***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 Patients with first-episode psychosis comprise a high-risk group in terms of suicide . AIMS To identify predictive factors for suicidal behaviour and to examine the effect of integrated treatment on suicidal behaviour and hopelessness . METHOD A total of 341 patients with a first-episode schizophrenia-spectrum disorder were r and omised to integrated treatment or treatment as usual . RESULTS During the 1-year follow-up period , 11 % attempted suicide . This was associated with female gender , hopelessness , hallucinations and suicide attempt reported at baseline , with the two latter variables being the only significant ones in the final multivariate model . The integrated treatment  reduced hopelessness . CONCLUSIONS Hallucinations and suicide attempt before inclusion in the study were the most significant predictors of suicide attempt in the follow-up period OBJECTIVE To examine the effects of citalopram augmentation of antipsychotics on suicidal ideation in middle-aged and older people with schizophrenia and subthreshold depressive symptoms . METHOD In this placebo-controlled trial conducted from September 1 , 2001 , to August 31 , 2007 , 198 out patients > or = 40 years old with DSM-IV-diagnosed schizophrenia or schizoaffective disorder and subthreshold depressive symptoms were r and omly assigned to flexible-dose citalopram ( n = 104 ) or placebo ( n = 94 ) augmentation of their antipsychotic for 12 weeks . Depression was measured with the Hamilton Depression Rating Scale ( HDRS ) and Calgary Depression Rating Scale ( CDRS ) . Primary suicidal ideation measures were the Clinical Global Impressions-Severity of Suicide scale ( CGI-SS ) and the InterSePT Scale for Suicidal Thinking ( ISST ) ; secondary outcomes were the Scale for Suicidal Ideation ( SSI ) , Beck Hopelessness Scale ( BHS ) , HDRS item 3 , and CDRS item 8 . RESULTS Compared to placebo , at the final visit , citalopram was associated with lower BHS scores ( 4.21 vs 4.98 ; P < .05 ) and lower likelihood of having suicidal ideation on the ISST ( 17.7 % vs 38.7 % ; P < .005 ) and HDRS item 3 ( 14.4 % vs 22.6 % ; P < .05 ) . Among the 114 participants with no baseline suicidal ideation , there were no significant differences between citalopram and placebo regarding " emergent " ideation on either primary outcome . Among the 55 participants with baseline suicidal ideation , fewer treated with citalopram had endpoint ideation on the ISST ( 28.6 % vs 66.7 % ; P < .05 ) . Significantly more depression responders than nonresponders went from having baseline suicidal ideation to no suicidal ideation on both the ISST ( 75.0 % vs 31.4 % ; P < .05 ) and CGI-SS ( 84.6 % vs 31.3 % ; P < .05 ) . CONCLUSIONS Treatment-emergent suicidal ideation was no more common with citalopram than placebo . In participants with baseline suicidal ideation , citalopram reduced suicidal ideation , especially in those whose depressive symptoms responded to treatment Abstract Objective To study the association between prescribed antipsychotic drugs and outcome in schizophrenia or schizoaffective disorder in the community . Design Prospect i ve cohort study using national central registers . Setting Community care in Finl and . Participants Nationwide cohort of 2230 consecutive adults hospitalised in Finl and for the first time because of schizophrenia or schizoaffective disorder , January 1995 to December 2001 . Main outcome measures Rates of discontinuation of drugs ( all causes ) , rates of rehospitalisation , and mortality associated with monotherapy with the 10 most commonly used antipsychotic drugs . Multivariate models and propensity score methods were used to adjust estimates of effectiveness . Results Initial use of clozapine ( adjusted relative risk 0.17 , 95 % confidence interval 0.10 to 0.29 ) , perphenazine depot ( 0.24 , 0.13 to 0.47 ) , and olanzapine ( 0.35 , 0.18 to 0.71 ) were associated with the lowest rates of discontinuation for any reason when compared with oral haloperidol . During an average follow-up of 3.6 years , 4640 cases of rehospitalisation were recorded . Current use of perphenazine depot ( 0.32 , 0.22 to 0.49 ) , olanzapine ( 0.54 , 0.41 to 0.71 ) , and clozapine ( 0.64 , 0.48 to 0.85 ) were associated with the lowest risk of rehospitalisation . Use of haloperidol was associated with a poor outcome  among women .  