***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 Efficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders . AIMS To compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive-behavioural therapy ( CBT ) . METHOD We undertook a multicentre , pragmatic , r and omised controlled treatment trial ( n=253 ) . Patients were assessed every 8 weeks for 18 months . RESULTS More than half of the patients had a recurrence by 18 months , with no significant differences between groups ( hazard ratio=1.05 ; 95 % CI 0.74 - 1.50 ) . Post hoc analysis demonstrated a significant interaction ( P=0.04 ) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes , but less effective in those with more episodes . CONCLUSIONS People with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT . However , such cases form the minority of those receiving mental healthcare OBJECTIVE Previous studies have found that family-focused treatment is an effective adjunct to pharmacotherapy in stabilizing symptoms in adult bipolar disorder . The authors examined whether pharmacotherapy and family-focused treatment for adolescents with bipolar disorder was more effective than pharmacotherapy and brief psychoeducation ( enhanced care ) in decreasing time to recovery from a mood episode , increasing time to recurrence , and reducing symptom severity over 2 years . METHOD A total of 145 adolescents ( mean age , 15.6 years ) with bipolar I or II disorder and a DSM-IV-TR manic , hypomanic , depressive , or mixed episode in the previous 3 months were r and omly assigned , with family members , either to pharmacotherapy and family-focused treatment , consisting of psychoeducation ( i.e. , recognition and early intervention with prodromal symptoms ) , communication enhancement training , and problem-solving skills training , delivered in 21 sessions over 9 months ; or to pharmacotherapy and three weekly sessions of enhanced care ( family psychoeducation ) . Independent evaluators assessed participants at baseline , every 3 months during year 1 , and every 6 months during year 2 , using weekly ratings of mood . RESULTS Twenty-two participants ( 15.2 % ) withdrew shortly after r and omization . Time to recovery or recurrence and proportion of weeks ill did not differ between the two treatment groups . Secondary analyses revealed that participants in family-focused treatment had less severe manic symptoms during year 2 than did those in enhanced care . CONCLUSIONS After an illness episode , intensive psychotherapy combined with best- practice pharmacotherapy does not appear to confer advantages over brief psychotherapy and pharmacotherapy in hastening recovery or delaying recurrence among adolescents with bipolar disorder OBJECTIVE To describe an adapted version of dialectical behavior therapy for adolescents with bipolar disorder . METHOD The dialectical behavior therapy intervention is delivered over 1 year and consists of two modalities : family skills training ( conducted with individual family units ) and individual therapy . The acute treatment period ( 6 months ) includes 24 weekly sessions ; sessions alternate between the two treatment modalities . Continuation treatment consists of 12 additional sessions tapering in frequency through 1 year . We conducted an open pilot trial of the treatment , design ed as an adjunct to pharmacological management , to establish feasibility and acceptability of the treatment for this population . Participants included 10 patients ( mean age 15.8 + /- 1.5 years , range 14 - 18 ) receiving treatment in an outpatient pediatric bipolar specialty clinic .  Symptom severity and functioning were assessed quarterly by an independent evaluator . Consumer satisfaction was also assessed posttreatment . RESULTS Feasibility and acceptability of the intervention were high , with 9 of 10 patients completing treatment , 90 % of scheduled sessions attended , and high treatment satisfaction ratings . Patients exhibited significant improvement from pre- to posttreatment in suicidality , nonsuicidal self-injurious behavior , emotional dysregulation , and depressive symptoms . CONCLUSIONS Dialectical behavior therapy may offer promise as an approach to the psychosocial treatment of adolescent bipolar disorder BACKGROUND This study reports on a preliminary evaluation of a cognitive behavioural intervention to improve social recovery among young people in the early stages of psychosis showing persistent signs of poor social functioning and unemployment . The study was a single-blind r and omized controlled trial ( RCT ) with two arms , 35 participants receiving cognitive behaviour therapy ( CBT ) plus treatment as usual ( TAU )  , and 42 participants receiving TAU alone . Participants were assessed at baseline and post-treatment . METHOD