***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: OBJECTIVE The relationship between cognition and outcome in people with schizophrenia has been established in studies that , for the most part , examined chronic patients and were cross-sectional in design . The purpose of this study was to analyze the relationships between neurocognitive variables assessed at illness onset and functional outcome in a longitudinal design . An additional area of interest was whether the severity of negative symptoms would predict outcome independently from neurocognitive variables or whether there would be an overlap in their predictive power . METHOD The authors administered a comprehensive cognitive battery and clinical assessment s to 99 subjects who were in their first episode of illness and analyzed the relationship of cognition and symptom severity at intake with community outcome after an average follow-up period of 7 years . RESULTS Verbal memory , processing speed and attention , and the severity of negative symptoms at intake were related to subsequent outcome . Global psychosocial functioning was predicted by negative symptoms and attention . Verbal memory was the significant predictor of the degree of impairment in recreational activities . Impairment in relationships was predicted by negative symptoms and memory , whereas attention and negative symptoms were predictive of work performance . There was an overlap in the variance in outcome explained by cognitive variables and negative symptoms . CONCLUSIONS Verbal memory and processing speed and attention are potential targets for psychosocial interventions to improve outcome . Results from cross-sectional or chronic patient studies do not necessarily correspond to the findings of this prospect i ve first-episode study in which cognition appears to explain less of the variance in outcome CONTEXT Progressive loss of brain gray matter ( GM ) has been reported in childhood-onset schizophrenia ; however , it is uncertain whether these changes are shared by pediatric patients with different psychoses . OBJECTIVE To examine the progression of brain changes in first-episode early-onset psychosis and their relationship to diagnosis and prognosis at 2-year follow-up . DESIGN Prospect i ve , multicenter , naturalistic , 2-year follow-up study . SETTING Six child and adolescent psychiatric units in Spain . PARTICIPANTS A total of 110 patients and 98 healthy controls were recruited between March 1 , 2003 , and November 31 , 2005 .  Magnetic resonance imaging of the brain was performed for 61 patients with schizophrenia ( n = 25 ) , bipolar disorder ( n = 16 ) , or other psychoses ( n = 20 ) and 70 controls ( both at baseline and after 2 years of follow-up ) . Mean age at baseline was 15.5 years ( patients ) and 15.3 years ( controls ) . MAIN OUTCOME MEASURES The GM and cerebrospinal fluid ( CSF ) volumes in the total brain and frontal , parietal , and temporal lobes . RESULTS Compared with controls , patients with schizophrenia showed greater GM volume loss in the frontal lobe during the 2-year follow-up ( left : -3.3 vs -0.6 cm(3 ) , P = .004 ; right : -3.7 vs -0.8 cm(3 ) , P = .005 ) and left frontal CSF volume increase ( left : 6.7 vs 2.4 cm(3 ) , P = .006 ) . In addition to frontal volume , changes for total GM ( -37.1 vs -14.5 cm(3 ) , P = .001 ) and left parietal GM ( -4.3 vs -2.2 cm(3 ) , P = .04 ) were significantly different in schizophrenic patients compared with controls . No significant differences emerged for patients with bipolar disease . Greater left frontal GM volume loss was related to more weeks of hospitalization , whereas severity of negative symptoms correlated with CSF increase in patients with schizophrenia . CONCLUSIONS Patients with schizophrenia or other psychoses showed greater loss of GM volume and increase of CSF in the frontal lobe relative to controls . Progressive changes were more evident in patients with schizophrenia than those with bipolar disorder . These changes in specific brain volumes after onset of psychotic symptoms may be related to markers of poorer prognosis Only few prospect i ve longitudinal studies have assessed the course of intelligence deficits in early onset schizophrenia ( EOS ) , and these have used different age appropriate versions of Wechsler Intelligence Scales and age appropriate norms . The post-psychotic development of intelligence in EOS has predominantly been characterized as relatively stable in these studies . However , comparisons of IQs from different test versions based on the different norms may not permit unequivocal interpretations . The objective of the current study was to compare the development of intelligence in EOS patients ( N = 10 ) from their first psychotic episode to 5 years of post onset with that of healthy controls ( N = 35 ) and patients who at baseline had been diagnosed with other non-affective psychoses ( N = 8) . The same version of a Wechsler Intelligence Scale  was administered at both baseline and follow-up assessment s , and the same norms were used to derive IQs at baseline and follow-up . Significantly smaller change in mean full scale intelligence quotient ( FSIQ ) was found in diagnostically stable EOS patients compared with healthy controls during