***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: Latinos constitute the largest minority in the United States , and there is an increasing number of Latino patients with schizophrenia and other psychoses living into old age . However , few specific behavioral interventions have been developed aim ed at improving the functioning of this group . We evaluated a psychosocial intervention design ed to improve the everyday living skills of middle-aged and older out patients with very chronic psychotic disorders . Three psychiatric clinics , specializing in care of Latinos , were r and omly assigned to ( 1 ) a 24-session intervention entitled Programa de Entrenamiento para el Desarrollo de Aptitudes para Latinos ( PEDAL ) group therapy ( n = 21 ) targeting areas identified in our previous work as being problematic for this population ( e.g. , using public transportation ) or ( 2 ) a time-equivalent friendly support group ( SG ; n = 8) . Compared to the patients r and omized to SG ,  PEDAL-treated patients ' performance on everyday living skills improved significantly postintervention and was still significantly better at a 6-month maintenance follow-up period and at a 12-month no-treatment follow-up period . There was no significant change in psychopathology . Limitations of this pilot study are discussed . Results suggest that participation in this skills training program , design ed specifically for older Latino patients with long-st and ing psychotic disorders , has the potential to significantly increase the patients ' independence and improve functional skills This descriptive survey investigated the level of perceived stigma among Chinese patients with severe mental illness ( SMI ) and its relationships with patients ’ psychosocial conditions and family caregivers ’ and mental health professionals ’ attitudes toward SMI in Hong Kong . A clustered , r and om sample of 311 patients and their family caregivers and 73 Chinese professionals participated . The patients reported a high level of withdrawal/secrecy and the professionals perceived a low to moderate level of stereotype/restriction to their patients . Families ’ expressed emotion and caregiving burden could increase patients ’ perceived stigma . Strategies in de-stigmatization of mental illness have been discussed , particularly from family-based approach OBJECTIVE Although skills training is a vali date d psychosocial treatment for schizophrenia , generalization of the skills to everyday life has not been optimal . This study evaluated a behaviorally oriented method of augmenting clinic-based skills training in the community with the aim of improving opportunities , encouragement , and reinforcement for out patients to use their skills in their natural environment . METHOD Sixty-three individuals with schizophrenia were r and omly assigned to 60 weeks of clinic-based skills training alone or of clinic-based skills training supplemented with manual-based generalization sessions in the community . Patients were also r and omly assigned to receive either haloperidol or risperidone . Therapists ' fidelity to the manuals was measured . Patients ' acquisition of the skills from pre- to posttraining was evaluated . The primary outcome measures were the Social Adjustment Scale-II and the Quality of Life Scale . RESULTS Seventy-one percent of the patients completed the trial . Only six participants experienced psychotic exacerbations during the trial . There was no evidence of a differential medication effect on social functioning . Social functioning improved modestly in both psychosocial conditions over time ; participants who received augmented skills training in the community showed significantly greater and /or quicker improvements . CONCLUSIONS Given judicious and effective antipsychotic medication that limited exacerbations to less than 10 % during the trial , a wide range of out patients with schizophrenia demonstrated substantial learning of illness management and social skills in the clinic . When clinic-based skills training was augmented by in vivo training and consultation , transfer of the skills to everyday life was enhanced . These benefits were established regardless of the medications prescribed Schizophrenia is a chronic , complex and heterogeneous mental disorder , with pathological features of disrupted neuronal excitability and plasticity within limbic structures of the brain . These pathological features manifest behaviorally as positive symptoms ( including hallucinations , delusions and thought disorder ) , negative symptoms ( such as social withdrawal , apathy and emotional blunting ) and other psychopathological symptoms ( such as psychomotor retardation , lack of insight , poor attention and impulse control ) . Altered glutamate neurotransmission has for decades been linked to schizophrenia , but all commonly prescribed antipsychotics act on dopamine receptors . LY404039 is a selective agonist for metabotropic glutamate 2/3 ( mGlu2/3 ) receptors and has shown antipsychotic