***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: This study examines attitudes toward work , work incentives , and the impact of work on quality of life for people with schizophrenia , and investigates whether these findings differ among Western countries . We interviewed 24 r and omly selected subjects with schizophrenia and schizoaffective disorder ( 12 employed and 12 unemployed ) at each of three sites : Boulder , Colorado , United States ; Berlin , Germany ; and Berne , Switzerl and . No significant differences were found in the subjects ' attitudes toward work or subjective well-being , although Swiss patients had a higher cost-of-living-adjusted income . Unemployed subjects reported a lower subjective reservation ( minimum financially worthwhile ) wage than employed subjects in Berlin and Berne , whereas the reverse was true in Boulder . When subjects from all sites were combined , employed patients displayed less psychopathology and significant advantages in terms of objective and subjective measures of income and well-being : They were also more likely to stress the importance of work . The results suggest that work is associated with a markedly better quality of life for people with schizophrenia , but that disability pension programs in the United States might introduce work disincentives Background This study of chronically ill patients with schizophrenia aim ed to identify patients who achieve sustained favorable long-term outcome - when the outcome incorporates severity of symptoms , level of functioning , and use of acute care services - and to identify the best baseline predictors of achieving this sustained favorable long-term outcome . Methods Using data from the United States Schizophrenia Care and Assessment Program ( US-SCAP ) ( N = 2327 ) , a large 3-year prospect i ve , multisite , observational study of individuals treated for schizophrenia in the US , a hierarchical cluster analysis was performed to group patients based upon baseline symptom severity . Symptom severity was assessed using the Positive and Negative Syndrome Scale ( PANSS ) scores , level of functioning , and use of acute care services . Level of functioning reflected patient-reported productivity and clinician-rated occupational role functioning . Use of acute care services reflected self-reported psychiatric hospitalization and emergency service use . Change of health state was determined over the 3-year period . A patient was classified as having a sustained favorable long-term outcome if their health state values had the closest distance to the defined " best baseline cluster " at each point over the length of the study . Stepwise logistic regression was used to determine baseline predictors of sustained favorable long-term outcome . Results At baseline , 5 distinct health state clusters were identified , ranging from " best " to " worst . " Of 1635 patients with sufficient data , only 157 ( 10 % ) experienced sustained favorable long-term outcome during the 2-years postbaseline . The baseline predictors associated with sustained favorable long-term outcome included better quality of life , more daily activities , patient-reported clearer thinking from medication , better global functioning , being employed , not being a victim of a crime , not having received individual therapy , and not having received help with shopping and leisure activities . Conclusions Only a small percentage of patients achieved sustained favorable long-term outcome in this study , suggesting there continues to be a great need for improvement in the treatment of schizophrenia . Findings suggest that clinicians could make early projections of health states and identify those patients more likely to achieve favorable long-term outcomes enabling early therapeutic interventions to enhance benefits for patients This study examined the longitudinal course of competitive employment  in patients with schizophrenia following treatment for an acute exacerbation , and prospect ively predicts work approximately 2 years later from sociodemographic and clinical characteristics . A sample of 528 patients was assessed at baseline , and 313 were followed up 1 and 2 years later . Assessment s included sociodemographic characteristics , premorbid functioning , work history , symptoms , social functioning , recent efforts to find work , and interest in work . Analyses examined changes in competitive work from baseline to the followups , the correlates of work history , the prospect i ve prediction of work at the 1- and 2-year followup assessment s , and correlates of competitive work . Competitive employment increased significantly from 10 percent at baseline to 23 percent and 21 percent at the 1- and 2-year followups , respectively . At baseline , among patients who were not competitively working , 61 percent reported interest in working . Patients who were not competitively employed at baseline but reported making recent efforts to find work were more likely to be working at the followups than other not employed patients . Work at the 1- and 2-year followups was predicted by prior work experience , patient and mother 's educational level , cognitive impairment , and social functioning . Similar correlates of current work status were found . Interventions may need to target educational level , cognitive impairment , and social competence and functioning in order to improve the competitive employment outcomes of persons with schizophrenia BACKGROUND Knowledge of the level of psychosocial impairment associated with psychosis is important in evaluating the impact of the illness on those affected . When such knowledge is derived from community-based epidemiological surveys , it can help in providing a public health perspective for service planning with information derived from representative sample s of patients . METHODS A two-phase epidemiological survey of persons with psychosis in four predominantly urban areas of Australia . First phase screening for psychosis ( N= 5,710 ) was followed by a semi-structured interview of a stratified r and om sample ( N = 980 ) to assess psychopathology ( lifetime and current ) and psychosocial disability . RESULTS Most of the interviewees were unemployed and had never married . There was widespread impairment in sexual and social relationships and in the performance of activities of daily living . Over half expressed dissatisfaction with life in general . Persons with affective psychoses were often as disabled as those with schizophrenia and diagnostic categorizations were not important in the conferment of risk for disability . Rather , poor pre-morbid work or social adjustment and poor course of illness were potent risk factors for diverse forms of disability in persons with psychosis . CONCLUSION A large proportion of persons with experience of psychosis living in the community suffers from significant levels of psychosocial disability . Disablement seems to reflect , in part , a diathesis of poor pre-morbid functioning and less than optimal response to treatment of the disorder OBJECTIVE To describe the longer-term clinical and functional outcome of a large , epidemiologic representative cohort of individuals experiencing a first episode of psychosis . METHOD A naturalistic , prospect i ve follow-up of an epidemiologic sample of 723 consecutive first-episode psychosis patients , followed between January 1998 and April 2005 , at a median of 7.4 years after initial presentation to the Early Psychosis Prevention and Intervention Centre ( EPPIC ) in Melbourne , Australia . EPPIC is a frontline public mental health early psychosis program , servicing a geographically defined catchment area with a population of about 800,000 people . The main outcome measures included the Brief Psychiatric Rating Scale , the Schedule for the Assessment of Negative Symptoms , the Beck Depression Inventory , the Global Assessment of Functioning Scale , the Social and Occupational Functioning Assessment Scale , the Quality of Life Scale , and the remission criteria developed by the Remission in Schizophrenia Working Group . RESULTS Follow-up information was collected on up to 90.0 % ( n = 651 ) of the baseline cohort of 723 participants , with 66.9 % ( n = 484 ) interviewed . In the last 2 years , 57 % of individuals with schizophrenia/schizophreniform , 54 % with schizoaffective disorder , 62 % with affective psychosis , and 68 % with other psychotic disorders reported some paid employment . Depending upon the criteria applied , symptomatic remission at follow-up was observed in 37%-59 % of the cohort . Social/vocational recovery was observed in 31 % of the cohort . Approximately a quarter achieved both symptomatic remission and social/vocational recovery . CONCLUSION The relatively positive outcomes are consistent with a beneficial effect of specialized early intervention programs ; however it is premature to draw firm conclusions . There was no control group and there are many differences between the relevant comparison studies and the present one . Although difficult to conduct , large scale controlled health services research trials are required to definitively determine the impact and optimal duration of specialized early psychosis programs AIM To examine the associations of job acquisition and loss in a representative , prospect i ve community sample of people with schizophrenia living in the UK , France and Germany . METHOD A representative sample of twelve hundred and eight people with schizophrenia were recruited from selected secondary mental health services in the U.K , France and Germany and followed up for 2 years . Information on demographic details , psychotic symptoms and work status was collected . RESULTS The odds of getting jobs were increased by being resident in Marseille , Leipzig , Hemer and Heilbronn and by a higher regional general population employment rate . The odds were reduced by living in Lyon , a later illness onset , a longer length of illness , a continuous illness course and more severe negative psychotic symptoms . Previous vocational training reduced the odds of losing employment , whilst living in Lyon or Leipzig , harmful use of alcohol and more positive psychotic symptoms at baseline all increased the odds . CONCLUSIONS In addition to illness related factors , area of residence and local labour market conditions appear to be important in explaining employment status change in people with schizophrenia Characteristics associated with psychiatrist-reported treatment-compliance problems were investigated using the 1999 Study of Psychiatric Patients and Treatments from the Practice Research Network of the American Psychiatric Institute for Research and Education ( n=1,843 ) .  