the follow-up period . However , no statistically significant difference in mean FSIQ change was observed between patients with EOS and patients with other non-affective psychoses , although this result must be interpreted with caution due to the small sample sizes . The results suggest abnormally slow acquisition of new intellectual information and skills in EOS patients during the first 5 years after full clinical presentation A total of 232 ( 84 % ) first episodes of schizophrenia from our epidemiologically defined ABC sample ( Age , Beginning and Course ) were retrospectively assessed with regard to the onset and early course of the disorder . In a follow-up study a representative subgroup ( n=133 ) was prospect ively examined in five cross sections over 3 years from first admission on .  Population -based incidence rates for 5-year age groups comprising a range of < 10-<60 years were calculated on the basis of two definitions of onset : first sign of disorder and first psychotic symptom . In 40 % of adult patients who had been admitted with a first schizophrenic episode after age 20 years the prodromal phase , in 11 % the psychotic prephase , began before that age . This demonstrates that schizophrenia often begins in an age period in which the social and cognitive development and brain maturation are still unfinished . Early-onset schizophrenias ( < -20 years ) were compared with a medium-onset group ( 21<35 years ) and a late-onset group ( 35-<60 years ) with regard to age and type of onset , early symptom-related course , social development and social course . The number of schizophrenia-specific positive and negative syndromes in early-onset schizophrenia is comparable to that of higher age groups . However , neurotic syndromes , emotional disorders and conduct disorders are most frequent in younger patients , especially in young men . Paranoid syndromes seem to prevail in late-onset schizophrenia , whereas less differentiated positive syndromes , such as delusional mood , are more frequent in the youngest age group . An earlier onset of schizophrenia has more severe social consequences than onset in adults , because it interrupts the cognitive and social development at an earlier stage . The worse social course of schizophrenia in men compared with women can not be related to a more severe symtomatology , but to the earlier age at onset and the impairment or stagnation of social ascent at an earlier stage of social and cognitive development . Social disability in the sense of an adaptation to the expectations of the social environment , as well as symtomatology during the further course of schizophrenia , show no major differences between the genders nor between the age groups Premorbid adjustment is an important prognostic factor of schizophrenia . The relationships between sub-components of premorbid adjustment and outcomes on symptoms and cognition in first-episode schizophrenia were under-studied . In the current study , we prospect ively followed up 93 patients aged 18 - 55 years presenting with first-episode schizophrenia-spectrum disorder .  Psychopathological and cognitive assessment s were conducted at baseline , clinical stabilization , 12 , 24 and 36 months . Premorbid adjustment was sub-divided into discrete functional domains , developmental stages and premorbid-course types based on ratings of the Premorbid Adjustment Scale ( PAS ) . The study focused on early developmental stages to minimize contamination by prodromal symptoms . Results indicated that gender differences in premorbid functioning were primarily related to early-adolescence adjustment and academic domain . Social domain was more strongly related to negative symptoms , while academic domain was more consistently linked to cognitive outcome ( Wisconsin Card Sorting test and verbal fluency ) . Patients with stable-poor premorbid course had more severe negative symptoms and cognitive impairment . In conclusion , in a Chinese cohort of first-episode schizophrenia-spectrum disorder , sub-components of early premorbid adjustment were shown to be differentially related to clinical and cognitive measures . The results highlighted the importance of applying a more refined delineation of premorbid functioning in study ing illness outcome Background There were few studies on the outcome of schizophrenia in developing countries . Whether the outcome is similar to or different from developed world is still a point for research . The main aim of the current study was to know if patients with early onset non affective psychosis can behave and function properly after few years from start of the illness or not . Other aims included investigation of possible predictors and associated factors with remission and outcome . Method The study prospect ively investigated a group of 56 patients with onset of psychosis during childhood or adolescence . Diagnosis made according to DSM-IV criteria and included ; schizophrenia , psychotic disorder not otherwise specified and acute psychosis . Severity of psychosis was measured by PANSS . Measures of the outcome included ; remission criteria of And reasen et al 2005 , the  children 's global assessment scale and educational level . Results Analysis of data was done for only 