Seventy-seven participants were recruited from secondary mental health teams after presenting with a history of unemployment and poor social outcome . The cognitive behavioural intervention was delivered over a 9-month period with a mean of 12 sessions . The primary outcomes were weekly hours spent in constructive economic and structured activity . A range of secondary and tertiary outcomes were also assessed . RESULTS Intention-to-treat analysis on the combined affective and non-affective psychosis sample showed no significant impact of treatment on primary or secondary outcomes . However , analysis of interactions by diagnostic subgroup was significant for secondary symptomatic outcomes on the Positive and Negative Syndrome Scale ( PANSS ) [ F(1 , 69)=3.99 , p=0.05 ] . Subsequent exploratory analyses within diagnostic subgroups revealed clinical ly important and significant improvements in weekly hours in constructive and structured activity and PANSS scores among people with non-affective psychosis . CONCLUSIONS The primary study comparison provided no clear evidence for the benefit of CBT in a combined sample of patients . However , planned analyses with diagnostic subgroups showed important benefits for CBT among people with non-affective psychosis who have social recovery problems . These promising results need to be independently replicated in a larger , multi-centre RCT OBJECTIVES To develop a cognitive behavioral intervention for adolescents with bipolar disorders , test its feasibility and preliminary efficacy . METHODS Based on existing research , a manualized , individually delivered cognitive behavioral intervention was developed and tested with adolescents with bipolar disorders as an adjunct to pharmacological treatment . Using existing data , baseline characteristics and outcome were compared to a matched group of eight adolescents with bipolar disorders who did not receive any psychosocial intervention .  RESULTS Preliminary results support the feasibility and efficacy of this manualized cognitive behavioral intervention . CONCLUSIONS Individually delivered cognitive-behavioral therapy ( CBT ) as an adjunct to pharmacological treatment is feasible and associated with symptom improvement in adolescents with bipolar disorders . R and omized controlled studies are needed BACKGROUND Most disability produced by psychotic illnesses , especially schizophrenia , develops during the prepsychotic period , creating a case for intervention during this period . However , only recently has it been possible to engage people in treatment during this phase . METHODS A r and omized controlled trial compared 2 interventions in 59 patients at incipient risk of progression to first-episode psychosis . We termed this group ultra-high risk to emphasize the enhanced risk vs conventional genetic high-risk studies . Needs-based intervention was compared with specific preventive intervention comprising low-dose risperidone therapy ( mean dosage , 1.3 mg/d ) and cognitive behavior therapy . Treatment was provided for 6 months , after which all patients were offered ongoing needs-based intervention . Assessment s were performed at baseline , 6 months , and 12 months . RESULTS By the end of treatment , 10 of 28 people who received needs-based intervention progressed to first-episode psychosis vs 3 of 31 from the specific preventive intervention group ( P=.03 ) . After 6-month follow-up , another 3 people in the specific preventive intervention group became psychotic , and with intention-to-treat analysis , the difference was no longer significant ( P=.24 ) . However , for risperidone therapy-adherent patients in the specific preventive intervention group , protection against progression extended for 6 months after cessation of risperidone use . CONCLUSIONS More specific pharmacotherapy and psychotherapy reduces the risk of early transition to psychosis in young people at ultra-high risk , although their relative contributions could not be determined . This represents at least delay in onset ( prevalence reduction ) , and possibly some reduction in incidence BACKGROUND Research has begun to eluci date the optimal pharmacological treatments for pediatric-onset bipolar patients , but few studies have examined the role of psychosocial interventions as adjuncts to pharmacotherapy in maintenance treatment . This article describes an adjunctive family-focused psychoeducational treatment for bipolar adolescents ( FFT-A ) . The adult version of FFT has been shown to be effective in forestalling relapses in two r and omized clinical trials involving bipolar adults . METHODS FFT-A is administered to adolescents who have had an exacerbation of manic , depressed , or mixed symptoms within the last 3 months . It is given in 21 outpatient sessions of