Logistic regression was used to study characteristics associated with compliance problems as perceived by treating psychiatrists . Among the 22 potential predictors of interest , all but three ( age , gender , and problems with primary support group ) were found to be significantly associated with treatment-compliance problems in bivariate analyses . A predictive model was developed consisting of eight independently significant predictors from diagnostic , clinical , psychosocial , and treatment-history domains . These predictors included substance use disorder diagnosis , medication side effects , moderate to severe psychotic symptoms , personality disorder diagnosis , economic problems , prior hospitalization , current Global Assessment of Functioning scale score , and duration of treatment with current psychiatrist . This predictive model correctly identified the presence or absence of treatment-compliance problems in 91 % of patients in a sample r and omly drawn from the data set before model construction . These findings may be useful to clinicians , research ers , and program planners interested in addressing the important issue of treatment-compliance problems in psychiatric care setting OBJECTIVE The objective of this study was to compare the 3-year course of schizophrenia between persons with tardive dyskinesia ( TD ) and persons without TD on multiple outcome measures . METHOD Data were drawn from a large , prospect i ve , naturalistic study of persons treated for schizophrenia-spectrum disorders ( DSM-IV criteria ) in the United States , conducted between July 1997 and September 2003 . Treatment outcomes were assessed at enrollment and at 12 , 24 , and 36 months postenrollment using measures of symptoms , functioning , productivity , activity , and quality of life .  Participants who had TD at enrollment ( fulfilling Schooler-Kane criteria , N = 637 ) were compared with those who did not ( N = 1538 ) on clinical and functional measures at enrollment and across the 3 years of follow-up . Additional analyses examined those with persistent TD compared to those without persistent TD . RESULTS With adjustment for known correlates of TD , participants with TD compared to those without TD had significantly more severe psychopathology , were less likely to experience symptom remission , had more severe extrapyramidal side effects , and had lower levels of quality of life and functioning , lower productivity , and fewer activities ( all p < .001 ) across the 3-year follow-up . Findings were essentially unchanged when the subgroup of participants with persistent TD ( at enrollment and at 1 year ) was examined . CONCLUSION These results indicate that , in the long-term treatment of schizophrenia , persons with TD have a significantly more severe and more refractory course of illness than those without TD , suggesting poorer prognosis and the need for specialized interventions Employment has been increasingly recognized as an important goal for individuals with schizophrenia . Previous research has shown mixed results on the relationship of specific antipsychotic medications to employment outcomes , with some studies finding greater benefits for second-generation antipsychotic medications ( SGAs ) over first-generation antipsychotic medication ( FGAs ) . A r and omized controlled trial ( CATIE ) examined medication assignment and both employment outcomes and participation in psychosocial rehabilitation ( PSR ) among 1,121 individuals with a diagnosis of schizophrenia r and omized to SGAs ( olanzapine , quetiapine , risperidone , ziprasidone ) or one FGA ( perphenazine ) .  Service use and employment were assessed at quarterly interviews . There were no differences between medication groups on employment outcomes or participation in PSR . Consistent with other CATIE results , there were no differences in employment or participation in PSR among these five medications , including the FGA perphenazine AIMS This study assessed clinical and functional outcomes following a switch from risperidone to olanzapine in a 1-year naturalistic study of schizophrenia patients in Japan . METHODS We used data from a large 1-year prospect i ve , multicenter , observational non-interventional study of individuals who were initiated on olanzapine for the treatment of schizophrenia in Japan . Current analyses focused on patients who were switched at study entry from risperidone to olanzapine ( n = 258 ) . Repeated measures analysis was employed to assess outcomes on vali date d measures . RESULTS At study entry , 45 % were in patients and 55 % out patients . Participants were in their 
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Additionally , environmental factors , eg , the availability of welfare benefits  and  vocational support programs , seemed to play a role .