Mortality was markedly raised in patients not taking antipsychotics ( 12.3 , 6.0 to 24.1 ) and the risk of suicide was high ( 37.4 , 5.1 to 276 ) . Conclusions The effectiveness of first and second generation antipsychotics varies greatly in the community . Patients treated with perphenazine depot , clozapine , or olanzapine have a substantially lower risk of rehospitalisation or discontinuation ( for any reason ) of their initial treatment than do patients treated with haloperidol . Excess mortality is seen mostly in patients not using antipsychotic drugs BACKGROUND The initial phase of a trial of cognitive-behavioural therapy ( CBT ) for acutely ill patients with schizophrenia of recent onset showed that it speeded recovery . AIMS To test the hypothesis that CBT in addition to treatment as usual ( TAU ) during the first or second acute episode of schizophrenia will confer clinical benefit over a follow-up period . METHOD This was an 18-month follow-up of a multicentre prospect i ve trial of CBT or supportive counselling administered as an adjunct to TAU , compared with TAU alone , for patients hospitalised for an acute episode of schizophrenia of recent onset . Primary outcomes were total and positive symptom scales , time to relapse and re-hospitalisation . RESULTS There were significant advantages for CBT and supportive counselling over TAU alone on symptom measures at 18 months but no group difference was seen for relapse or re-hospitalisation . There was a significant centre-treatment interaction , reflecting centre differences in the effect of introducing either treatment , but not in the comparison of CBT and supportive counselling . Medication dosage and compliance did not explain group differences . CONCLUSIONS Adjunctive psychological treatments can have a beneficial long-term effect on symptom reduction Objective : This r and om‐controlled study evaluated benefits derived from continued integrated biomedical and psychosocial treatment for recent‐onset schizophrenia Objectives To evaluate the effectiveness of integrated motivational interviewing and cognitive behavioural therapy in addition to st and ard care for patients with psychosis and a comorbid substance use problem . Design Two centre , open , rater blind r and omised controlled trial . Setting Secondary care in the United Kingdom . Participants 327 patients with a clinical diagnosis of schizophrenia , schizophreniform disorder , or schizoaffective disorder and a diagnosis of dependence on or misuse of drugs , alcohol , or both according to the Diagnostic and Statistical Manual of Mental Disorders , fourth edition . Intervention The intervention was integrated motivational interviewing and cognitive behavioural therapy plus st and ard care , which was compared with st and ard care alone . Phase one of therapy—“motivation building”—concerns engaging the patient , then exploring and resolving ambivalence for change in substance use . Phase two—“action”—supports and facilitates change using cognitive behavioural approaches . Up to 26 therapy sessions were delivered over one year . Main outcome measures The primary outcome was death from any cause or admission to hospital in the 12 months after completion of therapy . Secondary outcomes were frequency and amount of substance use ( assessed using the timeline followback method ) , readiness to change , perceived negative consequences of use , psychotic symptom ratings , number and duration of relapses , and global assessment of functioning and deliberate self harm at 12 and 24 months , with additional timeline followback assessment s at 6 and 18 months . Analysis was by intention to treat and robust treatment effect estimates were produced . Results 327 participants were r and omly allocated to either the intervention ( n=164 ) or treatment as usual ( n=163 ) . At 24 months , 326 ( 99.7 % ) were assessed on the primary outcome and 246 ( 75.2 % ) on the main secondary outcomes . Treatment had no beneficial effect on hospital admissions or death during follow-up , with 23.3 % ( 38/163 ) of the therapy group and 20.2 % ( 33/163 ) of controls deceased or admitted ( adjusted odds ratio 1.16 , 95 % confidence interval 0.68 to 1.99 ; P=0.579 ) . Therapy had no effect on the frequency of substance use or the perceived negative consequences of misuse , but did have a statistically significant effect on amount used per substance using day ( adjusted ORs for main substance 1.50 , 95 % CI 1.08 to 2.09 ; P=0.016 ; and all substances 1.48 , 95 % CI 1.07 to 2.05 ; P=0.017 ) . Treatment had a statistically significant effect on readiness to change use at 12 months ( adjusted OR 2.05 , 95 % CI 1.26 to 3.31 ; P=0.004 ) that was not maintained at 24 months ( 0.78 , 95 % CI 0.48 to 1.28 ; P=0.320 ) . There were no effects