***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: Aim : The aim of the present study was to evaluate the effect of assertive community treatment ( ACT ) in the Tønder Region , South Jutl and , where the first Danish ACT team was established to treat patients with severe and persistent mental illness ( SMI ) . Methods : The study compares outcome over a 2-year period between recipients of ACT and st and ard community mental healthcare .  Results : The study included 86 cases and 88 controls . At the time of recruitment , the cases and the controls did not differ significantly in demographic details and eligibility criteria . At the 2-year follow-up , the ACT patients showed a significant reduction in admissions , bed days and day hospital days , and a significant increase in the number of consultations compared with the controls . Adherence to outpatient services was higher in the ACT group . No significant improvements in psychopathology were found after 2 years , but a significant improvement in met needs and fewer unmet needs , indicating better functioning , occurred . Clients ’ satisfaction with care ( Client Satisfaction Question naire , CSQ ) was significantly higher among ACT patients than among controls . Conclusion : The treatment of these patients in this ACT service has yielded promising results , suggesting that ACT treatment may be a useful intervention for SMI patients . However , large , rigorous , r and omized control trials with ACT are needed in Europe as the existing evidence mainly comes from American studies OBJECTIVE To determine the effectiveness of an intervention to promote medication adherence . METHOD Data were collected for adults with exacerbation of schizophrenia who were treated at one of 6 U.S. Department of Veterans Affairs ( VA ) Medical Centers ( VAMCs ) in 3 regional VA networks ( Veterans Integrated Service Networks [ VISNs ] ) from March 1999 to October 2000 . All 6 VAMCs received a basic guideline implementation strategy for medication management of schizophrenia using usual VA procedures . One VAMC within each VISN was r and omly selected to receive an enhanced implementation strategy design ed to promote guideline -concordant prescribing by physicians and medication adherence by patients . In the enhanced strategy , a research nurse worked with study participants to identify medication adherence barriers and to develop patient-specific strategies to overcome those barriers . Participants ( N = 349 ) were interviewed at enrollment and 6 months later , using the Structured Clinical Interview for the Positive and Negative Syndrome Scale ( PANSS ) , the Barnes Akathisia Rating Scale , and the Schizophrenia Outcomes Module ( SCHIZOM ) . Medication adherence was measured via subjects ' self-report , using the SCHIZOM , and from data abstract ed from medical records . RESULTS Participants were primarily male ( 94 % ) and nonwhite ( 69 % , primarily African American ) with a mean age of 46 years .  Medication adherence at follow-up was modeled using logistic regression , controlling for adherence at baseline , demographic characteristics , PANSS total score , akathisia at baseline , family history of mental illness , and substance abuse . A logistic regression model for adherence at follow-up was significant ( likelihood ratio = 52.72 , df = 14 , p < .0001 ) . Patients enrolled at sites receiving the enhanced intervention were almost twice as likely to be adherent at follow-up . Those who were nonadherent at baseline were significantly less likely to be adherent at follow-up . In addition , adherence at follow-up was significantly greater at 2 of the VA networks as compared to the third network . CONCLUSIONS These data suggest that a patient-centered strategy to identify and overcome barriers to adherence can improve adherence to antipsychotic medications Abstract Objectives To evaluate the effects of integrated treatment for patients with a first episode of psychotic illness . Table 2 Clinical outcomes and user satisfaction of patients with a first episode of psychotic illness who received integrated treatment or st and ard treatment . Values are means ( SD ) unless stated otherwise 1 year follow-up ( n=419 ) 2 year follow-up ( n=369 ) Integrated treatment ( n=227 ) St and ard treatment ( n=192 ) Estimated mean difference ( 95 % CI ) P