potential in animal studies . With data from rodents , we provide new evidence that mGlu2/3 receptor agonists work by a distinct mechanism different from that of olanzapine . To clinical ly test this mechanism , an oral prodrug of LY404039 ( LY2140023 ) was evaluated in schizophrenic patients with olanzapine  as an active control in a r and omized , three-armed , double-blind , placebo-controlled study . Treatment with LY2140023 , like treatment with olanzapine , was safe and well-tolerated ; treated patients showed statistically significant improvements in both positive and negative symptoms of schizophrenia compared to placebo ( P < 0.001 at week 4 ) . Notably , patients treated with LY2140023 did not differ from placebo-treated patients with respect to prolactin elevation , extrapyramidal symptoms or weight gain . These data suggest that mGlu2/3 receptor agonists have antipsychotic properties and may provide a new alternative for the treatment of schizophrenia BACKGROUND Heavy users of psychiatric services , often defined as the population that uses the most beds , consume a large part of the re sources used by the whole service , despite being relatively small in number . Any intervention that reduces heavy use is therefore likely to lead to significant savings , and enhancement of st and ard care using a form of intensive case management akin to assertive community treatment was thought to be a pragmatic strategy for testing in this group . METHODS The effectiveness of  enhanced community management ( ECM ) was compared with st and ard care alone in heavy users , who represented the 10 % of patients with the highest number of hospital admissions and occupied bed days over the previous 6.5 years in an outer London borough . One hundred and ninety-three patients were r and omly assigned to ECM or st and ard care and their use of services was determined after 1 and 2 years , with assessment s of costs , clinical symptoms , needs , and social function made before entry into the study and after 1 and 2 years . RESULTS Despite a 24 fold increase in community contacts in the study group , there were no significant differences between the two groups in any of the main outcome measures . Small savings on in-patient and day-hospital service costs were counterbalanced by the increased costs of outpatient and community care for the subjects assigned to ECM . Clinical outcome data derived from interviews in two-thirds of the subjects were similar in both groups . CONCLUSIONS Providing additional intensive community focused care to a group of heavy users of psychiatric in-patient services in an outer London borough does not lead to any important clinical gains or reduced costs of psychiatric care Long-acting injectable antipsychotic formulations of conventional antipsychotics were developed to address the problem of partial adherence among patients with schizophrenia . Injection site pain , other skin reactions and patient satisfaction with treatment were assessed in two large , multicentre studies of long-acting injectable risperidone ( Risperdal CONSTA ™ , Janssen Pharmaceutica Products , Titusville , New Jersey , USA ) , the first available long-acting atypical antipsychotic agent . Patients rated injection site pain using a 100-mm Visual Analogue Scale ( VAS ) , and investigators rated injection site pain , redness , swelling and in duration . Patient satisfaction with treatment was assessed with the Drug Attitude Inventory ( DAI ) . VAS pain ratings were low at all visits across all doses in both studies , and decreased from first to final injection . In the 12-week , double-blind study , mean±SD VAS scores at the first and final injections were 15.6±20.7 and 12.5±18.3 for placebo-treated  patients , and 11.8±14.4 ( first ) and 10.0±12.4 ( final ) for 25 mg ; 16.3±21.9 ( first ) and 13.6±21.7 ( final ) for 50 mg ; and 16.0±17.9 ( first ) and 9.6±16.0 ( final , P<0.01 ) for 75 mg of long-acting risperidone  . Mean VAS scores in the 50-week , open-label study at the first and final injection were : 17.9±22.2 ( first ) and 9.5±16.7 ( final , P<0.0001 ) for 25 mg ; 18.1±19.7 ( first ) and 10.4±14.8 ( final , P<0.0001 ) for 50 mg ; and 18.5±21.6 ( first ) and 13.6±19.9 ( final , P=0.0001 ) for 75 mg of long-acting risperidone . Overall , there was no or minimal injection site pain and skin reactions were rare . Mean DAI ratings were available for the 50-week study and indicated high patient satisfaction throughout the trial ( baseline=7.30 ; endpoint=7.70 ; P<0.0001 versus baseline ) . These findings may positively affect patient and clinician attitudes towards long-term therapy with long-acting injectable risperidone Background : Recent research indicates that cognitive-behaviour therapy ( CBT ) can be effective in ameliorating persistent positive symptoms in chronic psychotic patients . The effectiveness of CBT in acute and recent-onset psychosis has been little explored , although a recent pilot study indicated that CBT could significantly improve