of treatment on clinical outcomes such as relapses , psychotic symptoms , functioning , and self harm . Conclusions Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and substance misuse do not improve outcome in terms of hospitalisation , symptom outcomes , or functioning . This approach does reduce the amount of substance used for at least one year after completion of therapy . Trial registration Current Controlled Trials : IS RCT N14404480 Background : Young people with early psychosis are at particularly high risk of suicide . However , there is evidence that early intervention can reduce this risk . Despite these advances , first episode psychosis patients attending these new services still remain at risk . To address this concern , a program called LifeSPAN was established within the Early Psychosis Prevention and Intervention Centre ( EPPIC ) . The program developed and evaluated a number of suicide prevention strategies within EPPIC and included a cognitively oriented therapy ( LifeSPAN therapy ) for acutely suicidal patients with psychosis . We describe the development of these interventions in this paper . Method : Clinical audit and surveys provided an indication of the prevalence of suicidality among first episode psychosis patients attending EPPIC . Second , staff focus groups and surveys identified gaps in service provision for suicidal young people attending the service . Third , a suicide risk monitoring system was introduced to identify those at highest risk . Finally , patients so identified were referred to and offered LifeSPAN therapy whose effectiveness was evaluated in a r and omised controlled trial . Results : Fifty-six suicidal patients with first episode psychosis were r and omly assigned to st and ard clinical care or st and ard care plus LifeSPAN therapy . Forty-two patients completed the intervention .  Clinical ratings and measures of suicidality and risk were assessed before , immediately after the intervention , and 6 months later . Benefits were noted in the treatment group on indirect measures of suicidality , e.g. , hopelessness . The treatment group showed a greater average improvement ( though not significant ) on a measure of suicide ideation . Conclusions : Early intervention in psychosis for young people reduces the risk of suicide . Augmenting early intervention with a suicide preventative therapy may further reduce this risk BACKGROUND Research evidence supports the efficacy of cognitive-behavioral therapy in the treatment of drug-refractory positive symptoms of schizophrenia . Although the cumulative evidence is strong , early controlled trials showed method ological limitations . METHODS A r and omized controlled design was used to compare the efficacy of manualized cognitive-behavioral therapy developed particularly for schizophrenia with that of a nonspecific befriending control intervention . Both interventions were delivered by 2 experienced nurses who received regular supervision . Patients were assessed by blind raters at baseline , after treatment ( lasting up to 9 months ) , and at a 9-month follow-up evaluation . Patients continued to receive routine care throughout the study . An assessor blind to the patients ' treatment groups rated the technical quality of audiotaped sessions chosen at r and om . Analysis was by intention to treat . RESULTS Ninety patients received a mean of 19 individual treatment sessions over 9 months , with no significant between-group differences in treatment duration . Both interventions result ed in significant reductions in positive and negative symptoms and depression . At the 9-month follow-up evaluation , patients who had received cognitive therapy continued to improve , while those in the befriending group did not . These results were not attributable to changes in prescribed medication . CONCLUSION Cognitive-behavioral therapy is effective in treating negative as well as positive symptoms in schizophrenia resistant to st and ard antipsychotic drugs , with its efficacy sustained over 9 months of follow-up Schizophrenia is associated with brain abnormalities and is typically evidence d by disorganized speech and behavior , delusions , and hallucinations ; it usually requires extended hospitalization . Its incidence in the western world 
    Output:
    
Conclusions Psychosocial interventions may be effective in reducing suicidal behaviour in patients with schizophrenia spectrum disorders and psychosis , although the additional benefit of these interventions above that contributed by a control condition or treatment-as-usual is not clear