value of difference Integrated treatment ( n=205 ) St and ard treatment ( n=164 ) Estimated mean difference ( 95 % CI ) P value of difference Psychopathology * : Psychotic dimension 1.09 ( 1.27 ) 1.35 ( 1.39 ) -0.31 ( −0.55 to −0.07 ) 0.02 1.06 ( 1.26 ) 1.27 ( 1.40 ) -0.32 ( −0.58 to −0.06 ) 0.02 Negative dimension 1.68 ( 1.10 ) 2.02 ( 1.12 ) -0.36 ( −0.54 to −0.17 ) < 0.001 1.41 ( 1.15 ) 1.82 ( 1.23 -0.45 ( −0.67 to −0.22 < 0.001 Disorganised dimension 0.40 ( 0.59 ) 0.42 ( 0.56 ) -0.04 ( −0.14 to 0.07 ) 0.5 0.37 ( 0.56 ) 0.50 ( 0.73 ) -0.12 ( −0.25 to 0.00 ) 0.06 GAF , symptom 48.2 ( 14.9 ) 44.9 ( 16.0 ) 3.00 ( 0.37 to 5.63 ) 0.03 51.18 ( 15.01 ) 48.67 ( 15.92 ) 2.45 ( −0.32 to 5.22 ) 0.08 GAF , function 51.7 ( 15.1 ) 49.4 ( 14.6 ) 2.61 ( 0.11 to 5.15 ) 0.04 55.16 ( 15.15 ) 51.13 ( 15.92 ) 3.12 ( 0.37 to 5.88 ) 0.03 User satisfaction† 24.9 ( 4.5 ) 23.0 ( 7.2 ) 1.88 ( 0.73 to 3.02 ) 0.001 26.1 ( 3.7 ) 22.9 ( 5.2 ) 3.09 ( 2.10 to 4.04 ) < 0.001 GAF = global assessment of functioning . * Estimated mean differences are based on a repeated measurements model with treatment site , sex , substance misuse , diagnosis at baseline , and baseline values of the scale included as covariates ( see text for details ) . † Based on client satisfaction question naire score . Estimated mean differences calculated by analysis of variance with treatment site as covariate . Design R and omised clinical trial . Setting Copenhagen Hospital Corporation and Psychiatric Hospital Aarhus , Denmark . Participants 547 patients with first episode of schizophrenia spectrum disorder . Interventions Integrated treatment and st and ard treatment . The integrated treatment lasted for two years and consisted of assertive community treatment with programmes for family involvement and social skills training . St and ard treatment offered contact with a community mental health centre . Main outcome measures Psychotic and negative symptoms ( each scored from 0 to a maximum of 5 ) at one and two years ' follow-up . Results At one year 's follow-up , psychotic symptoms changed favourably to a mean of 1.09 ( st and ard deviation 1.27 ) with an estimated mean difference between groups of −0.31 ( 95 % confidence interval −0.55 to −0.07 , P = 0.02 ) in favour of integrated treatment . Negative symptoms changed favourably with an estimated difference between groups of −0.36 ( −0.54 to −0.17 , P < 0.001 ) in favour of integrated treatment . At two years ' follow-up the estimated mean difference between groups in psychotic symptoms was −0.32 ( −0.58 to −0.06 , P = 0.02 ) and in negative symptoms was −0.45 ( −0.67 to −0.22 , P < 0.001 ) , both in favour of integrated treatment . Patients who received integrated treatment  had significantly less comorbid substance misuse , better adherence to treatment , and more satisfaction with treatment . Conclusion Integrated treatment improved clinical outcome and adherence to treatment . The improvement in clinical outcome was consistent at one year and two year follow-ups OBJECTIVE To compare the 1-year cost-effectiveness of therapeutic assertive community treatment ( ACT ) with st and ard care in schizophrenia . ACT was specifically developed for patients with schizophrenia , delivered by psychosis experts highly trained in respective psychotherapies , and embedded into an integrated care system . METHOD Two catchment areas in Hamburg , Germany , with similar population size and health care structures were assigned to offer 12-month ACT ( n = 64 ) or st and ard care ( n = 56 ) to 120 first- and multiple-episode patients with schizophrenia spectrum disorders ( DSM-IV ) , the latter with a history of relapse due to medication nonadherence . Primary outcome was the incremental cost-effectiveness ratio ( ICER ) based on mental health care costs from a payer perspective and quality -adjusted life-years ( QALYs ) as a measure of health effects during the 12-month follow-up period ( 2006 - 2007 ) . RESULTS ACT was associated with significantly lower inpatient but higher outpatient costs than st and ard care , result ing in nonsignificantly lower total costs ( P = .27 ) . Incremental QALYs in the ACT group were 0.1 ( P < .001 ) . Thus , the point estimate for the ICER showed dominance of ACT . The probability of an ICER below 50,000 per QALY gained was 99.5 % . CONCLUSIONS The implementation of a psychotherapeutically oriented schizophrenia-specific and -experienced ACT team led to an improved patient outcome with reduced need of inpatient care . Despite the introduction of such a rather " costly " ACT team , treatment in ACT was cost-effective with regard to improved quality of life at comparable yearly costs . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01081418 We compare  psychiatric management of antipsychotic non-adherence among schizophrenia out patients with high and low levels of family contact . A national survey was conducted among a r and om sample of psychiatrists treating schizophrenia , providing data on 310 patients . Patients were stratified by level of family contact . Psychiatrists were more likely to use  family interventions  to manage non-adherence among patients with high family contact . Psychiatrists were significantly more likely to change antipsychotic dosing in patients with high family contact , though less likely to start depot antipsychotic medications . Family interventions  appear to be commonly used in the psychiatric management of medication non-adherence in schizophrenia OBJECTIVE : This study analyzed data from a r and omized trial to examine the impact on medication adherence of integrated treatment delivered via assertive community treatment ( ACT ) versus st and ard clinical case management ( SCCM ) . METHOD : Data from the original study included 198 study participants with co-occurring psychotic and substance use disorders who were r and omly assigned to receive integrated treatment via ACT or SCCM and were followed for 3 years . We applied mixed-effects logistic regression to estimate group ( ACT vs. SCCM ) by time effects on a self-report measure of medication adherence . Adherence was dichotomized as 20 % or more missed medication days ( “ poor adherence ” ) versus less than 20 % missed medication days ( “ adequate adherence ” ) . RESULTS : Participants who were assigned to ACT reported significant improvement in medication adherence compared with those assigned to SCCM . CONCLUSIONS : Integrated treatment delivered via ACT may benefit persons with co-occurring psychotic and substance use disorders who are poorly adherent to medications OBJECTIVE This study compared the time to discontinuation for any reason of first-generation antipsychotics -- in oral versus depot formulation -- in the usual care of schizophrenia . METHODS This study used data from a three-year , prospect i ve , nonr and omized , noninterventional , multisite study of schizophrenia . Participants initiated on oral haloperidol or fluphenazine ( N=202 ) were compared with those initiated on haloperidol or fluphenazine in depot formulation ( N=97 ) on time to all-cause discontinuation for one year after initiation , by using Kaplan-Meier survival analysis , a Cox proportional hazards regression model , and propensity score-adjusted bootstrap resampling methods . RESULTS Compared with participants treated with the oral formulation , those treated with depot first-generation antipsychotics had a significantly longer mean time to all-cause medication discontinuation and were twice as likely to stay on the medication . CONCLUSION In the usual care of schizophrenia , treatment with first-generation antipsychotics in depot formulation appears to be associated with longer time to all-cause medication discontinuation compared with oral formulation of the same medication Background : The Sri Lankan government employs graduates from local universities ( trained in nonpsychiatry disciplines ) as Mental Health Development Officers ( MHDOs ) to fulfill the role of a psychiatric social worker . Material s and Methods : This was a prospect i ve interventional cohort study on preventing relapses of schizophren 
    Output:
    
There is inconclusive evidence suggesting superior adherence with an atypical versus typical antipsychotic or with a long-acting injectable versus an oral formulation .
Lack of social or family support may adversely affect adherence , necessitating the assistance of health care professionals , such as social workers .
Evidence supports the concept that an enhanced team-oriented approach to managing patients with schizophrenia improves adherence and supports corresponding reductions in relapse rates , inpatient admissions , and associated costs .