recovery in acutely psychotic in patients . Method : Short-term individual CBT was compared to supportive counselling/psychoeducation ( SC ) as an adjunct to st and ard inpatient hospital care and medication in 21 in patients experiencing a recent-onset acute schizophrenic episode . Results : Both groups showed significant reductions in Brief Psychiatric Rating Scale ( BPRS ) scores following treatment , although there were no group differences . Time to discharge did not differ significantly between the groups , although there was a greater variance for the SC patients . Two-year follow-up showed no significant differences between the groups , although the number of patients who relapsed , the number of relapses and the time to recurrence of psychotic symptoms was lower in the CBT group than the SC group . Interestingly , the time to readmission was shorter in the CBT group . Conclusions : CBT and SC are acceptable treatments for recent-onset acutely psychotic in patients . A larger r and omised controlled trial over multiple hospital sites is warranted Social functioning deficits ( e.g. , social skill , community functioning ) are a core feature of schizophrenia . These deficits are only minimally improved via the frontline treatments for schizophrenia ( e.g. medication , social skills training , cognitive-behavioral therapy ) . Social cognition is a promising treatment target in this regard as it may be more strongly related to social functioning outcomes than traditional neurocognitive domains [ Couture , S. , Penn , D.L. , Roberts , D.L. , 2006 . The functional significance of social cognition in schizophrenia : a review . Schizophrenia Bulletin ( Suppl . 1 ) , S-44 - 63 ] . Social cognition and interaction training ( SCIT ) is a 20-week , manualized , group treatment design ed to improve social functioning in schizophrenia by way of improved social cognition . This article reports preliminary data from a quasi-experimental study comparing SCIT + treatment as usual ( TAU ; n=20 ) to TAU alone  ( n=11 ) among out patients . Results using analysis of variance ( ANOVA ) suggest SCIT-related improvements in emotion perception and social skill OBJECTIVE Comorbidity of substance abuse disorders with schizophrenia is associated with a greater risk for serious illness complications and poorer outcome . Method ologically sound studies investigating treatment approaches for patients with these disorders are rare , although recommendations for integrated and comprehensive treatment programs abound . This study investigates the relative benefit of adding an integrated psychological and psychosocial treatment program to routine psychiatric care for patients with schizophrenia and substance use disorders . METHOD The authors conducted a r and omized , single-blind controlled comparison of routine care with a program of routine care integrated with motivational interviewing , cognitive behavior therapy , and family or caregiver intervention . RESULTS The integrated treatment program result ed in significantly greater improvement in patients ' general functioning than routine care alone at the end of treatment and 12 months after the beginning of the study . Other benefits of the program included a reduction in positive symptoms and in symptom exacerbations and an increase in the percent of days of abstinence from drugs or alcohol over the 12-month period from baseline to follow-up . CONCLUSIONS These findings demonstrate the effectiveness of a program of routine care integrated with motivational interviewing , cognitive behavior therapy , and family intervention over routine psychiatric care alone for patients with comorbid schizophrenia and alcohol or drug abuse or dependence Two methods of providing an educational intervention for families of patients with schizophrenia in Finl and were compared . The aims of the intervention were to improve relatives ' level of knowledge about the illness , and change the level of expressed emotion ( EE ) , objective burden and psychological distress .  Sixty-nine persons participated in the oral presentation groups comprising eight sessions and 128 persons participated in the video education comprising six sessions . The education led to significant knowledge gains and to an increase in the psychological well-being of the participants , but there were no significant changes in objective burden or EE status after inter 
    Output:
    
Most of these five approaches applied to people with schizophrenia have demonstrated satisfactory levels of short- to medium-term clinical efficacy in terms of symptom control or reduction , level of functioning , and /or relapse rate .
With the exception of patient relapse , the longer-term ( eg , > 2 years ) effects of these approaches on most psychosocial outcomes are not well-established among these patients .
To conclude , current approaches to psychosocial interventions for schizophrenia have their strengths and weaknesses , particularly indicating limited evidence on long-term effects .