37 patients . Thirty patients diagnosed as schizophrenia and 7 with Psychotic disorder not otherwise specified . Mean duration of follow up was 38.4 + /- 16.9 months . At the end of the study , 6 patients ( 16.2 % ) had one episode , 23(62.1 % ) had multiple episodes and 8 ( 21.6 % ) continuous course . Nineteen patients ( 51.4 % ) achieved full remission , and only 11(29.7 % ) achieved their average educational level for their age . Twenty seven percent of the sample had good outcome and 24.3 % had poor outcome . Factors associated with non remission and poor outcome included gradual onset , low IQ , poor premorbid adjustment , negative symptoms at onset of the illness and poor adherence to drugs . Moreover , there was tendency of negative symptoms at illness start to predict poor outcome . ConclusionS ome patients with early onset non affective psychosis can behave and function properly after few years from the start of the illness . Although remission is a difficult target in childhood psychosis , it is still achievable BACKGROUND The association between the duration of untreated psychosis ( DUP ) and outcome of schizophrenia may be confounded by other factors such as poor pre-morbid adjustment . The aim of the present study was to examine the independent contributions of DUP and of pre-morbid adjustment to the clinical and social outcomes of schizophrenia . METHOD A longitudinal , prospect i ve , 2-year follow-up study of 423 patients with first-episode schizophrenia-spectrum psychosis was conducted . Patients were comprehensively assessed at entry , 1-year and 2-year follow-up . At entry , DUP was measured by IRAOS ( an instrument for the assessment of onset and early course of schizophrenia ) and pre-morbid adjustment was measured by the Pre-morbid Adjustment Scale ( PAS ) as ' pre-morbid social adaptation ' and ' pre-morbid school adaptation ' . Outcome measures included the Scale for the Assessment of Positive Symptoms ( SAPS ) , the Scale for the Assessment of Negative Symptoms ( SANS ) , the Social Network Schedule and social information . Multiple linear regression models were used for data analysis . RESULTS The median DUP was 48 weeks , which is long compared to other studies . Longer DUP was independently associated with more psychotic symptoms at entry , 1-year and 2-year follow-up . Poorer pre-morbid social adaptation was independently associated with more negative symptoms and smaller social network at entry and 1-year follow-up . Poorer pre-morbid school adaptation was independently associated with poor vocational outcome at 1-year and 2-year follow-up . CONCLUSIONS Longer DUP is associated with poorer 2-year outcome of psychosis in schizophrenia-spectrum disorders , when pre-morbid functioning and other prognostic factors are controlled for . Impaired pre-morbid development is independently associated with more negative symptoms and poorer social outcome Adolescent-onset psychoses often raise diagnostic difficulties because of the mixture of schizophrenic and affective features . This study examined prospect ively which clinical dimensions contribute to difficulty in initial diagnosis and which clinical features have predictive value for outcomes of  schizophrenia  or affective disorders  , and for eventual psychosocial functioning .  Thirty-six adolescents consecutively admitted for a psychotic episode were followed up for 1 to 4 years . Symptoms were assessed at admission , at discharge , and once a year . DSM-III-R ( APA 1989 ) diagnoses were assessed at admission and once a year . Comparisons were performed across initial and followup diagnostic groups . Positive symptoms did not differentiate the initial clinical pictures , while negative symptoms , manic symptoms , and disorganization differentiated the manic and depressive episodes in the acute phase . When initial positive symptoms ( mainly delusions ) were severe , they predicted a final 
    Output:
    
Using multivariate models , the most replicated predictors of worse clinical , functional , cognitive , and biological outcomes in EOP were premorbid difficulties and symptom severity ( especially of negative symptoms ) at baseline .
Longer duration of untreated psychosis ( DUP ) predicted worse clinical , functional , and cognitive outcomes .
Higher risk of attempting suicide was predicted by greater severity of psychotic illness and of depressive symptoms at the first episode of psychosis .
Age at onset and sex were not found to be relevant predictors of outcome in most multivariate models , whereas studies using bivariate analyses yielded inconsistent results .
Lower intelligence quotient at baseline predicted lower insight at follow-up , worse functional outcomes , and a diagnostic outcome of schizophrenia .
Lower levels of antioxidants at baseline predicted greater brain volume changes and worse cognitive functioning at follow-up , whereas neuroimaging markers such as regional cortical thickness and gray matter volume at baseline predicted remission and better insight at follow-up , respectively .
EOP patients with poorer premorbid adjustment and prominent negative symptoms at initial presentation are at risk of poor outcome .
Early intervention strategies to reduce DUP may also improve outcome in EOP