patients . Method Fifty-five r and omly selected patients on the Care Programme Approach were interviewed using the LQLP , the MANSA and the Brief Psychiatric Rating Scale .  Results Correlations between subjective quality of life scores on MANSA and LQLP were all 0.83 or higher ( 0.94 for the satisfaction mean score ) . Cronbach 's alpha for satisfaction ratings was 0.74 , and association with psychopathology was in line with results for LQLP as reported in the literature . Conclusions The MANSA is a brief instrument for assessing quality of life focusing on satisfaction with life as a whole and with life domains . Its psychometric properties appear satisfactory Background and aims : There is a dearth of data on the predictors of insight in schizophrenia . This study attempted to assess the predictors of insight in a cohort of first-episode schizophrenia followed up over 5 years . Methods : Patients diagnosed to have Diagnostic and statistical manual of mental disorders ( 4th ed . ; DSM-IV ) schizophrenia ( n = 131 ) were assessed prospect ively for insight , psychopathology and explanatory models of illness over a 5-year period using st and ard instruments . Multiple linear regression and generalized estimating equations ( GEE ) were employed to assess predictors of insight . Results : We could follow up 95 ( 72.5 % ) patients , 5 years after recruitment . A total of 65 of these patients interviewed at 60 months ( 68.4 % ) achieved remission . Cross-sectional evaluations suggest a relationship between insight , psychosis rating and explanatory models of illness with good insight and medical models associated with good outcome . However , baseline and early illness data do not predict insight scores at 5 years . Serial longitudinal assessment of insight is negatively associated with Brief Psychiatric Rating Scale ( BPRS ) scores and positively associated with the number of nonmedical explanatory models of illness held by patients . Conclusion : These findings argue that insight and explanatory models of illness are secondary to psychopathology , course and outcome . They are dependent on the trajectory of the person ’s illness , are not independent of the condition and call for multifaceted underst and ing of the issues 
    Output:
    
There is an indication that causal explanations are associated with various treatment outcomes , including attitudes towards treatment and satisfaction with therapeutic relationships as well as internalized stigma .
Spiritual beliefs appeared to be adopted as a coping mechanism and a way to reduce stigma but did not appear to be associated with treatment outcome .
Individuals with psychosis do appear to develop causal beliefs that may be associated with engagement with services and treatment , as well as impacting on their attitudes towards themselves and others with mental illness .
This may have important implication s for clinical practice .
An individual 's causal explanation may influence how they engage with services and treatment , as well as providing a way of coming to terms with their difficulties .
Causal explanations may also contribute to the experience of stigma , which is often a significant barrier to recovery for this client group