psychoeducation , communication enhancement training , and problem solving skills training . We describe modifications to the adult FFT model to address the developmental issues and unique clinical presentations of pediatric-onset patients . RESULTS An open treatment trial involving 20 bipolar adolescents ( 11 boys , 9 girls ; mean age 14.8+/-1.6 ) found that the combination of FFT-A and mood stabilizing medications was associated with improvements in depression symptoms , mania symptoms , and behavior problems over 1 year . LIMITATIONS These early results are based on a small-scale open trial . CONCLUSIONS Results from an ongoing r and omized controlled trial will clarify whether combining FFT-A with pharmacotherapy improves the 2-year course of adolescent bipolar disorder . If the results are positive , then a structured manual-based psychosocial approach will be available for clinicians who treat adolescent bipolar patients in the community OBJECTIVES Previous studies have identified behavioral phenotypes that predispose genetically vulnerable youth to a later onset of bipolar I or II disorder , but few studies have examined whether early psychosocial intervention can reduce risk of syndromal conversion . In a one-year open trial , we tested a version of family-focused treatment adapted for youth at high risk for bipolar disorder ( FFT-HR ) . METHODS A referred sample of 13 children ( mean 13.4±2.69 years ; 4 boys , 9 girls ) who had a parent with bipolar I or II disorder participated at one of two outpatient specialty clinics . Youth met DSM-IV criteria for major depressive disorder ( n=8 ) , cyclothymic disorder ( n=1 ) , or bipolar disorder not otherwise specified ( n=4 ) , with active mood symptoms in the past month . Participants were offered FFT-HR ( 12 sessions in four months ) with their parents , plus psychotropic medications as needed . Independent evaluators assessed depressive symptoms , hypomanic symptoms , and global functioning at baseline and then every four months for one year , with retrospective severity and impairment ratings made for each week of the follow-up interval . RESULTS Families were mostly adherent to the treatment protocol ( 85 % retention ) , and therapists administered the FFT-HR manual with high levels of fidelity . Youth showed significant improvements in depression , hypomania , and psychosocial functioning scores on the Adolescent Longitudinal Interval Follow-up Evaluation . They also showed significant improvements in Young Mania Rating Scale and Children 's Depression Rating Scale scores . CONCLUSIONS FFT-HR is a promising intervention for youth at high risk for BD . Larger-scale r and omized trials that follow youth into young adulthood will be necessary to determine whether early psychosocial intervention can reduce the probability of developing bipolar I or II disorder among genetically vulnerable youth BACKGROUND It is unknown whether young adults with bipolar disorder are able to benefit from early intervention combining optimised pharmacological treatment and group psychoeducation . The aim of the present report was to compare the effects of early intervention among patients with bipolar disorder aged 18 - 25 years to that of patients aged 26 years or older . METHODS Patients were r and omised to early treatment in a specialised outpatient mood disorder clinic versus st and ard care . The primary outcome was risk of psychiatric re-hospitalisation . RESULTS A total of 158 patients with mania/bipolar disorder were included among whom 29 ( 18.4 % ) were between 18 and 25 years and 129 patients were 26 years or older . For both age groups , the point estimate of the hazard ratio of re-hospitalisation was insignificantly decreased for patients treated in the mood disorder clinic versus st and ard treatment but more so for patients between 18 and 25 years ( HR 0.33 , 95 % CI 0.10 - 1.07 ; p=0.064 ) than for patients 26 years or older ( HR 0.68 , 95 % CI 0.40 - 1.14 , p=0.14 ) . Younger adults treated in the mood disorder clinic used mood stabilisers and antipsychotics  more in contrast to those treated in st and ard care . The differences between the estimates of effects did not reach significance in tests of interactions ( p>0.2 ) . LIMITATIONS The study was based on a post hoc subgroup analysis and due to the small number of patients aged 18 - 25 years , type II errors can not 
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Although the available interventions were well adapted to the level of maturity and social environment of young people , few interventions target specific developmental psychological or physiological processes ( eg , ruminative response style or delayed sleep phase ) , or offer detailed strategies for the management of substance use or physical health